World Diabetes Day’ WDD was launched by the World Health Organization and the International Diabetes Federation in 1991 and is set on November 14 each year with the aim of generating global awareness and awakening to diabetes.
On World Diabetes Day, people want to learn more about the relationship between diabetes and health. As society develops and progresses, more and more attention is being paid to women’s reproductive health, so what is reproductive health? How exactly does diabetes relate to women’s reproductive health?
At the International Conference on Population and Development held in Cairo in September 1994, the “Programme of Action” adopted by 178 countries provided a complete definition of “reproductive health” and its contents. The World Health Organization (WHO) defines reproductive health as “a state of physical, mental and social well-being in all stages of reproductive functioning and throughout the life course, and not merely the absence of disease and infirmity. Its connotation emphasizes the ability to have a responsible, satisfying and safe sex life; the freedom to reproduce and to decide whether and when to have children; the ability of women to have safe pregnancies and deliveries, and the survival and healthy outcomes of their pregnancies; and the ability to make informed choices about safe, effective and acceptable methods of birth control.
Since reproductive health is a life-long process for women, let’s look at the relationship between diabetes and female reproductive health at different stages of a woman’s life, respectively.
I. Diabetes and puberty
The period of growth and development from the appearance of secondary sexual characteristics such as breast development to the maturation of reproductive organs and the acquisition of sexual reproductive capacity. The World Health Organization defines puberty as the period between the ages of 10 and 19. When a girl enters puberty, her body grows and develops rapidly under the influence of neuroendocrine, while her sexual organs and secondary sexual characteristics mature gradually, and her psychological behavior also undergoes drastic changes. The first menstruation of teenage girls is called menarche, but at this time, because the positive feedback mechanism of the central system to estrogen is not yet mature, so the menstrual cycle is often irregular, after 2-4 years of regulation, menstruation gradually normal. However, we sometimes hear that some mothers worry that their daughters have been menstruating for many years, but they are still not allowed to do so, sometimes only once every two or three months.
There are many causes of scanty menstruation, and diabetes is one of them. Diabetes is a disease of the endocrine system, which can affect the endocrine function of the ovaries through a series of endocrine mechanisms, resulting in abnormal secretion of sex hormones and symptoms such as menstrual disorders. If diabetes is developed when the gonads have not yet begun to develop, the dysfunction of the islets will cause the development of the ovaries to be affected accordingly. As a result, the level of sex hormones is lower and the appearance of secondary sexual characteristics and the onset of menstruation are relatively delayed.
At the same time, the rapid metabolic changes that occur during puberty can also make it difficult for diabetic patients to have stable control of their blood glucose and affect the development of certain diabetic complications. The complex changes in hormone levels during adolescence lead to large fluctuations in blood glucose levels, so blood glucose should be monitored more closely and the dosage of hypoglycemic drugs should be adjusted in a timely manner in order to control blood glucose at the desired level.
With further scientific research, polycystic ovary syndrome (PCOS), a female reproductive endocrine disorder, has attracted much attention. Studies have shown that PCOS is intrinsically linked to both type I and type II diabetes. abnormal glucose tolerance is common in PCOS, and the literature reports that 30% to 40% of PCOS patients can have abnormal glucose tolerance, and up to 10% of patients develop type II diabetes at the age of about 40, with a significantly higher prevalence than women of the same age. PCOS is an endocrine disorder syndrome in which reproductive dysfunction coexists with abnormal glucose metabolism. Persistent anovulation, androgen excess and insulin resistance are its important features. The clinical manifestations of adolescent PCOS are mainly menstrual scarcity and hyperandrogenic manifestations (including obesity, acne, hirsutism, etc.), which are the common reasons for their visits to the clinic.
Second, diabetes and infertility
Infertility is also a hot issue in today’s society. In the Reproductive Endocrinology and Infertility Clinic of the Family Planning Department of the Second Hospital of Tianjin Medical University, many couples who are eager to have children come to the clinic every day. Of course, there are many causes of infertility, and each patient’s situation is different, so careful examination is needed to find the cause and treat it accordingly. Ovulation disorders account for a large percentage of these cases, and the absence of eggs is the equivalent of planting a crop without seeds. But why do ovulation disorders occur? Some of them are also related to PCOS, a condition in which the ovaries of women with PCOS show many small follicles but are unable to form large dominant or mature follicles that can be ovulated, thus causing infertility.
Case 2: XXX, female, 29 years old, presented to the clinic with the main reason of 3 years of marriage without pregnancy. The patient was obese and hairy with sporadic menstruation. Both ovaries showed polycystic manifestations on ultrasound examination. On the basis of weight control and treatment with metformin and anti-androgen drugs, we administered a series of treatments such as ovulation promotion, monitored ovulation and guided conception. Now, the patient has successfully conceived a baby.
Female infertility is a condition in which the woman is able to conceive but fails to have a child, all ending in miscarriage, premature birth, stillbirth or stillbirth. So, what is the relationship between diabetes and female infertility?
There are two types of diabetes during pregnancy, one is pre-existing diabetes before pregnancy, called diabetes combined with pregnancy, and the other is normal glucose metabolism or potential hypoglycemia before pregnancy, and diabetes only appears or is found during pregnancy, called gestational diabetes. Hyperglycemia can cause abnormal development or even death of the embryo, and the incidence of miscarriage is as high as 15%-30%. The rate of fetal malformations is also higher than that of non-diabetic pregnant women, with cardiovascular malformations and neurological malformations being the most common, and are an important cause of perinatal death.
Case 3: XXX, female, 33 years old, presented with 3 consecutive spontaneous abortions as the main cause. The patient could conceive spontaneously, but all three spontaneous abortions occurred in early pregnancy, i.e., within the third month of pregnancy. After careful examination of the causes of recurrent miscarriage, we focused our attention on the fact that the patient had diabetes. When she became pregnant again, she was treated with an individualized insulin regimen, which was adjusted according to her condition, the progress of her pregnancy, and the results of her blood glucose monitoring, so that she successfully passed through the entire pregnancy and gave birth to her baby.
III. Diabetes and vaginitis
We know that there are many different types of vaginitis with different pathogens and triggers. One very common type of vaginovaginal pseudomycosis (VVC), or what used to be called mycosis fungoides, can also be associated with diabetes. Diabetes is often associated with a variety of comorbidities, and the incidence of VVC in combination with diabetes has been reported to be about 46%. When a woman has diabetes, her immune system decreases, and the increase in glycogen and acidity in the vaginal tissues is conducive to the reproduction of pseudomycotic yeast. The main manifestations of VVC are itching and burning pain in the vulva and vagina, which may be accompanied by painful urination, and white thick or tofu-like vaginal discharge. Diabetic women should pay attention to the prevention of VVC, and if women have repeated episodes of VVC and no other triggering factors can be found, they should be alerted to any problems with blood sugar, and screen and detect diabetes early.
Diabetes and sex life
Diabetes is a chronic metabolic disease, bringing physical pain and mental burden to patients. Many patients are therefore afraid to have sex for fear of aggravating their condition. In fact, for diabetic patients, in addition to serious acute and chronic complications, in general, can adhere to the regular sex life of couples. A proper sex life will not only not aggravate the disease, but also lower blood sugar and blood lipids, producing a healthy effect, which is conducive to the recovery of diabetes. Sexual activity is a good exercise, suitable and regular sexual activity, can promote the body energy consumption, and enhance physical fitness. It is known that the consumption of energy in the body is greater during sexual intercourse, thus facilitating the oxidative metabolism of glucose in the blood for energy supply, and also facilitating the metabolism of fat for energy supply in obese people. Of course, the frequency and intensity of sexual life of diabetic patients should be controlled appropriately depending on the person and the condition. Although diabetes is a chronic disease, even a lifelong disease, but don’t be intimidated by it. A normal sexual life is beneficial to the health condition and beneficial to the treatment.
However, diabetes may also contribute to some degree to sexual dysfunction in women. Sexual dysfunction includes low sexual desire, sexual arousal disorders, orgasm disorders and painful intercourse. Some studies have shown that about 35% of women with diabetes have varying degrees of sexual dysfunction. The reason for this may be related to vascular or neurological lesions complicating diabetes. At the same time, most women with diabetes have a certain psychological burden, or even a tendency to depression, and depression can also trigger sexual dysfunction. Therefore, women with this problem should actively look for reasons from psychological factors and consult with a professional psychiatrist in a timely manner.
Five, diabetes and menopause
Menopause, also known as perimenopause, is a transitional period when women move from a vigorous reproductive function to decline, generally at the age of 45 to 55. According to statistics, women’s blood glucose levels after the age of 45 are on average higher than those of men of the same age, and the rate of diabetes in menopausal women is even higher than that of men. The decline of ovarian function in menopausal women leads to a series of endocrine changes that reduce the body’s ability to regulate glucose metabolism, and in addition, sympathetic nervousness leads to anxiety, irritability, excessive sweating and other problems, and it is easy to gain weight due to irregular diet, both of which increase insulin resistance and increase the risk of diabetes in women. Women who are already diabetic will have more difficulty controlling their blood sugar after menopause. Studies have also shown that menopause is 4 to 6 years earlier in diabetics than in the general population.
Therefore, menopausal women should monitor their blood sugar regularly, keep their mood happy and relaxed, strengthen physical exercise, lose weight appropriately, and be alert to the occurrence of diabetes. Women who already have diabetes should monitor their blood sugar closely and adjust the dose of hypoglycemic drugs or insulin in time to prevent drastic fluctuations in blood sugar.
In summary, diabetes and female reproductive health are inextricably linked, and I hope that this article will help people to pay more attention to it, as well as to women with diabetes and reproductive health problems.