Hormone replacement therapy and diabetes mellitus

Abstract

The increasing prevalence of type 2 diabetes mellitus in postmenopausal women requires proper therapeutic regimen. Both glucose metabolism disturbances as the potential benefits and risks due to hormone replacement therapy (HRT) should be taken in the consideration.

Lipid abnormalities, atheromatosis and obesity are common in the menopause. As women age, they are more likely to develop type 2 diabetes, insulin resistance rises. Moreover, in one third of these women diabetes remains undiagnosed. Diabetic women suffer more often from arterial hypertension and harmful lipid profile in comparison with non-diabetic ones. Cardiovascular events are the most common cause of death in diabetic women.

Beneficial effect of HRT on cardiovascular risk factors was reported previously. But, pharmacological and non-pharmacological control of body mass, lipids and glucose concentration, normalization of blood pressure, smoking cessation, decrease of alcohol consumption, optimal dietary habits and regular physical activity are of great importance.

All accepted HRT contraindications must be regarded in diabetic patients. The choice of type of HRT (dose, preparation, route of administration) should be based on patients age, metabolic disturbances, potential risks of estrogen. For the diabetic postmenopausal women transdermal route, lower dose of estrogen, and progestogen without androgenic properties should be adviced.