Menopause in T1D and Perceived Glucose Regulation
Esther M. Speksnijder, Suat Simsek, Peter H. Bisschop, Dirk Jan Stenvers, Sarah E. Siegelaar and the MenoPause Consortium
Perceived blood glucose regulation after menopause: a cross-sectional survey in women with type 1 diabetes in the Netherlands. Diabetologia. 2025 Nov;68(11):2499-2510. Epub 2025 Aug 16.
Women with type 1 diabetes (T1D) experience hormonally driven changes in insulin requirements across the menstrual cycle and during pregnancy, yet the impact of menopause on glycaemic management has remained largely unexplored. As oestradiol and progesterone decline sharply after the final menstrual period, it is plausible that this hormonal shift affects glucose regulation in women with T1D. This cross-sectional survey study, conducted by researchers from Amsterdam UMC/Diabeter Center Amsterdam as part of the MenoPause Consortium, is among the first to systematically examine whether postmenopausal women with T1D perceive changes in their glucose regulation — and what factors are associated with those perceived changes.
An online survey was distributed through 41 hospitals and three T1D patient platforms across the Netherlands. Postmenopausal women (at least one year of amenorrhoea) with T1D, aged 45–65 years, were included. The primary outcome was the extent of perceived change in glucose regulation after the final menstrual period, assessed using a five-point Likert scale. Menopausal symptom severity was measured using the Greene Climacteric Scale (GCS), and sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI).
KEY FINDINGS
- Two thirds of women perceived moderate to severe changes in glucose regulation after menopause: Among 159 eligible participants, 67.4% reported moderate to severe postmenopausal changes in glucose regulation, highlighting the clinical significance of this transition for women with T1D.
- The perceived changes were diverse, affecting both hyper- and hypoglycaemia: While 41.9% reported higher glucose levels overall, 62% experienced more hyperglycaemic events and 38.5% experienced more hypoglycaemic events — reflecting increased glucose variability rather than a uniform directional shift.
- Greater menopausal symptom severity was associated with a higher likelihood of perceiving glycaemic changes: An increase in postmenopausal GCS symptom score was associated with higher odds of reporting glycaemic changes (adjusted OR 1.04; 95% CI 1.01–1.08), suggesting that menopausal symptoms and perceived glycaemic disturbances are interrelated — possibly because symptoms such as hot flushes, night sweats, and fatigue can mimic those of hypo- or hyperglycaemia.
- Perceived changes were more common in the early postmenopausal period: Women within five years of their final menstrual period were more likely to report moderate to severe glycaemic changes compared with those more than five years post-menopause (74.1% vs. 52.7%), pointing to the peri-menopausal transition as a particularly vulnerable phase.
- Poor sleep quality was prevalent but not independently associated with perceived glycaemic changes: Over half of participants (57.2%) had poor sleep quality according to the PSQI, and those with diabetes complications reported significantly worse sleep. However, poor sleep quality alone was not associated with perceived postmenopausal glycaemic changes in the adjusted analysis.
- Hormone therapy use was low and did not differ in perceived glycaemic outcomes: Only 16.9% of participants used hormone therapy, and no significant differences in perceived glycaemic changes were observed between users and non-users, though HT was associated with lower postmenopausal symptom severity.
This study provides the first systematic evidence that a substantial majority of postmenopausal women with T1D perceive meaningful changes in their glucose regulation after menopause, characterised by increased variability, more hyperglycaemic events, and also more hypoglycaemic episodes. These findings call for greater clinical awareness of the menopausal transition as a hormonally complex period that can significantly affect diabetes self-management. Prospective studies combining subjective reporting with objective CGM data are needed to confirm and quantify these changes over the full menopausal transition.
CONCLUDING THE AUTHORS STATE
"These results highlight the need for awareness among medical professionals treating women with type 1 diabetes, as those going through the menopausal transition may experience changes in glucose metabolism, which can affect their diabetes management."
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