Abstract
Introduction:
Throughout life, the female body is subject to hormonal fluctuations. The transition to menopause is particular dominated by a drop and a rapid rise of female hormones. This transition has considerable effects on the control of glucose metabolism and therefore on the manifestation of diabetes mellitus associated secondary diseases. The prevalence of developing diabetes increases at the age of 45, while expectancy of life increases at the same time. The aim of this work is to investigate the relationship between changes in the female hormonal situation (particularaly estrogens (E2) and follicle-stimulating hormones (FSH)) during the menopausal transition and the occurrence of insulin resistance as a precursor to diabetes. Based upon this, possible preventive recommendations to reduce the risk of diabetes should be derived in order to be able to improve the women’s quality of life. In the context of this work, the following question is investigated: „How does the hormonal situation during menopause influence glucose metabolism and the associated risk of developing type 2 diabetes?“
Methods:
The corresponding topic was tackled by a systematic literature review in five electronic databases and a manual search in scientific journals. Afterwards the studies were analyzed and interpreted. A self-developed assessment tool was used to assess study quality; the assessment of the evidence level was carried out using a tool from the Oxford Center of Evidence Based Medicine.
Results:
The results indicate that high estrogen levels have a protective effect on developing diabetes. The treatment of early postmenopausal women with 0.15 mg transdermal E2 for just one week increased ERα gene expression in adipose tissue and improved SAT insulin sensitivity. Furthermore, higher FSH rise rates at least two years before the last period showed a significantly lower risk of diabetes.
Discussion and Conclusion:
The studies showed that ERa plays an important role in glucose homeostasis and insulin sensitivity. High FSH levels influence the risk of diabetes. The question arises whether preventive hormone administration can protect against diabetes in vulnerable risk groups. Further long-term studies covering the period from adolescence to senility are needed to clarify this question. In order to reduce the development of diabetes and to break the stigma surrounding the climacteric subject, comprehensive educational programs that also include the areas of „healthy nutrition“ and „exercise“ are important.
Keywords:
climacteric, glucose metabolism, hormones, risk of diabetes, estrogen