From the Research
Diabetes mellitus (DM) does not directly cause menorrhagia or metrorrhagia, but it can contribute to menstrual irregularities through hormonal imbalances and other mechanisms. According to the most recent and highest quality study 1, abnormal uterine bleeding (AUB) is a term used to describe uterine bleeding that varies from the normal parameters of menstruation, and its etiologies can be classified using the PALM-COEIN system. While diabetes is not a direct cause of AUB, it can lead to hormonal imbalances, particularly affecting estrogen and progesterone levels, which regulate the menstrual cycle. Insulin resistance, common in type 2 diabetes, may increase androgen production and disrupt ovulation, potentially causing irregular or heavy bleeding. Additionally, diabetes can cause endometrial thickening due to these hormonal changes, which may result in heavier periods. Women with diabetes also have a higher risk of developing polycystic ovary syndrome (PCOS), a condition associated with menstrual irregularities including heavy bleeding.
Some key points to consider in the management of AUB in women with diabetes include:
- Evaluating the etiology of the bleeding using the PALM-COEIN system 1
- Considering medical therapy, such as combination oral contraceptives, progestin-containing intrauterine devices, tranexamic acid, and nonsteroidal anti-inflammatory drugs 1, 2
- Surgical procedures, such as polypectomy, fibroidectomy, uterine artery embolization, and endometrial ablation, may be considered in cases where clear structural causes are identified or medical management is ineffective 3, 4
- Managing diabetes effectively through medication adherence, blood sugar control, healthy diet, regular exercise, and weight management can help reduce the risk of menstrual irregularities 1
It is essential to note that the management of AUB in women with diabetes should be individualized, taking into account the patient's desire for current or future fertility, as well as the presence of any underlying medical conditions. Therefore, women with diabetes who experience heavy abnormal uterine bleeding should consult their healthcare provider for proper evaluation and management.