If you have diabetes, menopause — and the years leading up to it during which your body gradually produces less estrogen (perimenopause) — may present unique challenges. Your blood sugar levels may fluctuate wildly, and both high and low levels may intensify menopausal symptoms such as mood changes, fatigue and hot flashes.

Learn more about the connection between menopause and diabetes, and how you can successfully navigate this life passage.

As you approach menopause, your ovaries gradually stop producing the female hormones estrogen and progesterone. Both of these hormones affect insulin, the hormone produced by your pancreas that delivers life-sustaining blood sugar (glucose) to every cell in your body. Declining levels of estrogen and progesterone can:

• Increase your blood sugar. During perimenopause, your body may become more resistant to insulin. This can cause blood sugar levels to rise.
• Decrease your blood sugar. As you reach menopause, your levels of estrogen and progesterone decline permanently. So your body may regain its sensitivity to insulin, which causes blood sugar levels to fall.

You may mistake menopausal symptoms such as hot flashes, moodiness and short-term memory loss for symptoms of low blood sugar. If you incorrectly assume these symptoms are a result of low blood sugar, you may consume unnecessary calories in an effort to raise your blood sugar, and inadvertently cause a surge in blood sugar.

Because of your diabetes, however, you may experience stronger and more frequent episodes of low blood sugar, especially at night. This can further compromise sleep already interrupted by menopause-associated hot flashes and night sweats. Such sleep deprivation can cause fluctuations in blood sugar that make control more difficult.

The combination of menopause and diabetes also may affect your sexual function, including your ability to become aroused and experience orgasm. Problems may include:

• Vaginal dryness. Decreased blood flow to the vagina causes its lining to become thin and dry.
• Bacterial and yeast infections. Increased levels of glucose in vaginal mucus and vaginal secretions that are less acidic and protective increase susceptibility to such infections.
• Urinary tract infections. Thinning of the lining of the bladder increases susceptibility to infections.

Though it's easy to confuse the symptoms of menopause and diabetes, and to treat your diabetes inappropriately as a result, you can take steps to reduce such problems.

To help manage your diabetes and menopause:

Measure your blood sugar frequently
You may have to check your blood sugar level three or four times a day, and occasionally during the night. If you keep a log of your levels and symptoms, it can help your doctor make necessary adjustments in your treatment.

Work with your doctor to adjust diabetes medications
If your blood sugar increases, you may need to increase the dosage of your diabetes medications or begin taking a new medication. This is especially likely if you gain weight or reduce your level of physical activity. If your blood sugar decreases, you may need to reduce your dosages. Your need for insulin, for example, may decline by up to 20 percent. If you gain weight or stop exercising, however, your dosages may remain the same, because additional pounds and lack of physical activity increase resistance to insulin.

Consider adding a cholesterol-lowering drug
If you have diabetes, you're at increased risk of cardiovascular disease. High levels of cholesterol — a fat-like substance — in your blood also increase your risk. So if you have diabetes, the accepted cholesterol levels are much lower than if you didn't have diabetes. As a result, the American College of Physicians recommends that almost everyone with diabetes take a cholesterol-lowering drug — usually a statin — to reduce this risk. This may be further important if you've reached menopause, which is associated with a possible increased risk of cardiovascular disease.

Get help for menopausal symptoms
You may want to see a gynecologist for help with especially intense hot flashes, vaginal dryness and thinning, and decreased sexual response. If you're having problems with vaginal symptoms, for example, your doctor can prescribe treatments to help restore moisture. And antibiotics can help treat urinary tract infections. If weight gain is a problem, consider consulting with a dietician to help review your meal plans.

Coping with the combination of diabetes and menopause may not be easy. Help ease the transition by working with your doctor and by closely monitoring and treating these conditions.