Diabetes and Menopause

What is Menopause?

He wā whakawhiti, he wā whakamana – A time of transition, a time of power

Menopause is a natural life stage, marking the end of menstrual cycles and reproductive years. It’s not a disease or a problem — it’s a biological transition, much like puberty. In medical terms, menopause is reached when a woman has gone 12 months without a period. But for many, the physical and emotional shifts begin well before that.

This transition is often divided into three phases:

• Perimenopause: The time before menopause when hormone levels begin to fluctuate. This can last several years. Symptoms may come and go.
• Menopause: Officially, the point 12 months after your last period.
• Postmenopause: The years following menopause, when oestrogen remains low and the body adjusts

For many Māori and Pacific women, menopause is associated with much more than just physical changes in the body; it can embrace a shift in identity, role, or have spiritual connotations.

Symptoms (experienced differently by everyone)

Menopause symptoms vary widely between women — in type, intensity, and how they’re experienced. Some may breeze through, while others find it overwhelming. Your experiences may be shaped by your health (especially diabetes), your stress levels, whānau responsibilities, and cultural beliefs.

Common symptoms include:

• Irregular or heavy periods
• Hot flushes / night sweats
• Mood swings, anxiety, or low mood
• Sleep disturbances
• Vaginal dryness and discomfort during sex
• Brain fog or memory lapses
• Weight gain or changes in body shape
• Joint pain or fatigue

Symptoms can be temporary, but they can also affect everyday life. For women with diabetes, these changes may also disrupt blood glucose levels and how your body responds to insulin.

The Role of Hormones

The main hormonal changes involve:

• Oestrogen – declines sharply, affecting everything from temperature regulation to heart health
• Progesterone – also decreases, influencing mood and sleep
• Testosterone – falls gradually and can affect libido, strength, and mood

For women with diabetes, the decline in oestrogen can worsen insulin resistance and blood sugar variability.

Cultural Understandings of Menopause

It would be remiss not to acknowledge the significance of menopause from a cultural perspective. Across te ao Māori and Pacific worlds, menopause has not always been medicalised or pathologised. Instead it has been viewed as:

• A shift in wairua and tapu – a time of deeper spiritual connection, reflection, and transition
• An emergence into leadership – a move from childbearing to a role as kuia or matua, guiding the whānau or fanau
• A taonga tuku iho – a stage to be honoured and supported, not feared or hidden

Yet colonisation, Western medicine, and lack of conservation around reproductive health have contributed to the loss of these narratives. Some Māori and Pacific women even today say they weren’t taught about menopause or didn’t have the words to talk about it.

“I thought I was losing my mind. No one told me this could happen — not even the nurse. I felt whakamā, like I was failing somehow.”

Restoring cultural language and collective understanding of menopause is one step toward healing — and reclaiming this powerful stage of life.

Why Menopause Needs More Attention in Diabetes Care

Despite how common menopause is, it’s rarely mentioned in diabetes education or medical appointments. But it matters — because hormonal changes can:

• Disrupt blood glucose levels
• Change how your body responds to insulin or medications
• Increase risk of complications like heart disease and osteoporosis
• Affect sleep, mood, energy — and your ability to manage your health

Too often, women are blamed for “poor control” of their diabetes during this time, when what’s really happening is a natural shift in hormones.

The silence around menopause in diabetes care is not just a gap — it’s a risk.

Let’s Change the Conversation!

We need to reclaim menopause as:

• A natural part of life
• A source of insight and strength
• A time that deserves compassion, support, and good information
• A season where your health needs might change — and that’s OK

We really need to draw on Māori and Pacific frameworks like Te Whare Tapa Whā and Fonofale to approach menopause not just as a medical issue, but as a whole-of-life experience: physical, emotional, spiritual, and relrelational

Adding Diabetes into the Menopause Experience

Menopause is already a big shift. But if you also live with diabetes, it can feel like the rug’s been pulled out from under you. Hormones fluctuate, symptoms come and go, and suddenly your blood sugar — which you may have managed for years — starts behaving unpredictably.

What’s Happening in the Body?

During perimenopause and menopause, the body undergoes major hormonal changes, especially:

• Oestrogen levels drop — reducing insulin sensitivity (meaning your body may not respond to insulin as effectively)
• Progesterone also declines — affecting fluid balance, mood, and possibly increasing insulin resistance
• Testosterone decreases — affecting muscle mass, libido, and strength

In turn these changes can lead to:

• Blood sugar swings
• Increased insulin resistance
• More abdominal fat
• Disrupted sleep (which raises stress hormones and blood glucose)
• Changes in appetite, energy, and motivation

Common Diabetes Challenges During Menopause

Symptom / Change Diabetes Impact

• Hot flushes Can feel similar to low blood sugar (hypo) — hard to tell them apart
• Night sweats and poor sleep Sleep deprivation raises cortisol and worsens insulin resistance
• Mood swings / anxiety Stress hormones (cortisol, adrenaline) raise blood sugar
• Brain fog Can affect diabetes decision-making and memory (e.g. meds or meals)
• Weight gain Oestrogen loss shifts fat to the belly, increasing insulin resistance
• Cycle irregularity Makes it harder to plan around hormonal glucose changes

Blood glucose levels can become even more unpredictable!

“I used to know how my blood sugar would react — now it’s random and feels like total guesswork.”

This isn’t our fault — it’s biology. In perimenopause, hormone levels don’t just decline — they yo-yo. One day oestrogen is high, the next it crashes. This hormonal instability affects how your body uses insulin and stores energy.

If you’re using insulin or sulfonylurea medications, you may experience:

• More frequent hypos (lows) on some days
• Unexpected spikes (highs) on others

If you’re on lifestyle management or metformin:

• You may find your usual routine isn’t working as well
• You may notice more stubborn highs, despite your efforts

Real-Life

“I kept waking up drenched in sweat and my sugars were all over the place. I didn’t know if it was a hypo or menopause. My nurse hadn’t mentioned any of this — I felt like I was doing something wrong.”

For Māori and Pacific women, this stage of life often overlaps with major whānau or community responsibilities — caring for tamariki and mokopuna, supporting ageing parents, juggling work, church, marae roles.

This extra emotional load can:

• Increase stress hormone levels (which raises glucose)
• Reduce time or energy for self-care
• Mask menopause symptoms (they’re seen as “just stress” or “just being tired”)

“I thought I was just burnt out from looking after everyone else — I didn’t realise my hormones were changing too.”

The Risk of Misunderstanding (and Misdiagnosis)

All too often, menopause-related blood sugar changes are mislabelled as “Poor control,” “Non-adherence,” or put down to “Lifestyle issues”

This can lead to:

• Increased medications without understanding the root cause
• Blame or shame-based messaging
• Missed opportunities to treat the underlying hormonal changes

What Can You Do?

Track symptoms alongside blood glucose

Keep a log of:

• Hot flushes, mood, sleep
• Blood glucose readings
• Menstrual patterns (if still cycling)

Review your medications

You may need:

Adjusted insulin doses

Changes to metformin or other meds

Support for mental health or sleep

Kōrero / Talanoa with your provider

Ask:

Could my symptoms be related to menopause?

Can we discuss hormonal changes and diabetes together?

Are hormone therapies or lifestyle supports safe for me?

Reclaim work/ life/ rest balance

You deserve support. This isn’t about “doing better” — it’s about being met with empathy, knowledge, and care that honours your full self.

 

 

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A Culturally Grounded Lens

 

In Te Whare Tapa Whā and Fonofale, we acknowledge:

• Taha wairua / Spirituality: You may feel disconnected, vulnerable, or in transition
• Taha hinengaro / Mind: Mood and mental clarity are deeply tied to hormonal shifts
• Taha whānau / Fanau: You may carry invisible labour for your family
• Va: The relational space between yourself and others needs nurturing

When providers ignore these domains, women feel dismissed. When they’re honoured, women feel seen.

 

How having Diabetes might affect Menopause