Radoslaw Slopien1, Ewa Wender-Ozegowska2, Anita Rogowicz-Frontczak3, Blazej Meczekalski1, Dorota Zozulinska-Ziolkiewicz4, Jesse D Jaremek4, Antonio Cano5, Peter Chedraui6, Dimitrios G Goulis7, Patrice Lopes8, Gita Mishra9, Alfred Mueck10, Margaret Rees11, Levent M Senturk12, Tommaso Simoncini13, John C Stevenson14, Petra Stute15, Pauliina Tuomikoski16, Stavroula A Paschou17, Panagiotis Anagnostis7, Irene Lambrinoudaki18. 1. Department of Gynecological Endocrinology, Poznań University of Medical Sciences, Poznan, Poland. 2. Department of Reproduction, Poznań University of Medical Sciences, Poznan, Poland. 3. Department of Diabetology, Poznań University of Medical Sciences, Poznan, Poland. 4. Poznań University of Medical Sciences, Poznan, Poland. 5. Department of Pediatrics, Obstetrics and Gynecology, University of Valencia and INCLIVA, Valencia, Spain. 6. Instituto deInvestigación e Innovación de SaludIntegral (ISAIN), Facultad de Ciencias Médicas, Universidad Católica de Santiago de Guayaquil, Guayaquil, Ecuador. 7. Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Greece. 8. Nantes, France Polyclinique de l'Atlantique Saint Herblain, F 44819 St Herblain, France; Université de Nantes, F 44093 Nantes Cedex, France. 9. School of Public Health, Faculty of Medicine, University of Queensland, Brisbane 4006, Australia. 10. University Women's Hospital of Tuebingen, Calwer Street 7, 72076 Tuebingen, Germany. 11. Women's Centre, John Radcliffe Hospital, Oxford OX3 9DU, UK. 12. Istanbul University Cerrahpasa School of Medicine, Dept. of Obstetrics and Gynecology, Division of Reproductive Endocrinology, IVF Unit, Istanbul, Turkey. 13. Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56100, Pisa, Italy. 14. National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital, London SW3 6NP, UK. 15. Department of Obstetrics and Gynecology, University Women's Hospital, Bern, Switzerland. 16. Helsinki University and Helsinki University Hospital, Eira Hospital, Helsinki, Finland. 17. Second Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, Greece. 18. Second Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, Greece. Electronic address: ilambrinoudaki@med.uoa.gr.
Abstract
INTRODUCTION: Whether menopause increases the risk of type 2 diabetes mellitus (T2DM) independently of ageing has been a matter of debate. Controversy also exists about the benefits and risks of menopausal hormone therapy (MHT) in women with T2DM. AIMS: To summarise the evidence on 1) the effect of menopause on metabolic parameters and the risk of T2DM, 2) the effect of T2DM on age at menopause, 3) the effect of MHT on the risk of T2DM, and 4) the management of postmenopausal women with T2DM. MATERIALS AND METHODS: Literature review and consensus of experts' opinions. RESULTS AND CONCLUSION: Metabolic changes during the menopausal transition include an increase in and the central redistribution of adipose tissue, as well as a decrease in energy expenditure. In addition, there is impairment of insulin secretion and insulin sensitivity and an increase in the risk of T2DM. MHT has a favourable effect on glucose metabolism, both in women with and in women without T2DM, while it may delay the onset of T2DM. MHT in women with T2DM should be administered according to their risk of cardiovascular disease (CVD). In women with T2DM and low CVD risk, oral oestrogens may be preferred, while transdermal 17β-oestradiol is preferred for women with T2DM and coexistent CVD risk factors, such as obesity. In any case, a progestogen with neutral effects on glucose metabolism should be used, such as progesterone, dydrogesterone or transdermal norethisterone. Postmenopausal women with T2DM should be managed primarily with lifestyle intervention, including diet and exercise. Most of them will eventually require pharmacological therapy. The selection of antidiabetic medications should be based on the patient's specific characteristics and comorbidities, as well on the metabolic, cardiovascular and bone effects of the medications.
INTRODUCTION: Whether menopause increases the risk of type 2 diabetes mellitus (T2DM) independently of ageing has been a matter of debate. Controversy also exists about the benefits and risks of menopausal hormone therapy (MHT) in women with T2DM. AIMS: To summarise the evidence on 1) the effect of menopause on metabolic parameters and the risk of T2DM, 2) the effect of T2DM on age at menopause, 3) the effect of MHT on the risk of T2DM, and 4) the management of postmenopausal women with T2DM. MATERIALS AND METHODS: Literature review and consensus of experts' opinions. RESULTS AND CONCLUSION: Metabolic changes during the menopausal transition include an increase in and the central redistribution of adipose tissue, as well as a decrease in energy expenditure. In addition, there is impairment of insulin secretion and insulin sensitivity and an increase in the risk of T2DM. MHT has a favourable effect on glucose metabolism, both in women with and in women without T2DM, while it may delay the onset of T2DM. MHT in women with T2DM should be administered according to their risk of cardiovascular disease (CVD). In women with T2DM and low CVD risk, oral oestrogens may be preferred, while transdermal 17β-oestradiol is preferred for women with T2DM and coexistent CVD risk factors, such as obesity. In any case, a progestogen with neutral effects on glucose metabolism should be used, such as progesterone, dydrogesterone or transdermal norethisterone. Postmenopausal women with T2DM should be managed primarily with lifestyle intervention, including diet and exercise. Most of them will eventually require pharmacological therapy. The selection of antidiabetic medications should be based on the patient's specific characteristics and comorbidities, as well on the metabolic, cardiovascular and bone effects of the medications.
Authors: Ekta Kapoor; Juliana M Kling; Angie S Lobo; Stephanie S Faubion Journal: Best Pract Res Clin Endocrinol Metab Date: 2021-09-10 Impact factor: 4.690
Authors: Angela H E M Maas; Giuseppe Rosano; Renata Cifkova; Alaide Chieffo; Dorenda van Dijken; Haitham Hamoda; Vijay Kunadian; Ellen Laan; Irene Lambrinoudaki; Kate Maclaran; Nick Panay; John C Stevenson; Mick van Trotsenburg; Peter Collins Journal: Eur Heart J Date: 2021-03-07 Impact factor: 29.983