Hormone replacement therapy and diabetes

Abstract

Menopausal Hormone Therapy (MHT) is the first-line treatment for menopausal symptoms. The controversy surrounding adverse effects associated with cardiovascular risk is well-known, making it prudent to analyze the potential consequences in patients with a highly prevalent condition like diabetes.

MHT generally has a neutral to beneficial effect on glycemic control and may reduce the incidence of type 2 diabetes, but it is neither approved nor specifically indicated for the prevention or treatment of diabetes, and its use should be decided based on individual cardiovascular risk. Several trials suggest that MHT delays the onset of type 2 diabetes, attributable to improvements in insulin sensitivity, insulin secretion, and body fat distribution. The EMAS (European Menopause and Andropause Society) clinical guidelines agree that MHT has a favorable effect on glucose metabolism in women with and without type 2 diabetes. From a broader perspective, we know that severe hot flashes are considered a cardiovascular risk factor if not treated appropriately.

The most important point is to individualize both the route of administration and the medications and dosages according to each patient's cardiovascular risk profile, taking into account parameters such as weight and body composition, as well as laboratory parameters. For example, choose progestins with a neutral effect on glucose metabolism, such as micronized progesterone, dydrogesterone, or norethisterone, and select the estrogen administration route considering variations in the lipid profile, since the oral route can increase triglyceride levels but could also be beneficial due to the increase in HDL cholesterol it produces.

In conclusion, hormone therapy in patients with diabetes should be an individualized decision, which, with proper prescription and follow-up, may not only be risk-free but may even generate benefits in glycemic control.