February 12, 2007

Estrogen and Blood Sugar

As I mentioned in my previous posts, I went off my long-term Estrogen Replacement Therapy about three weeks ago. I did this after reading an excellent book, Hot flashes, hormones, & your health, by Joann E. Manson and Shari Bassuk. Dr. Manson heads the Woman's Health Initiative (WHI) which studied the long term effects of HRT and ERT.

This book made an excellent case for using the kind of estrogen I was taking (Menest) for about five years, and then stopping, because that is the point where the potential to stimulate cancers outweighs the benefit. The author also explained that most of the side effects associated with menopause, like hot flashes, are caused by sputtering hormone levels, and that once these levels flatten out, the side effects stop for most women.

With that in mind, I figured it was time to stop my estrogen, as I've been on it for six years. When I tried to stop it 3 1/2 years ago, I had a miserable time with interrupted sleep, hot flashes, and terrible moods. But so far, I am feeling fine and have not had any hot flashes yet.

I have, however, seen my blood pressure and blood sugar creep up. This is exactly what happened the last time I stopped the estrogen, so I thought it would be worth discussing both these effects here for any of you who might be going through something similar.

Estrogen lowers blood pressure by increasing the elasticity of blood vessels. This is one reason why it was expected to help prevent heart disease, which it turned out not to do.

Over the past weeks my blood pressure which had stabilized over the past year at a high of 120/80, which is normal, even when stressed at the doctors office, to 130/80 at home when not stressed. Unfortunately, while this doesn't seem like a big change, it pushes me back into the range that is not healthy, and I will have to talk to my doctors about going back on Diovan at my next appointment. I had taken Diovan for years until after a year of taking Metformin when, rather surprisingly, my blood pressure dropped dramatically even though I hadn't lost any weight.

My blood sugar started creeping up this past week, around the time that the last of the estrogen probably left my body. My average fasting bgs are about 10 mg/dl higher than they were the previous weeks. This, too, is what I saw when I stopped estrogen in the past.

If I do start the Diovan again, it will probably lower both my blood pressure and my blood sugar, as that was what I found to be the case when I took it in the past. In fact, when I tried Diovan a year ago, when Levemir was raising my blood sugar, I discovered that Diovan was causing me to hypo when taken in combination with the basal insulin! Unfortunately, it also caused my blood pressure to drop too low, even at the smallest dosage, which is why I had stopped taking it.

Note: the blood sugar lowering effect of Diovan only seems to happen in people like myself who are not significantly insulin resistant. The reason for this happening is that Diovan (valsartan) and other ARB drugs of the "sartan" family affect PPAR-gamma, the receptor that is also affected by Avandia and Actos, though more mildly than those drugs do.

One reason I stayed on the estrogen as long as I did was because it seemed to me that these effects on blood sugar and blood pressure had to be good for me, but the discussion of cancer risk in the book cited above was sobering, and I decided that the benefits of the hormones weren't worth continuing, especially if the menopausal symptoms weren't a problem.

The final really annoying "side effect" of going off the estrogen is that I have packed on 3 lbs within three weeks after years of keeping my weight stable except right before the holidays when I'd seriously overdo things. I haven't been overdoing things, dietwise, but I still am gaining weight. I have to assume that some of the gain s water weight (pray! pray!) but some of it is probably from metabolic changes due to ending the estrogen--the same changes that are pushing up my blood sugar. Whatever it is, I hate it and I'm going to have to go on a serious diet after Valentines day to prevent any further weight gain.


Anonymous said...

I notice that when I eat more carbs my BP goes up and when I eat less carbs my BP goes back down independant of weight. Could that be what is happening even though the Januvia lets you eat more of them?

Jenny said...

I doubt that is the explanation. I'm eating the same amount of carbohydrate now as I was when I was taking R insulin with every meal. During the whole time I was using R insulin, my blood pressure dropped despite raising the carb intake.

Also, I am one of those oddballs who did NOT see blood pressure drop when I began low carbing very stringently many years ago. In fact, it went up.

I was eating a Bernstein-style diet during the period when my doctor first put me on blood pressure medications. I only stopped taking blood pressure meds after I started metformin--which was when I started eating slightly MORE carbs.

marina said...

dear Jenny! i'm so glad i found this site-so many valuble information.really appreciate it,and it's fun to read! I'm type 2,diagnosed before i started approaching menopause.taking Metformin.at this time I go through this menopause ,but problem is not hot flashes,but extreme anxiety and panic attacks.i refused to take any HRT,since i have family history of ovarian cancer ( my mom),but my anxiety is so bad,that ,reading about your experience with Menest, i think: may be give it a try? you just need to know when to stop,but who can tell you that...? if you could,please,tell more about Menest? thank you. Marina.

Jenny said...


It's easier to answer questions if you email me--use the link in my profile.

The best information about hormones is found in the book written by the doctor who heads the huge Woman's Health Initiative which came up with the definitive data about the risks. The book is:

Hot flashes, hormones, & your health by Joann E. Manson, M.D. and Shari Bassuk.

Anonymous said...

I took low dose estrogen patches for app 20 years after a hysterectomy. Every time I stopped, unbearable hot flashes started. Almost two years ago I decided it was time, despite the hot flashes. It seems to be a familial thing, my sister never took any hormones and has been suffering with them for 15+ years. I did not notice any change in bgs, nor do I notice anything with diovan, tho actos worked for me when I was taking it. However, I was diagnosed with breast cancer several weeks ago and had to have a lumpectomy. A staph infection has caused my bgs to take a huge jump, and I am trying to contain them with insulin.

dkmb07 said...

This is an old post, but I want to chime in.
I am 54 yo female T2 on Metformin. I have tried HRT few times, variety of TD (transdermal) delivery systems; every time I end up with much higher BG fasting and around the clock running 30-40 points higher from ERT. If I add progesterone, it take my BG to another level.
Puzzled as you reported the opposite, better BG control on estrogen replacement.
Could it be that I am not menopausal yet, still going through the change?

Jenny said...

dkmb07, It may just be that, as is the case with so much relating to blood sugar disorders, we have different underlying causes raising our blood sugar.

That is why there is NO one-size-fits-all recommendation that will give everyone normal blood sugars and why we all have to test various approaches until we find the one that works for us.

Johannah said...

Thank you for this post. Due to cancer, I have been put on an "anti-estrogen" medication. I have been so distraught that my blood sugars have gone up even though I have watched my diet very closely. This lowering of estrogen probably explains my problem. No wonder nothing I do works. I guess I need to monitor my blood pressure now too. Before this pill, I was able to get off all meds. Doctors are just never happy with that (sarcasm - sort of). I hope this doesn't lead to more pills to fix effects from this one. You do wonderful work with your blogs! Thank you.

Jenny said...

Johanna, So sorry to hear you have to contend with the anti-estrogen medication. The good news is that they appear to be very effective against estrogen-sensitive cancers.

Have you tried cutting back on carbohydrates? That and metformin have both shown anti-cancer properties.

Johannah said...

My husband was diagnosed as a diabetic a few years back and I knew if I didn't change my eating habits, I would shortly follow. I do follow a low carb diet and have lost 115 lbs. since I started (all pre-cancer). I was never on diabetic meds, but I was on atenolol and hydrochlorothiazide for blood pressure. I am off them totally this year and was feeling so much better than I had for years even after that horrid chemo experience I spent doing all last summer. Then they gave me that anti-estrogen pill and it had to make me feel worse again. I am thankful to the Drs. as I'm living on borrowed time right now as I'm still here. The pill may be helping, so I'll keep taking it. It has totally arrested my weight loss project. Being less than the "obese category" has always been my life's goal. I really want to get there before I die without it being from illness. I'm just 20 lbs away. So, how do you lose weight without estrogen?

Jenny said...

People do lose weight without estrogen. But people who have lost as much as you have often find that it becomes very hard to lose any more no matter what the hormone status. Remember that you've put on extra bone and muscle to carry around your extra weight, so your truly normal weight will be higher than that of a person who never lost weight.

One healthy approach is to work on maintenance now. If you cut back on what you are eating you run the risk of slowing your metabolism further. What we eat at the end of the weight loss phase of a diet is very similar to what we have to keep eating to maintain. So put a year into maintaining--that's the tough part of any diet. And then see where you are a year later when your body has adjusted to the lower estrogen levels.

It will adjust. It just takes a while which is why menopause has such a bad rep.

dkmb07 said...

Thank you for your reply. Sorry I did not check back sooner and did not see your response.
I am so frustrated with BHRT in regards of glucose control, it allows me to live semi-normal life in many aspects.
I have checked info on Menest, and women also report blood glucose raise on this estrogen.
I guess there is only one way to find out is to try Menest, even my OBGYN is very against oral HRT for diabetics, she feels TD delivery is much safer in terms of blood clots.

Rayncatt said...

Oh wow a lot of info here and a lot of things to consider...that said I am years later in commenting so hoping this can be of use to someone.
I am a 44 yr old type 1 very brittle diabetic of 35 yrs who recently had a complete hysterectomy (including ovaries - I am now wishing I had kept them!). I had a Luperon shot about 5 weeks prior to the hysterectomy so my estrogen levels had been lowered though they did give a hormone replacement (medroxyprogesterone 5mg) to help relieve symptoms I was having (migraines and hot flashes). Being a brittle type one I am on an insulin pump but also metformin as I am after all these years insulin resistant as well. My blood pressure has always been on the low end 110/60 till recently. I had no clue how estrogen affects BP so I find this interesting and have a lot to learn!
About 4-5 days post -op my sugars have started escalating dramatically and oddly during times when it is usually running lower. Tomorrow will be 1 week since surgery and as of last night my sugars jumped into the high 300 range which is about 200 mg/dL above where they normally sit! I had a very difficult time bringing them down and was uncertain if the pumps infusion set placement might have had something to do with this as it was changed earlier in the evening. This morning it went over 400 mg/dL and I could not bring it down despite bolus-ing actual syringe insulin shot! It wasn't until moving the infusion set and giving more manual insulin that I did get it to come down but also put a call into my doctor who had not yet given me a prescription for HRT like they said they would. Well they gave me sample of Premarin .625 mg which I will try and I hope I have no reaction to save bringing down my BG or keeping it down without a fight. I know it is early in this still but I really hope this works...thanks for all the info ladies!
Hope this does not post twice!

Jenny said...

Rayncatt, You might also take your temperature and make certain you don't have a post-op infection going on. That would also raise your blood sugar.

As far as the hormone replacement goes, research has found that Menest (esterified estrogen) might be a bit better. It is not made from the urine of pregnant mares as is Premarin, and might not provoke some antibodies as the other stuff may. It costs about $30 a month on my insurance rather than $8 but is worth it. I have no problem with it and my blood sugar though I have had real problems with other versions.

Also, be sure to stop taking the supplemental estrogen one week a month. I started doing that years ago because the stuff seemed to stop working if I didn't cycle on it. Recently I reread the Menest label and found that it is now on the label that you should stop taking it for a week each month!

It will take a while to adjust to the new hormonal environment, but you should adjust and then it is just a matter of experimenting with the doses until you get them right.

As far as keeping your ovaries goes, from what I recall even when people keep them after hysterectomy they very often stop working. So this way you don't have to worry at all about ovarian cancer which can happen if they are left behind.

LaurieAndrade said...

Iam a 62 year old type one going off estrogen replacement slowly and now my blood sugars in the morning are over 250. Also My hair is falling out! I give up

Jenny said...


With blood sugars that high and the hair issue you need to be on insulin and possibly thyroid hormone. Find an endocrinologist, preferably a younger one associated with a teaching hospital. You can get this under control.