Nobody wants to learn they have prediabetes — elevated blood sugar levels that increase the risk for Type 2 diabetes. But having that knowledge can be a wake-up call to make the lifestyle changes needed to prevent the progression to diabetes.
However, prediabetes can sometimes go undetected in people assigned female at birth (AFAB) due to differences in presentation and hormonal fluctuations. As a result, traditional screening tests may not always pick up on warning signs, leaving women with a missed opportunity for prevention.
Here are reasons why prediabetes may be missed in women, and what you can do about it:
Women regulate blood sugar differently than do men
Research shows that women's issues with glucose regulation may present differently than in people assigned male at birth (AMAB):
- Women are more likely to have impaired glucose tolerance: Blood sugar stays elevated for two hours following a meal.
- Men are more likely to have impaired fasting glucose: Blood sugar is high even when they don't eat or drink anything for eight hours.
The problem is that different screening tests evaluate blood glucose in different ways. There are several tests that can be used to screen for prediabetes, including:
- Fasting plasma glucose (FPG) test, which measures your blood sugar after an overnight fast — only having water for at least eight hours before testing
- Oral glucose tolerance test (OGTT), which shows how well your body processes glucose
- Hemoglobin A1C (HbA1c) test, which measures your blood glucose over a longer period — typically two to three months
FPG and HbA1c are the most common tests in clinical settings. While an HbA1c test may pick up on prediabetes in a woman, an FPG test may not.
Take these steps:
While only one test is necessary to diagnose prediabetes, many primary care physicians (PCP) will use two separate tests, knowing that they measure blood glucose differently. Ask your physician to use OGTT to screen for prediabetes.
Hormonal changes make it challenging to accurately measure glucose levels
Researchers continue to gather evidence about the female hormone estrogen and its critical role in the body's ability to process glucose. Higher estrogen levels protect you from prediabetes by improving insulin sensitivity — how well your cells respond to the hormone that manages blood glucose.
As hormones change throughout the menstrual cycle, glucose levels and insulin sensitivity change with them. That means the results of a prediabetes screening can vary depending on when during the menstrual cycle the screening occurs.
Estrogen levels also fluctuate wildly during perimenopause before diminishing after periods permanently stop. The hormonal changes affect your body's ability to regulate insulin and may skew screening results.
Take these steps:
Ask your PCP about an HbA1c test, which measures blood sugar over a longer period. It will provide a better picture of your average blood glucose levels, instead of relying on a single point in your menstrual cycle.
Symptoms of prediabetes can mimic menopausal symptoms
If you are nearing menopause (perimenopause) or recently went through it (postmenopause), prediabetes symptoms may be mistaken for menopausal symptoms.
The symptoms that prediabetes has in common with menopause may include:
- Excess weight gain around the middle, which can happen if insulin is unregulated
- Fatigue from your body's inability to efficiently convert sugar into energy
- Mood changes as blood sugar fluctuations affect brain function
- Sexual issues, such as vaginal dryness, if high blood sugar leads to nerve and blood vessel damage
- Vaginal yeast infections, which can occur when blood sugar is high
Research shows that women who report vasomotor symptoms of menopause, such as hot flashes and night sweats, have an 18% higher risk for Type 2 diabetes. The risk continues to increase along with the severity and duration of the symptoms.
Take these steps:
Keep a symptom log and talk to your PCP about your concerns. Ask about treatment options for hot flashes to keep your diabetes risk lower. If you have symptoms common to both, ask for diabetes screening.
Additional factors can increase prediabetes risk
Women who maintain a healthy weight and lifestyle may not be considered for prediabetes screening.
However, many women have health conditions that put them at higher risk, such as:
- Early menopause: Women who go through menopause before age 45 typically have a higher risk of developing Type 2 diabetes.
- Gestational diabetes: People diagnosed with gestational diabetes during pregnancy — or who gave birth to a baby weighing more than 9 pounds — have significantly higher risk for prediabetes and diabetes later in life.
- Polycystic ovary syndrome (PCOS): Many people with PCOS have trouble using insulin effectively (insulin resistance). As a result, more than 50% of women with PCOS develop Type 2 diabetes before age 40.
PCOS involves hormonal imbalance. Much like menopause, PCOS can have symptoms that overlap with prediabetes, such as weight gain and fatigue. As a result, symptoms of prediabetes can be easily mistaken for PCOS symptoms.
Take these steps:
Discuss your health history with your PCP. If you have risk factors for diabetes, talk to your physician about a plan for diabetes prevention and screening. If you have PCOS, ask for prediabetes screening.
