This EMAS guideline is a literature review and consensus of experts’ opinions, the aim of which is to summarize the evidence of the effect of menopause on metabolic parameters and the risk of type 2 diabetes mellitus (T2DM), of T2DM on age at menopause and the effect of menopausal hormone therapy (MHT) on the risk of T2DM . Moreover, this clinical guide offers indications on the management of postmenopausal women with T2DM. Menopause is associated with an adverse metabolic profile that increases the risk of diabetes. Metabolic changes during the menopausal transition include an increase in and a central redistribution of adipose tissue, as well as a decrease in energy expenditure. In addition, there is impairment of insulin secretion and insulin sensitivity and an increase in the risk of T2DM. MHT has a favorable effect on glucose metabolism, both in women with and in women without T2DM, while it may delay the onset of T2DM. The presence of diabetes is not a contraindication to MHT. An individualized approach is recommended. MHT in women with T2DM should be administered according to their risk of cardiovascular disease (CVD). In women with T2DM and low CVD risk, oral estrogens may be preferred, while transdermal 17β-estradiol is preferred for women with T2DM and coexistent CVD risk factors, such as obesity. In any case, a progestogen with neutral effects on glucose metabolism should be used, such as progesterone, dydrogesterone or transdermal norethisterone. Postmenopausal women with T2DM should be managed primarily with lifestyle intervention, including diet and exercise. Most of them will eventually require pharmacological therapy. The selection of antidiabetic medications should be based on the patient’s specific characteristics and co-morbidities, as well on the metabolic, cardiovascular and bone effects of the medications.
Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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