Effects of menopause and estrogen replacement therapy or hormone replacement therapy in women with diabetes mellitus: Consensus opinion of The North American Menopause Society

Objective: Given that the prevalence of non-insulin-dependent diabetes mellitus (type 2 DM) is increasing in postmenopausal women and type 2 DM substantially increases the risk for cardiovascular events in postmenopausal women, a population that is at higher risk for coronary heart disease, The North American Menopause Society (NAMS) developed a consensus opinion on appropriate management strategies for postmenopausal women who have or who are at risk for developing type 2 DM. Design: NAMS held a closed conference of experts in the field to evaluate the published clinical data on the effects of menopause, type 2 DM, and estrogen or hormone replacement therapy (ERT/HRT) in women, especially the effects on cardiovascular risk factors, and to discuss therapeutic options. The proceedings of the conference were used to assist the NAMS Board of Trustees in developing this consensus opinion. Results: On the basis of the current knowledge, NAMS established consensus on the following issues: (1) Controlling cardiovascular risk factors through pharmacologic and nonpharmacologic means can significantly decrease the risk for developing cardiovascular events. (2) A broad-based recommendation for ERT/HRT cannot be made; rather, the benefits and risks must be weighed in the context of each woman's risk factors. (3) When ERT/HRT is recommended, the greatest benefits may be obtained from the use of transdermal estrogen preparations, low doses of oral estrogens, progesterone instead of progestin, and/or nonandrogen preparations, although more research is needed in this area. (4) Counseling can help maximize the patient's adherence to multiple medication regimens and increase her understanding of the potential benefits and risks of ERT/HRT. Conclusions: Controlling an individual woman's risk factors for cardiovascular events should be the focus of any management strategy for a postmenopausal woman who has or is at risk for developing type 2 DM. (C) 2000, The North American Menopause Society.