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The interplay between diabetes mellitus and menopause: clinical implications

Abstract

The menopausal transition is an impactful period in women’s lives, when the risk of cardiovascular disease is accelerated. Similarly, diabetes mellitus profoundly impacts cardiovascular risk. However, the interplay between menopause and diabetes mellitus has not been adequately studied. The menopausal transition is accompanied by metabolic changes that predispose to diabetes mellitus, particularly type 2 diabetes mellitus (T2DM), as menopause results in increased risk of upper body adipose tissue accumulation and increased incidence of insulin resistance. Equally, diabetes mellitus can affect ovarian ageing, potentially causing women with type 1 diabetes mellitus and early-onset T2DM to experience menopause earlier than women without diabetes mellitus. Earlier age at menopause has been associated with a higher risk of T2DM later in life. Menopausal hormone therapy can reduce the risk of T2DM and improve glycaemic control in women with pre-existing diabetes mellitus; however, there is not enough evidence to support the administration of menopausal hormone therapy for diabetes mellitus prevention or control. This Review critically appraises studies published within the past few years on the interaction between diabetes mellitus and menopause and addresses all clinically relevant issues, such as the effect of menopause on the development of T2DM, and the management of both menopause and diabetes mellitus.

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Fig. 1: Physiology and implications of menopause.
Fig. 2: Effects of diabetes mellitus on ovarian ageing and menopause.
Fig. 3: Pathophysiological changes after menopause that predispose to the development of diabetes mellitus.
Fig. 4: Management of menopause and diabetes mellitus in women with diabetes mellitus.

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All authors researched data for the article, contributed substantially to discussion of the content, wrote the article and reviewed and/or edited the manuscript before submission.

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S.A.P. has participated in clinical trials sponsored by NovoNordisk, Sanofi and Eli Lilly, and has received honoraria for advisory board membership or lectures from NovoNordisk, Sanofi, Bausch Health and Abbott. All other authors declare no competing interests.

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A search was undertaken in the electronic databases PubMed (MEDLINE), Scopus, EMBASE and Cochrane Central Register of Controlled Trials (CENTRAL) for English-language publications through to 31 December 2021 using the following search terms: menopause; menopausal hormone therapy; diabetes mellitus; type 1 diabetes; type 2 diabetes; diabetes therapy; obesity; cardiovascular disease; cardiovascular risk factors. The literature search focused on systematic reviews and meta-analyses, randomized controlled trials (RCTs) and position statements. Further references, after a manual search in key journals in the fields of endocrinology, diabetology, menopause, cardiology and angiology, were also included.

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Lambrinoudaki, I., Paschou, S.A., Armeni, E. et al. The interplay between diabetes mellitus and menopause: clinical implications. Nat Rev Endocrinol 18, 608–622 (2022). https://doi.org/10.1038/s41574-022-00708-0

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