Menopause and Blood Sugar: What Every BIPOC Woman Should Know About Her Risk

Menopause and blood sugar: what you need to know

Diabetes Digital Podcast by Food Heaven

0:00

Welcome back to another episode of the Diabetes Digital Podcast.

Today we are talking about something that affects me personally, and that is menopause and perimenopause.

Trust me, this is a conversation you definitely want to listen to, Especially until the end, because I had no idea about any of this and found myself like going to so many different doctors trying to figure out what was wrong with me, only to find out that I was dealing with something called primary ovarian insufficiency, which is a form of early menopause.

0:34

And when I tell you that getting on hormone replacement therapy changed my life, it gave me my life back.

Seriously.

Yeah.

It was no joke with the symptoms.

So today we’re going to have an expert on to talk to you all about what exactly is menopause and perimenopause. And how menopause and blood sugar are linked.

We’re going to dispel some of those myths related to hormone replacement therapy because so many people, including myself, were terrified of this.

0:57

And I feel like our parents generation didn’t even do the hormones and just suffered in silence.

You know, there was some bad studies that came out about why they were not helpful, but we’re going to debunk those today.

We’re also going to talk about are there natural remedies ’cause you see a lot of people on TikTok talking about what they’re doing and alternatives and there actually is some truth to some of these alternatives and some reasons why they might be able to help.

1:21

And then of course we’re going to talk about the link between diabetes and pre diabetes or impaired fasting, glucose and menopause and hormone issues and why many of the times fixing your hormones might actually fix your blood sugar regulation issues.

1:39

So it’s an amazing episode and Wendy’s going to talk about the guests they were interviewing today.

Yes.

Today we had the pleasure of talking with Doctor Kathleen Jordan, who is the Chief Medical Officer at Medi Health.

Doctor Jordan leads a large team of clinicians that serve women across the US for their midlife health needs.

1:58

She’s an internist and certified menopause specialist.

The MIDI team uses an insurance covered telehealth platform to reach women and help them navigate and treat the many health challenges that come with menopause, addressing hot flashes, cholesterol issues, stress, anxiety and more.

2:16

Welcome to the Diabetes Digital Podcast.

I’m Wendy.

And I’m Jess, and we’re best friends, registered dietitians and diabetes educators.

Through our telehealth platform, Diabetes digital.co, we offer accessible and personalized virtual nutrition counseling for people with diabetes and pre diabetes.

2:33

Visit diabetesdigital.co. That’s Co to book your first appointment.

We accept insurance and offer affordable self pay options.

Now let’s get into today’s episode on menopause and blood sugar.

So with that, we’re just going to jump right into the episode.

2:48

Welcome to the podcast, Doctor Jordan.

Great to be here.

OK, can you start off by telling us?

I know this is probably a basic question for you, but there are so many people who have no idea what is menopause and also I think some people feel like menopause is something gone wrong and they can avoid it.

3:06

But is this something that all women experience?

Oh, it’s not a softball question at all, and I think a lot of people don’t actually understand it.

So menopause just means the time when your periods stop.

So if your periods are gone for 12 months, you’re menopausal.

3:23

There’s no test.

There’s nothing else you need.

Assuming you’re not pregnant, of course.

Right.

The typical age is around 51.

And then I’m gonna anticipate your next question and say, what is perimenopause?

Right.

So perimenopause is basically the decade that leads to menopause.

3:41

So what triggers menopause is our ovaries stop making estrogen and progesterone and then we stop kicking out eggs and our ovaries kind of just stop making hormones.

It does not happen overnight.

So really for about 5 to 10 years before full menopause, we’re making less and less estrogen and progesterone and you can actually start to develop a lot of symptoms in perimenopause.

4:05

And yes, it’s inevitable as long as you live long.

OK, I was going to ask, is there a genetic component?

I don’t know if that’s hearsay, but you know, like amongst family members like, Oh well, I got menopause early, so you might get menopause early or something like that.

4:23

Is there any truth to that?

So, well, let’s talk about what’s early and what’s late 1st, and then I’ll get to your question.

When I say the average age is 51, really, if you look at it, most women will.

Menopause can be anywhere from 45 to mostly 55.

4:39

You’re going to get the bulk of women getting their full menopause then.

Perimenopause is starting 10 years before then, so you can get symptoms as early as late 30s and definitely in your 40s.

There’s about 6% of women that actually go in what we call early menopause.

4:56

So that means their full menopause is before 45 and 1% even before 40.

So you can get menopause in your 20s.

There’s a very rare cases even in your teens.

So why it happens in that 6%, we don’t, we don’t fully know.

5:13

A lot of it is this thought to be autoimmune, things like that, Some of it’s from surgeries, right.

So certainly if you take your ovaries out because you’re bracket positive or you have a tumor or something, then you’ll experience early menopause.

So I think layered in your question is if my mother had menopause when she was in her 40s, not her 50s.

5:36

Am I more likely, Yes, probably.

And then you mentioned the symptoms.

Can you talk about what are those common symptoms of perimenopause and menopause?

Great question.

So everyone probably has heard of hot flashes and night sweats, but there are way more symptoms of hot than hot flashes and night sweats, right?

5:57

I think the common ones that people bring up at MIDI all the time are sleep trouble, right?

So 2/3 of women in perimenopause and menopause are going to have trouble sleeping, and I think that’s surprising to a lot of women.

There’s also when our hormones change, a lot of things change.

6:14

It affects our serotonin levels or dopamine, and that probably is the mechanism how it affects our sleep.

But that also can trigger or exacerbate depression and anxiety.

People have panic attacks, People have exacerbations of ADHD and then it also changes our metabolism which I know you guys here as well as I do and what I think is not well understood, we actually see a change in insulin sensitivity.

6:39

We see a change in cholesterol metabolism.

We’ve known for decades that when our hormone levels drop, cholesterol goes up and our blood sugar levels go up.

So you see more women entering pre diabetes.

There’s also changes to skin and hair.

You get hair thinning, you get skin dryness and sort of crepey like skin.

6:57

There’s also genital urinary syndrome of menopause where you get recurrent UTI, sort of vaginal atrophy, painless sex.

So there’s a long, long list of things because we really have estrogen receptors everywhere.

So it affects really kind of everything.

7:16

Yeah, I can attest to all of those symptoms and more.

And I am one of the six percent who went through the under 40 menopause.

Now in terms of ’cause you mentioned the pre diabetes and that’s something that a lot of our patients have been diagnosed with, whether it’s impaired fasting, glucose impaired, glucose tolerance or even insulin resistance.

7:40

And that’s something I also was diagnosed with when I was going through the hormone challenges before I got on hormone replacement therapy.

From a clinical perspective, does hormone replacement therapy fix all of these things including the impaired fasting, glucose or pre diabetes or are there potentially like other factors at play and you can’t solve everything with the hormones?

8:03

Well, fix is a strong word.

I would say that hormone replacement therapy helps significantly.

I mean, we’ve known the WHI study, which was the huge study done in the 90s.

We showed women on hormone replacement therapy, 20% less diabetes, right.

8:19

We know that in persons with diabetes they get better blood sugar control.

We also know if you don’t have diabetes, you have better blood sugar control.

So persons with diabetes will have better control, but they still have diabetes.

But it’s definitely a component and I think we just need to understand that it exacerbates it.

8:37

I hear women all the time say, you know, I’ll send screening labs and almost 40% will have pre diabetes and a lot will have high lipids for the first time and they’ll say, wow, I’ve never had that problem before.

How did that happen, ’cause I haven’t changed a thing.

Like, they’re still doing their same exercise, they’re still doing their same diet, but all of a sudden their numbers sort of worsen.

9:00

And that’s actually very typical and very normal.

And I just want women to realize that.

So midlife is the time to really have these tests done, screen for them, and really understand that we need to change as our body changes.

So we may need to have less glycemic foods, for example, right?

9:19

And watch our cholesterol, watch our lipids.

And you know, for a lot of women, I think hormone replacement therapy can be an aid too.

Yeah.

People hear hormone replacement therapy.

It can sound kind of scary if, you know, you don’t really know what it is and you’re like, OK, I’m giving my body external hormones.

9:40

And we’ve seen some of the clients that we have, like maybe they have safety concerns and things like that.

Is that something that you’ve come across?

So can you talk about the safety?

You’re so right that women are concerned about the safety of hormone replacement therapy.

And I think the fear leads to too few women accessing it really.

9:58

So thanks for bringing it up.

Really, a lot of the fear stemmed from the Women’s Health Initiative study that was about 25 years ago and it had six arms of the study and one of the six arms of the study had a slightly higher instance of breast cancer and a few more heart attacks and strokes.

10:20

That arm actually used a synthetic progesterone that we don’t use in hormone replacement therapy anymore.

What’s not understood as we actually followed those same women from that study and there were subsequent studies on them done in 2010, again in 2020.

10:36

And it actually showed that estrogen actually decreased your risk of breast cancer by 20%.

It also showed digesting the data later that when you start hormone replacement therapy close to menopause, you actually help cardiovascular risks.

10:52

And I think that information got lost in sort of this over hyped panic mode.

So not only is hormone replacement therapy safe, it’s actually good for your health for most women.

Now I’m gonna put a few caveats on that.

There are some women where I would use non hormonal interventions to help them.

11:12

It doesn’t mean that there’s not treatment.

So you’re gonna get a lot of symptoms in perimenopause and menopause and there are treatments for everyone.

Hormone replacement therapy statistically can have higher response rates and can help with quite a few of them, but there’s solutions that are non hormonal as well.

11:29

And persons I would lean on that would be if you have hormone receptor positive breast cancers, you actually have cancer, then we would usually lean to non hormonal interventions and then if you have a lot of coronary artery disease already.

11:46

So for women, maybe late 60s or for whatever reason have early coronary artery disease.

When we give you hormone replacement therapy, it does help with hardening of the arteries.

It can actually soften the plaque and dislodge.

So you have a slight risk when you start hormone replacement therapy if you have a lot of established heart disease.

12:06

And that’s one of the reasons we really want to start hormone replacement therapy at a younger age.

One, it’s good for your metabolism.

It actually can help your bone health.

It can help a lot of the skin health, hair health, your metabolism, your sugars.

So the closer and sooner we started, the more years you get benefits.

12:25

But also, before you get atherosclerosis, it’s actually helpful.

And for people who are listening, who may even not be in the perimenopause range, or maybe they are and they they’re not even linking these symptoms with perimenopause, which I feel a lot of women just in general were dismissed, right.

12:44

We come in and it’s like, again, all the symptoms you said I was having, like diagnosed with ADHD felt like it was so much worse.

And for people who don’t even know what HRT is and like how how it works, like, can you just explain a little bit more about what you’re taking when you have HRT, like and demystify it, ’cause I think people think it’s a scary thing and it really isn’t.

13:07

So hormone replacement therapy that we use now are bioidentical.

So your body is making estrogen, your ovaries make estrogen and they make progesterone and the hormone replacement therapy that’s commonly used, that’s covered by your insurance that you can get from your local pharmacy is also bioidentical or at least the ones we prescribe.

13:27

So you’re basically giving yourself some native estrogen and progesterone.

Now we don’t replace you up to levels that you had in your 20s, right.

So if for a woman might be having levels of estrogen, it changes during your cycle, but 2-3 hundred, right?

13:44

And when you go post menopausal, your estrogen level’s below 10.

So when we replace hormones, you’re generally hitting sort of 50, right.

So you’re not getting your estrogen levels that you had when you were in your fertile years, but you are getting enough estrogen to take you out of the symptomatic range and let things function.

14:05

Well, is HRT something that you would take for life after you get perimenopause or menopause, or is it recommended only for a certain period of time?

Oh, I’m so glad you asked that question you for a while.

14:21

When I was earlier in my career, there was a thought that we should come off hormone replacement therapy once we were in our 60s and 70s, that we should really just take it in the 10 years post menopause.

We now have many studies that show the benefits are ongoing.

14:37

So there’s a study of Cedar Sinai following women that have been on it for decades and they stay on it really indefinitely.

They’ve had 30% less atherosclerosis or heart disease.

They’ve actually had higher longevity.

So they’re living longer.

14:53

And then they have some quality of life parameters which we talked about before, right.

You have benefits to skin, hair, genital, urinary health.

So right now, the American College of Gynecology, the North American Menopause Society, and anyone who’s actually following the space in the literature, when we start hormone replacement therapy, you take it indefinitely as long as you’re benefiting from it.

15:16

I’m also wondering for people with perimenopause where it’s like they may not have full blown menopause, is there any research showing that those folks should be starting HRT and avoiding a lot of the distress that it feels like your body is in when it does have lower hormone levels like estrogen?

15:37

Jess, well, thank you for sharing your story about how starting it earlier helped you.

I think that women in perimenopause and women that experience menopause early really suffer the most, right?

Because as I said, the level doesn’t drop in one day and the symptoms tend to accumulate over over years.

15:58

So you’re accumulating symptoms, and I think there’s some misguided advice going on out there where people think you have to wait to full menopause to benefit from therapy.

You can start hormone replacement therapy in perimenopause and you can greatly benefit from it.

16:15

I have a lot of women that show up at MIDI.

Maybe they’re 51, they know they’re classic and their periods stop and we start them on hormone replacement therapy and they come back and they really the a common comment is why did I not do this five years earlier?

It’s the first time I’ve slept in five years.

16:32

I feel so much better.

So I really think perimenopause is when women should start and can benefit and feel better on hormone replacement therapy.

I’m gonna add 1 little caveat though.

So remember in perimenopause you are still occasionally ovulating and you are still fertile.

16:50

So sometimes in perimenopause we use birth control pills, certain birth control pills with certain ratios because remember birth control pills also have estrogen and progesterone, so they are a version of hormone replacement therapy.

17:07

So you can have traditional hormone replacement therapy with bioidentical estrogen and progesterone in low level supplements or if you also are seeking help with contraception, we might give you a birth control pill that helps with both and then convert you to more traditional hormone replacement therapy once you are in your 50s.

17:27

I have a follow up question for the hormone replacement therapy.

So what are your thoughts on testosterone ’cause I know you mentioned estrogen, progesterone, which from my understanding from my doctors, you have to take them together to prevent problems.

17:46

You can maybe elaborate on that.

I can elaborate on.

That yeah.

And then also, I hear a lot of people online and I’m in a lot of like support groups for ’cause I have POI like primary ovarian insufficiency, which is causing the early menopause, but they’re talking about testosterone.

18:02

Help them give them more energy, help them build more muscle mass, ’cause they were losing a lot of muscle mass as they got older.

What are your thoughts on that ’cause I know I don’t believe it’s FDA approved, right?

Such a good question.

Wow, a whole.

We could have a whole conversation on that by itself.

But I’m going to answer your simple softball question first one is if you have a uterus, if you’ve not had a hysterectomy, you do need to take progesterone with estrogen.

18:26

There’s a lot more data that the estrogen replacement is what’s actually making you feel good at addressing a lot of your symptoms.

But the progesterone’s needed because it manages your uterine lining.

If I just gave you progesterone, your uterine lining would build up and build up and build up over years.

18:42

Those cells would sit and would put you at risk for uterine cancer, right?

So by giving you progesterone, it helps manage your uterine lining and you don’t have that issue.

So as long as you have a uterus, which most women do, you should take estrogen with progesterone and not do estrogen alone.

19:00

And estrogen is usually the replacement that women are seeking.

Now, testosterone is super interesting because we don’t have the dramatic drop that we do in the other hormone levels.

So because we make testosterone outside of our ovaries.

So you do have a drop, but it’s not as dramatic and it doesn’t bring this abrupt onset of symptoms.

19:20

But there’s increasing amounts of data how it can be helpful for women.

Probably the best data and best study, the one quoted most, is that it helps women with libido.

And there’s a lot of data in men about how it helps phone health and muscle strength and can help even cognitive behavior, right?

19:39

So now we’re starting to study it in women and we do have some small scale studies that show it can benefit women in these ways as well.

But as you mentioned, there’s no FDA approved product to give testosterone to women.

There just isn’t.

19:55

So the only way to really get a woman’s dose of testosterone, which in general is about 110th of what a male would need.

So men receive testosterone replacement for a variety of reasons.

One, they may have a deficiency.

That’s the most common reason, but they need 10X what a woman would need.

20:12

So to get a tenth of the dose is very hard when you’re using male dosing.

So we lean into compounding and some other sort of creative forms to get you testosterone replacement, which then unfortunately puts it in the realm where it’s not covered by insurance and it’s cash pay.

So I would say that many, many, many women benefit from estrogen and progesterone, that’s your core hormone replacement therapy.

20:37

And some women benefit from testosterone, particularly if you’re having challenges around bone health, sarcopenia, which means muscle atrophy.

And we do want to prevent becoming frail.

So while we don’t necessarily worry about that in our 40s and 50s, it’s what we want to avoid when we’re in our sixties, 70s and 80s.

20:57

So what we do now matters.

So I think we’re going to see a lot of exciting stuff coming out about testosterone women, particularly around brain health, bone health and muscle health can.

You talk about home remedies cause on the TIK toks, there’s like home remedies for everything including diabetes.

21:18

And there’s some videos that we’ve seen like natural alternatives to HRT.

Is that symptomatic, Like, is this effective?

And what are some of those natural remedies that maybe you have heard about?

So I’m in a sort of break that question down to a few things.

21:38

There are some non prescriptive evidence based solutions for some of the symptoms for sure.

Take for example someone who’s not sleeping and they’re experiencing more stress ’cause you get higher cortisol levels from menopause too and then you that ribs you up.

21:53

You’re not having good sleep.

There are supplements and there are lifestyle interventions you can do that actually help with that.

For instance, yoga.

Yoga actually increases your serotonin levels, can help you relax, can help you sleep.

Cognitive behavioral therapy can help you sleep.

22:09

Magnesium supplements may help you sleep.

So there’s a lot of home remedies as you call them, but I would say supplements and they’re they’re evidence based interventions that can help.

It’s actually one of the reasons we have a full time naturopath and we have naturopathic trained clinicians at MIDI, because we bring those solutions in ’cause you don’t need a prescription for everything.

22:30

As I’m saying before midlife, there’s a lot changing.

Our metabolism changes, we have a difficult time sleeping, we have weight changes, we have stress changes.

It’s also stressful time of life.

So weaving in some of these lifestyle interventions and some of the supplements can really be helpful, I think.

22:49

Yeah, What about physical activity?

Because you mentioned a goal in midlife is to preserve muscle mass, Even though there’s these factors at play that are kind of causing muscle mass to decrease, especially if you don’t really do anything with like taking hormones and things like that.

23:08

Are there any recommendations that you guys generally give for women in midlife, or how to exercise in a way that’s like not stressing them out but also helping to preserve that muscle?

Exercise is hugely helpful to women and I think particularly in midlife, that I will confess it’s the one I struggle with the most because I have a a job where I’m on telehealth all the time.

23:34

But we know that exercise decreases your risk of breast cancer, right?

And breast cancer effects one in eight women.

So this is hugely important.

We know exercise helps you sleep.

It helps actually with serotonin.

We know that exercise helps your insulin sensitivity.

23:49

So I actually did a little experiment for MIDI where I ate the same thing for breakfast every day.

And I watched what it did when I exercised in the morning, and I watched what it didn’t, what it did when I didn’t exercise.

I will say that my blood sugars were much better for having hadn’t exercise before I ate, right?

24:09

And we know there’s studies that show that exercise helps with your insulin, your insulin and your metabolism.

So it’s not just about the calories you burn.

I think a lot of times we think we’re working out to burn calories or for an aesthetic for muscle tone, but it’s actually good for our bodies.

24:27

It helps with serotonin, it helps with metabolism, it helps with our metabolism in general.

Yes, now approaching perimenopause are menopause and they want support, they want treatment.

24:44

What kind of doctor should they go to?

Cause everyone just was going through this.

She went to like God knows how many doctors.

And it’s like, who are you supposed to go to?

Who is the specialist in these mad gynecologists?

Or should it be something even more specialized than that?

25:02

I think it’s a problem you’re seeing healthcare struggle with in general and too many women struggle.

I had the same struggle.

I, you know, obviously I’m a doctor, but I tried to find someone who could care for me and really it was hard and I really kept getting sent to concierge docs.

25:20

And because this kind of visit is so heavily consultative and requires listening, we’ve really driven the experts in it to concierge docs because our current health care system, it’s hard to sustain that kind of practice financially.

So this is really why MIDI was created and why I’ve been so excited to be part of the founding team at MIDI.

25:41

So things you can look for in a provider, one listen to educational podcasts like this.

So if you’re listening already, you’re halfway there, right.

So you can ask great questions.

There is a North American Menopause Society which lists providers that are certified in menopause.

25:59

So actually trained in all these things.

So often a North American menopause certified clinician will actually be most helpful.

I am one and many clinicians that many are as well probably educate yourself.

Now remember 87% of OB gines in IT when surveyed have said that they are not trained in menopause.

26:19

So.

That’s.

All saying it, we have whole OB gine practices that send us all their patients for menopause ’cause remember much of the training has been focused on obstetrics and delivering babies and which is a whole beautiful field in and of itself.

And then they are also gynecologic surgeons.

26:38

So we collaborate with a lot of OB GYN’s.

We send our patients in for their Pap smears if they need endometrial biopsies or ultrasounds, right.

So all sorts of things.

So some OB GYN’s have educated themselves and become menopause specialists, but many have not.

26:54

So I think you have to understand if your OB GYN is one of those or isn’t.

Yeah.

And if someone is feeling off just in general and kind of based on the symptoms you said not sleeping all the things, like are there any tests that they should recommend?

27:14

Now I think if they go to the right doctor, they would know the right test, but let’s just say they don’t have access for whatever reason.

Are there tests they can ask their doctor for to confirm?

Especially for folks in perimenopause who maybe they are still getting a sporadic period here and there so they don’t fully have that menopause diagnosis?

27:34

What a good question.

Lab testing has become an industry in itself for for women.

If you are in your late 40s or 50s and your period stop for 12 months, you’re menopausal.

You don’t need a test to confirm.

I can tell you that it’s harder if you’re younger and you may be in this 6%, right?

27:55

That’s going to go through early menopause or experiencing early perimenopause.

The problem with lab testing in this age group is that your hormones are on a roller coaster, so your estrogen levels are dropping and then your pituitary kicks up.

So on Tuesday you may have low levels and by Friday you may have high levels and it may go like that.

28:17

So so lab testing in this period is erratic and isn’t always diagnostic.

I do recommend an order lab test for particularly my younger patients ’cause I can get a couple over time and that will give me a more average to let me know sort of globally where you are.

28:36

But one test in time will not tell you where you are.

So if you are experiencing classic symptoms in this time period, the recommendations are to actually treat you for symptoms and see if you improve, right?

28:53

I also get basic FSH levels and basic estradiol levels to actually help because those two labs, they’re easily available.

You can get them at LabCorp, you can get them at Quest.

They’re covered by insurance.

They cost less than $20 each for both, so they’re easily and readily available.

29:13

They will give me a ballpark on where you are, but remember it’s not completely diagnostic and if you have classic symptoms, that is a diagnosis in and of itself.

That’s really helpful.

Now for people who want to work with a team of specialists like the team at MIDI, and maybe they want to work with you, how can they?

29:34

One, we welcome you.

We love to work with women across the US We are open in 50 states.

We are getting on insurance platforms in all these states.

So come to join midi.com.

We will ask you some questions.

29:50

We’ll let you know if we take your insurance.

We’ll get you in a visit within one to two weeks.

We ask you some questions before you come to make the visit more efficient.

So we’ll ask you what symptoms you’re having, what your past medical history is, when your periods were.

So that when I show up in the visit, I actually know already a lot about you and we can spend the half an hour together really delving through what the care plan should look like.

30:14

And then it is a telehealth platform.

But we can order labs, we can order rate mammograms, we can order whatever we need from your local resources through your insurance covered options.

Really proud to say that ’cause I think it’s really made the care accessible.

We don’t have any extra fees.

30:30

It’s all through traditional healthcare payment models.

That sounds incredible.

Everybody check out MIDI Join midi.com.

Especially if you’re having these symptoms.

You don’t have to suffer.

You can get help.

And Doctor Jordan, we appreciate you so much and are thankful that you founded Mitty because again, people should not have to go to a doctors to get answers and to get care.

30:53

So we appreciate it and yeah, loved your insight today.

Yeah, and thank you for getting the word out.

I think that educating women on the signs, symptoms and access solutions and solutions in general is really the first step in getting more women feeling better.

31:11

Thanks for joining us for today’s episode.

If you’re interested in nutrition counseling with one of our expert dietitians to help improve your pre diabetes or diabetes, visit us at diabetesdigital.co.

Also, if you found our conversation helpful, do us a favor and rate and review this podcast on iTunes.

31:29

Plus, share with someone who might find this helpful.

You can also connect with us on Instagram at Diabetes Digital dot.co and TuneIn every Wednesday for practical, inclusive and culturally humble diabetes insights.