Latest / Clearly Hormonal / Ep 28: Menopause, Hormones, & Diabetes Prevention

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Ep 28: Menopause, Hormones, & Diabetes Prevention · Clearly Hormonal

• 0:02
  Dr. Komal Patil-Sisodia: Welcome to Reset Recharge, the podcast where women's health takes center stage.
• 0:06
  Dr. Komal Patil-Sisodia: I'm your host, Dr.
• 0:08
  Dr. Komal Patil-Sisodia: Komal Patil-Sisodia, a triple board certified endocrinologist and women's health expert.
• 0:13
  Dr. Komal Patil-Sisodia: This show is all about empowering you with the knowledge to understand your metabolic health, navigate hormonal changes, and feel confident in the conversations you're having with your healthcare provider.
• 0:24
  Dr. Komal Patil-Sisodia: Whether you're managing symptoms, exploring treatment options, or just want to feel more in tune with your body, you're in the right place.
• 0:30
  Dr. Komal Patil-Sisodia: As a physician, my goal is to educate on this podcast.
• 0:34
  Dr. Komal Patil-Sisodia: The content shared here is for informational purposes only and should not replace personalized medical advice.
• 0:40
  Dr. Komal Patil-Sisodia: If something we discuss resonates with you, please talk to your healthcare provider at your next visit.
• 0:45
  Dr. Komal Patil-Sisodia: Now let's dive in and help you reset, recharge, and take control of your health.
• 1:02
  Dr. Komal Patil-Sisodia: Hi everyone.
• 1:02
  Dr. Komal Patil-Sisodia: Welcome back to Reset Recharge.
• 1:04
  Dr. Komal Patil-Sisodia: Today we are going to talk about one of the most fascinating and hopeful areas in women's metabolic health.
• 1:11
  Dr. Komal Patil-Sisodia: How menopause hormone therapy or MHT may actually reduce the risk of developing diabetes in perimenopausal women with pre-diabetes.
• 1:21
  Dr. Komal Patil-Sisodia: There was a study published last year in Diabetes and Metabolism by Dr.
• 1:26
  Dr. Komal Patil-Sisodia: Shih and colleagues, which has added important evidence to this discussion, and I wanted to unpack what it means.
• 1:32
  Dr. Komal Patil-Sisodia: I have a lot of patients who are coming into my office who are asking what this study means for them and for family members.
• 1:38
  Dr. Komal Patil-Sisodia: So let's unpack it.
• 1:40
  Dr. Komal Patil-Sisodia: Figure out how this interaction between hormones and prediabetes and diabetes works, and what women and other clinicians can take away from this.
• 1:48
  Dr. Komal Patil-Sisodia: Let's talk first a little bit about the study.
• 1:51
  Dr. Komal Patil-Sisodia: What did the research find?
• 1:53
  Dr. Komal Patil-Sisodia: The investigators from this particular study analyzed health data from over 6,500 women between the ages of 46 and 60 years old who had pre-diabetes before menopause already.
• 2:04
  Dr. Komal Patil-Sisodia: I'm loving that.
• 2:05
  Dr. Komal Patil-Sisodia: They're studying the right age group, which is 46 to 60.
• 2:10
  Dr. Komal Patil-Sisodia: One of my big great.
• 2:11
  Dr. Komal Patil-Sisodia: So if you've listened to some of my other podcast episodes has been that the Women's Health Initiative studied an older population of women for prevention of cardiac disease.
• 2:21
  Dr. Komal Patil-Sisodia: And I think that's partly why we didn't see the results we were hoping to see.
• 2:26
  Dr. Komal Patil-Sisodia: So this study is already off to a good start, 6,500 women, which is a significant number of women.
• 2:32
  Dr. Komal Patil-Sisodia: In the right age range.
• 2:33
  Dr. Komal Patil-Sisodia: Some of these women received menopause hormone therapy, either estrogen alone or in combination with progesterone, while others did not, and over a 20 year follow up, they found something pretty remarkable.
• 2:45
  Dr. Komal Patil-Sisodia: The women who used hormone therapy were about 30% less likely to develop type two diabetes than those who didn't.
• 2:53
  Dr. Komal Patil-Sisodia: The study reports a hazard ratio of 0.69.
• 2:57
  Dr. Komal Patil-Sisodia: You might be listening to this and being like, my goodness, what is she talking about?
• 3:00
  Dr. Komal Patil-Sisodia: Think about it this way.
• 3:01
  Dr. Komal Patil-Sisodia: If a hundred people were going to get diabetes and only 69 of them did.
• 3:08
  Dr. Komal Patil-Sisodia: That means that almost the risk was reduced by almost one third, right?
• 3:12
  Dr. Komal Patil-Sisodia: So there's 31 people out there who didn't get it.
• 3:14
  Dr. Komal Patil-Sisodia: So that's that 30% reduction that they're seeing, and that's a pretty meaningful long-term benefit.
• 3:19
  Dr. Komal Patil-Sisodia: But here's where it gets interesting.
• 3:21
  Dr. Komal Patil-Sisodia: The effect was not uniform across everyone in the study age.
• 3:26
  Dr. Komal Patil-Sisodia: There were certain predictors that were interesting to look at.
• 3:29
  Dr. Komal Patil-Sisodia: Age was one of the strongest predictors, and the strongest protection was in women age, 46 to 50.
• 3:34
  Dr. Komal Patil-Sisodia: Second was ethnicity.
• 3:37
  Dr. Komal Patil-Sisodia: There was clear benefit in women who are white but not, it was not statistically significant in women who are black or Asian.
• 3:43
  Dr. Komal Patil-Sisodia: So you can't apply this to everybody across all ethnic groups.
• 3:47
  Dr. Komal Patil-Sisodia: And then the last one, which I find the most interesting is that women who had a normal or moderately elevated, BMI up to 29.9, so in the normal or overweight category actually had benefit.
• 4:01
  Dr. Komal Patil-Sisodia: However, women who struggled with obesity and had a BMI greater than or equal to 30 did not have benefit.
• 4:08
  Dr. Komal Patil-Sisodia: So the big takeaway is that menopause hormone therapy can help lower diabetes risk, but the individual characteristics matter.
• 4:17
  Dr. Komal Patil-Sisodia: So you need to talk to your doctor about whether this is actually something that is helpful for you based on age range, based on ethnicity, based on your BMI.
• 4:26
  Dr. Komal Patil-Sisodia: All of these things matter into how MHT will work for you.
• 4:29
  Dr. Komal Patil-Sisodia: Let's talk a little bit about why estrogen or hormone therapy in general would reduce diabetes risk.
• 4:35
  Dr. Komal Patil-Sisodia: Let's talk about a few key things that are happening in our bodies that lead to reduced diabetes risk when using hormones.
• 4:43
  Dr. Komal Patil-Sisodia: The first thing that happens is we see improved insulin sensitivity.
• 4:47
  Dr. Komal Patil-Sisodia: Estrogen enhances how our muscles and fat cells respond to insulin and allow glucose to enter cells more efficiently.
• 4:55
  Dr. Komal Patil-Sisodia: This means a lower fasting glucose, lower insulin levels, and an improved hemoglobin A1C.
• 5:01
  Dr. Komal Patil-Sisodia: The second thing that estrogen does is it supports pancreatic beta cells, which are the cells that make insulin and improve their ability to respond to rising blood sugar.
• 5:13
  Dr. Komal Patil-Sisodia: The third thing that we see is reduced what we call central adiposity or that weight gain around the middle.
• 5:20
  Dr. Komal Patil-Sisodia: I have a lot of patients complain about this particular symptom, the weight gain around the middle.
• 5:25
  Dr. Komal Patil-Sisodia: What happens in menopause is that the fat shifts towards the abdomen and primarily inside the abdomen, which increases that metabolic risk because any fat tissue that's inside your abdominal cavity is that visceral fat that's very inflammatory.
• 5:39
  Dr. Komal Patil-Sisodia: Estrogen will help curb this redistribution, meaning it won't be visceral fat per se, that is accumulating.
• 5:47
  Dr. Komal Patil-Sisodia: You could still have what we call subcutaneous fat, which is the fat that sits under the skin, but that is not as inflammatory.
• 5:53
  Dr. Komal Patil-Sisodia: Number four, we see an effect on inflammation and energy balance.
• 5:58
  Dr. Komal Patil-Sisodia: When estrogen levels fall, inflammation will rise and the metabolism slows down.
• 6:03
  Dr. Komal Patil-Sisodia: Menopause hormone therapy will counteract these effects by keeping inflammation lower and helping.
• 6:09
  Dr. Komal Patil-Sisodia: Women expend more energy.
• 6:11
  Dr. Komal Patil-Sisodia: And lastly number five, there are effects on your lipid profile, which is the cholesterol and on the liver hormone therapy can improve cholesterol levels and reduce the liver's glucose production, which helps lower blood sugars and help support metabolic health.
• 6:30
  Dr. Komal Patil-Sisodia: There are many metabolic benefits of menopause hormone therapy, and together they will contribute in lowering this diabetes risk in the individuals that we talked about before.
• 6:40
  Dr. Komal Patil-Sisodia: The next logical question is, why do these effects vary by age, ethnicity, and BMI?
• 6:47
  Dr. Komal Patil-Sisodia: With age, there's something called the timing hypothesis, and this suggests that hormone therapy works best when it started near menopause, or maybe even in perimenopause.
• 6:56
  Dr. Komal Patil-Sisodia: Younger perimenopausal women have better insulin sensitivity and they've had less damage to their blood vessels throughout their body because they haven't been.
• 7:06
  Dr. Komal Patil-Sisodia: Hormone deficient for as long, and that allows hormones to continue exerting protective effects.
• 7:13
  Dr. Komal Patil-Sisodia: What happens later is that as we age and the longer we've been off hormones, more inflammatory things can develop.
• 7:21
  Dr. Komal Patil-Sisodia: We saw in the Women's Health Initiative, when you give hormones to women who are further out from menopause, we actually see bad things happen.
• 7:29
  Dr. Komal Patil-Sisodia: Number two, ethnicity.
• 7:32
  Dr. Komal Patil-Sisodia: These differences can stem from genetics, diet, cultural patterns, other metabolic adaptations.
• 7:38
  Dr. Komal Patil-Sisodia: And so we really need to study different populations of women to understand this better.
• 7:43
  Dr. Komal Patil-Sisodia: So I want everybody to understand that.
• 7:45
  Dr. Komal Patil-Sisodia: The study that was done showed that this effect was there in women who are white, not who are black or Asian.
• 7:52
  Dr. Komal Patil-Sisodia: So we can't apply this data uniformly or promise the same effects when we're talking to our patients.
• 7:59
  Dr. Komal Patil-Sisodia: And then the third one is BMI in women who Struggle.
• 8:04
  Dr. Komal Patil-Sisodia: Overweight or obesity.
• 8:06
  Dr. Komal Patil-Sisodia: And in this case, obesity, specifically, insulin resistance is already somewhat high, and the benefit of the estrogen is blunted by the inflammation.
• 8:16
  Dr. Komal Patil-Sisodia: The benefit of the estrogen is likely blunted or decreased because of all the chronic inflammation that's happening, The key message here is that personalized medicine is crucial.
• 8:25
  Dr. Komal Patil-Sisodia: Menopause hormone therapy is not a one size fits all intervention, and it's not going to have the same metabolic effect in everybody.
• 8:32
  Dr. Komal Patil-Sisodia: The other differences that can play into this are the types of menopause hormone therapy that are utilized because they're not all created equal.
• 8:51
  Dr. Komal Patil-Sisodia: In women who have typically had a hysterectomy, they can take estrogen alone because they don't have a uterus.
• 9:00
  Dr. Komal Patil-Sisodia: They don't need a progestin to thin out the lining for endometrial cancer prevention because that risk is gone with a hysterectomy.
• 9:07
  Dr. Komal Patil-Sisodia: The other category of hormone therapy is estrogen plus a progestogen, and this is required for women who have their uterus.
• 9:15
  Dr. Komal Patil-Sisodia: In order to protect against endometrial cancer.
• 9:18
  Dr. Komal Patil-Sisodia: You need both, and the type of progestogen matters.
• 9:21
  Dr. Komal Patil-Sisodia: Micronized progesterone, or there's another one that's not available in the us.
• 9:25
  Dr. Komal Patil-Sisodia: I think it's called dydrogesterone.
• 9:27
  Dr. Komal Patil-Sisodia: Both Are metabolically neutral and preferred.
• 9:30
  Dr. Komal Patil-Sisodia: The other one that I will tend to use is drosperinone, but I don't know that it's been studied in this particular case.
• 9:36
  Dr. Komal Patil-Sisodia: The route of administration, meaning how you take the medication, also matters.
• 9:44
  Dr. Komal Patil-Sisodia: Oral estrogen goes through what we call first pass effect in the liver, where when it gets metabolized through the liver, it will have influence on the triglycerides and on clotting factors.
• 9:55
  Dr. Komal Patil-Sisodia: And so for women who are struggling with overweight or obesity.
• 9:58
  Dr. Komal Patil-Sisodia: Transdermal estrogen, which comes in patches, gel sprays, avoids that first pass effect, and it gives steadier hormone levels and less risks for clotting and inflammation.
• 10:10
  Dr. Komal Patil-Sisodia: So that tends to be my preference when I'm prescribing for my patients.
• 10:14
  Dr. Komal Patil-Sisodia: In studies, both routes, oral and transdermal, improved glucose metabolism, but transdermal estradiol was often more favorable for women who are struggling with obesity or were at high cardiovascular risk, because of that decreased risk of inflammation and clotting.
• 10:35
  Dr. Komal Patil-Sisodia: There was a 2025 study that found estrogen alone lowered insulin resistance more strongly than estrogen plus progestin therapy.
• 10:46
  Dr. Komal Patil-Sisodia: So formulation and route will both matter.
• 10:48
  Dr. Komal Patil-Sisodia: So I think that's important to note.
• 10:50
  Dr. Komal Patil-Sisodia: And as always, when we talk about hormone therapy, we have to weigh the benefits against the potential risks such as cardiovascular events, breast cancer, and venous thrombosis.
• 11:03
  Dr. Komal Patil-Sisodia: The good news is that when we start hormone therapy closer to the time of menopause, especially in women who are under 60, the cardiovascular risk profile is beneficial.
• 11:13
  Dr. Komal Patil-Sisodia: Transdermal estrogen carries the lowest clotting risk, and then the dosing you can individualize just to optimize people's safety.
• 11:22
  Dr. Komal Patil-Sisodia: The American Heart Association and Endocrine Society both support this concept of quote, window of opportunity.
• 11:30
  Dr. Komal Patil-Sisodia: Or the timing hypothesis, which we talked about earlier, which is starting therapy early at the right dose and for the right reason.
• 11:37
  Dr. Komal Patil-Sisodia: For Women who have pre-diabetes or metabolic syndrome, menopause hormone therapy, can serve as both symptom relief and potentially metabolic production protection, which is a double win, right?
• 11:49
  Dr. Komal Patil-Sisodia: So two birds, one stone.
• 11:51
  Dr. Komal Patil-Sisodia: To wrap up this topic, let's talk about.
• 11:56
  Dr. Komal Patil-Sisodia: To wrap up, there's a few key things I want you to take away from this episode.
• 12:08
  Dr. Komal Patil-Sisodia: Menopause hormone therapy when individualized can reduce the likelihood of developing diabetes, especially in perimenopausal women with pre-diabetes.
• 12:17
  Dr. Komal Patil-Sisodia: This applies to women who are white and who have a BMI of less.
• 12:21
  Dr. Komal Patil-Sisodia: Than 30.
• 12:22
  Dr. Komal Patil-Sisodia: It was not seen in women who are black or Asian or in women who struggle with obesity and already have some degree of insulin resistance.
• 12:30
  Dr. Komal Patil-Sisodia: The science is still evolving, and we need to look at other ethnic groups to understand what the benefit is across all women If you are approaching menopause and wondering whether hormone therapy is right for you, you need to have a personalized discussion with your clinician about your risks, what the goals are, and what your preferences are for treatment.
• 12:49
  Dr. Komal Patil-Sisodia: Let me know if there's another article you want me to break down, or if you have a clinical question that you want broken down on a podcast episode.
• 12:56
  Dr. Komal Patil-Sisodia: Thank you for tuning in for today's episode.
• 13:00
  Dr. Komal Patil-Sisodia: I'll see you on the next one.