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Diabetes; Ovarian Cycle; Hormonal Changes; Insulin

Introduction

The shedding of the uterine lining through the vagina, occurring when progesterone and estrogen levels decrease, is commonly known as menstruation or periods [1]. An ovarian cycle, encompassing this menstrual process, usually spans 3 to 7 days. The duration from the initial day of one menstrual period to the initial day of the next is recognized as the ovarian cycle. Although a standard ovarian cycle is often considered to last 28 days, variations are common, with cycles ranging anywhere from 24 to 38 days among individuals.

The influence of diabetes on the ovarian cycle varies between type 1 and type 2 diabetes.

Type 1 diabetes

In individuals with type 1 diabetes, the regularity and intensity of the ovarian cycle and menstrual periods are generally unaffected. While occasional ovarian abnormalities may accompany type 1 diabetes, the onset of menstruation during puberty is typically not impacted. The typical age for the commencement of menstruation is around 12 years, and the occurrence of the first period should not be affected by type 1 diabetes. Although rare cases exist of delayed first periods in individuals with type 1 diabetes, there should be no significant delays as long as the person is not underweight and effectively manages their type 1 diabetes [2].

Type 2 diabetes

Individuals with type 2 diabetes face an increased likelihood of experiencing anovulation, a condition where the ovary fails to release an egg into the fallopian tube. This absence of ovulation leads to a lack of menstruation. It is important to note, however, that not all individuals with type 2 diabetes will experience anovulation. The connection between type 2 diabetes and anovulation suggests that diabetes may contribute to disruptions in the normal ovarian cycle, potentially impacting menstrual regularity [3].

The development of type 2 diabetes may be linked to irregular ovarian cycles, as indicated by a comprehensive study in 2020 involving 75,546 females [4]. The findings revealed that women with prolonged or irregular ovarian periods during adolescence and adulthood faced a higher risk of developing type 2 diabetes compared to those with regular ovarian cycles.

Researchers suggest that the association between irregular ovarian cycles and the onset of type 2 diabetes is likely influenced by hormonal imbalances. They emphasize that extended ovarian cycles and irregular periods serve as indicators of hyperinsulinemia or elevated insulin levels [5]. This, in turn, may trigger a cascade of events worsening insulin resistance and condition in which the body struggles to efficiently use insulin to regulate blood sugar levels. Other risk factors for type 2 diabetes highlighted in the study included (1) being overweight or obese, (2) physical weakness, and (3) consuming a low-quality diet.

Results

The interplay of blood sugar, insulin, and the ovarian cycle is also explained. Hormonal changes during the ovarian cycle, particularly in the luteal phase (the second half of the cycle following ovulation), lead to increased progesterone levels. Progesterone's temporary boost can induce insulin resistance, known as luteal phase insulin resistance. A 2013 study involving six females with type 1 diabetes noted higher blood glucose levels during the luteal phase of the ovarian cycle [6].

In individuals with type 1 diabetes, decreased blood sugar levels may occur at the onset of their periods. Accordingly, adjustments to insulin intake may be necessary. Subsequent to the menstrual period, blood glucose levels typically return to normal. Understanding these intricate interactions between hormonal fluctuations, insulin resistance, and blood glucose levels sheds light on the complex relationship between diabetes and the ovarian cycle [7].

Polycystic Ovarian Syndrome (PCOS) is characterized by a hormonal imbalance, particularly elevated levels of androgen hormones, which can hinder the normal ovulation process. The following signs are indicative of PCOS: (1) Irregular menstrual cycles, (2) Weight gain or challenges in weight management, (3) Acne, (4) Excessive body or facial hair, (5) Thinning hair on the scalp, (6) Darkening of the skin around the neck, breasts, and groin, and (7) Skin tags in the armpits or neck region [8].

Discussion

Individuals with PCOS face an increased risk of developing type 2 diabetes, according to the Centers for Disease Control and Prevention (CDC). This risk is further heightened if the person is also overweight or obese. The CDC reports that more than half of those with PCOS go on to develop type 2 diabetes by the age of 40. However, individuals with PCOS may be able to mitigate this risk by adopting a healthy diet and engaging in regular exercise to maintain a reasonable weight. Lifestyle modifications can play a crucial role in managing both PCOS and reducing the likelihood of developing type 2 diabetes in individuals with this condition.

Predictable and regular ovarian cycles are essential indicators of overall health. Therefore, if an individual experiences irregular ovarian cycles or any unusual changes in their cycle, seeking medical advice is crucial [9]. Furthermore, it is advisable to consult a doctor if any of the following symptoms are noticed: (1) bleeding between periods, (2) experiencing severe periods with large blood clots lasting 5-7 days, or (3) not having a period for more than three months.

For individuals with diabetes facing challenges in managing blood sugar levels during specific phases of their ovarian cycle, seeking guidance from a healthcare professional is important. Discussing these concerns with a doctor can help individuals understand appropriate steps to take. Tracking blood glucose levels throughout the ovarian cycle can also be a valuable tool for identifying patterns related to a person's overall health. Regular communication with healthcare providers ensures comprehensive care and proactive management of any potential health issues [10].

Conclusion

Diabetes, whether type 1 or type 2, may increase a person's risk of unpredictable or irregular ovarian cycles. It is significant to remember that a person's diabetes may also be impacted by hormonal changes that take place during the ovarian cycle. Changes in insulin and blood glucose levels might result from hormonal changes. Therefore, managing these changes is a responsibility for those with diabetes. If a person has diabetes and is having erratic or odd ovarian cycles, they should see a doctor. If they are having trouble controlling their blood glucose levels throughout their ovarian cycle, they should also see a doctor.

Acknowledgement

None

Conflict of Interest

None

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