Menopoz ve Diyabet: Kadın Sağlığında Çift Yönlü Bir İlişki

Öz

Diabetes mellitus ve menopoz, kadın sağlığını önemli ölçüde etkileyen ve birbirleriyle karmaşık bir ilişki içinde olan süreçlerdir. Diyabetin varlığı over fonksiyonlarını olumsuz etkileyerek menopozun erken başlamasına neden olabilirken, menopoz da hormonal değişiklikler yoluyla insülin direncini artırarak tip 2 diabetes mellitus riskini yükseltebilir. Menopozda vazomotor semptomların şiddeti tip 2 diabetes mellitus gelişme riskini arttırırken, gelişen ürogenital semptomlar da diyabetin etkisiyle daha da artış gösterebilir. Menopoz döneminde östrojen seviyelerinin azalması, metabolik değişiklikler, merkezi yağ birikimi ve kardiyovasküler hastalık riskini artırırken, diyabet bu etkileri daha da şiddetlendirebilir. Ayrıca menopozdaki kadınlarda östrojen eksikliği kemik kaybına ve kemik yapısının bozulmasına yol açarak osteoporotik kırık riskini artırırken diyabetin eşlik etmesiyle kemik mikroyapısı da bozularak kırık ve osteoporoz riski daha da artabilmektedir. Aynı zamanda diyabet ve menopoz birlikteliği östrojen seviyelerindeki düşüş ve diyabetin neden olduğu sinir hasarı, menopozal kadınların cinsel sağlık sorunlarında artışa da yol açabilir. Bu nedenle, diyabetli menopozal kadınların sağlık yönetimi; glisemik kontrol, vazomotor ve ürogenital semptomların yönetimi, kardiyovasküler sağlık, kemik sağlığı, cinsel sağlık ve yaşam kalitesini korumaya yönelik bütüncül bir yaklaşım gerektirir. Hormon replasman tedavisi ve yaşam tarzı değişiklikleri, bu süreçlerin olumsuz etkilerini hafifletmek için önemli stratejiler arasında yer almaktadır. Bu derlemede, diyabet ve menopoz arasındaki karşılıklı etkileşim ile kadın sağlığı üzerindeki etkileri ve diyabetli menopozal kadınların yönetimi literatür doğrultusunda ele alınmıştır.

Anahtar Kelimeler

• Diyabet
• Menopoz
• Kadın Sağlığı
• Hemşirelik

Menopause and Diabetes: A Bidirectional Relationship in Women's Health

Öz

Diabetes mellitus and menopause are two significant processes that intricately affect women's health. The presence of diabetes may negatively influence ovarian function, potentially leading to an earlier onset of menopause, conversely menopause, through hormonal changes, can increase insulin resistance and consequently elevate the risk of developing type 2 diabetes mellitus. The severity of vasomotor symptoms during menopause is associated with an increased risk of type 2 diabetes, and urogenital symptoms may be exacerbated by diabetes. The decline in estrogen levels during menopause leads to metabolic changes, central fat accumulation, and an increased risk of cardiovascular disease, all of which may be further intensified by diabetes. Additionally, estrogen deficiency in postmenopausal women contributes to bone loss and deterioration of bone architecture, thereby increasing the risk of osteoporotic fractures. The coexistence of diabetes may further impair bone microarchitecture, compounding the risk of osteoporosis and fractures. Furthermore, the combination of decreased estrogen levels and diabetes-induced neuropathy may lead to a higher prevalence of sexual health problems among postmenopausal women. Therefore, healthcare management of postmenopausal women with diabetes requires a comprehensive approach encompassing glycemic control, management of vasomotor and urogenital symptoms, cardiovascular health, bone health, sexual well-being, and overall quality of life. Hormone replacement therapy and lifestyle modifications are among the key strategies to mitigate the adverse effects of these conditions. This review discusses the bidirectional relationship between diabetes and menopause, their implications for women's health, and the management of postmenopausal women with diabetes in light of current literature.

Anahtar Kelimeler

• Diabetes mellitus
• menopause
• women
• nursing

Kaynakça

1. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2006 Jan;29 (Suppl 1):43-8.
2. International Diabetes Federation. IDF Diabetes Atlas [Internet]. 11th ed. Brussels: International Diabetes Federation; 2025 [cited 2025 May 8]. Available from: https://www.diabetesatlas.org/resources/idf-diabetes-atlas-2025/
3. Centers for Disease Control and Prevention (CDC). Data and research on diabetes [Internet]. Atlanta (GA): CDC; [updated 2024 Dec 13; cited 2025 Jan 17]. Available from: https://www.cdc.gov/diabetes/php/data-research/index.html
4. Kaymak Y, Tırnaksız F. Menapoz ve deri. Turkiye Klinikleri J Med Sci. 2006;26(6):675-84.
5. American College of Obstetricians and Gynecologists (ACOG). Updated guidelines for management of cervical cancer screening abnormalities [Internet]. Washington (DC): ACOG; 2020 Oct [cited 2025 Jan 20]. Available from: https://www.acog.org/clinical/clinical-guidance/practice-advisory/articles/2020/10/updated
6. Anagnostis P, Christou K, Artzouchaltzi AM, Gkekas NK, Kosmidou N, Siolos P, et al. Early menopause and premature ovarian insufficiency are associated with increased risk of type 2 diabetes: a systematic review and meta-analysis. Eur J Endocrinol. 2019;180(1):41-50. DOI: 10.1530/EJE-18-0602.
7. Paschou SA, Papanas N, Kandaraki EA, Maltezos E, Tsatsoulis A, Lambrinoudaki I. Diabetes in Menopause: Risks and Management. Curr Vasc Pharmacol. 2019;17(6):556-63. DOI: 10.2174/1570161116666180625124405.
8. LeBlanc ES, Desai M, Perrin N, Van Marter J, Nee R, Weitlauf JC. Reproductive history and risk of type 2 diabetes mellitus in postmenopausal women: findings from the Women's Health Initiative. Menopause. 2017;24(1):64-72. DOI:10.1097/GME.0000000000000714.

9. Andlib N, Sajad M, Thakur SC. Association of diabetes mellitus with risk of reproductive impairment in females: A comprehensive review. Acta Histochem. 2024;126(5-7):152173. DOI: 10.1016/j.acthis.2024.152173.
10. Türkiye Endokrinoloji ve Metabolizma Derneği. Diabetes mellitus ve komplikasyonlarının tanı, tedavi ve izlem kılavuzu [Internet]. Ankara: Türkiye Endokrinoloji ve Metabolizma Derneği; 2018 [cited 2025 Feb 1]. Available from: https://www.temd.org.tr/
11. Slopien R, Wender-Ozegowska E, Rogowicz-Frontczak A, Meczekalski B, Zozulinska-Ziolkiewicz D, Jaremek JD et al. Menopause and diabetes: EMAS clinical guide. Maturitas. 2018;117:6-10. DOI: 10.1016/j.maturitas.2018.08.009.
12. World Health Organization. Diabetes [Internet]. Geneva: WHO; 2021 [cited 2023 Nov 9]. Available from: https://www.who.int/news-room/fact-sheets/detail/diabetes
13. Paschou SA, Kandaraki E, Tsatsoulis A, Lambrinoudaki I. Therapeutic strategies for type 2 diabetes mellitus in women after menopause. Maturitas. 2019;126:69-72. DOI: 10.1016/j.maturitas.2019.05.003.
14. Vural PI, Balcı Yangın H. Menopoz algısı: Türk ve Alman kadınların karşılaştırılması. Gümüşhane Univ Sağlık Bilim Derg. 2016;5(3):7–15.
15. T.C. Sağlık Bakanlığı. Sağlık İstatistikleri Yıllığı 2021 [Internet]. Ankara: Sağlık Bakanlığı; 2021 [cited 2023 Nov 9]. Available from: https://dosyasb.saglik.gov.tr/Eklenti/45316/0/siy2021-turkcepdf.pdf
16. Khalil N, Sutton-Tyrrell K, Strotmeyer ES, Greendale GA, Vuga M, Selzer F et al. Menopausal bone changes and incident fractures in diabetic women: a cohort study. Osteoporos Int. 2011 May;22(5):1367-76. DOI: 10.1007/s00198-010-1357-4.
17. Monterrosa-Castro A, Blümel JE, Portela-Buelvas K, Mezones-Holguín E, Barón G, Bencosme A et al. Type II diabetes mellitus and menopause: a multinational study. Climacteric. 2013;16(6):663-72. DOI: 10.3109/13697137.2013.798272.
18. Kjaer K, Hagen C, Sando S, Eshoj O. Epidemiology of menarche and menstrual disturbances in an unselected group of women with insulin-dependent diabetes mellitus compared to controls. J Clin Endocrinol Metab. 1992;75(2):524-29. DOI: 10.1210/jcem.75.2.1639955.
19. Dorman JS, Steenkiste AR, Foley TP, et al. Menopause in type 1 diabetic women: is it premature?. Diabetes. 2001;50(8):1857-62. DOI: 10.2337/diabetes.50.8.1857.
20. Brand JS, Onland-Moret NC, Eijkemans MJ, Tjønneland A, Roswall N, Overvad K et al. Diabetes and onset of natural menopause: results from the European Prospective Investigation into Cancer and Nutrition. Hum Reprod. 2015;30(6):1491-98. DOI: 10.1093/humrep/dev054.
21. Yi Y, Harlow SD, Karvonen-Gutierrez C, et al. Women with Type 1 diabetes (T1D) experience a shorter reproductive period compared with nondiabetic women: the Pittsburgh Epidemiology of Diabetes Complications (EDC) study and the Study of Women's Health Across the Nation (SWAN). Menopause. 2021;28(6):634-41. Published 2021 Mar 1. DOI: 10.1097/GME.0000000000001758.
22. Yarde F, van der Schouw YT, de Valk HW, Franx A, Eijkemans MJ, Spiering W et al. Age at menopause in women with type 1 diabetes mellitus: the OVADIA study. Human Reproduction (Oxford, England). 2015 Feb;30(2):441-46. DOI: 10.1093/humrep/deu327.
23. Kim, C., Cleary, P. A., Cowie, C. C., Braffett, B. H., Dunn, R. L., Larkin, et al. Effect of glycemic treatment and microvascular complications on menopause in women with type 1 diabetes in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) cohort. Diabetes Care. 2014;37(3):701-8. DOI: 10.2337/dc13-1746.
24. Sjöberg L, Pitkäniemi J, Harjutsalo V, Haapala L, Tiitinen A, Tuomilehto J et al. Menopause in women with type 1 diabetes. Menopause 18(2):p 158-163, February 2011. | DOI: 10.1097/gme.0b013e3181ef3af0.
25. Yi, Y., El Khoudary, S. R., Buchanich, J. M., Miller, R. G., Rubinstein, D., Orchard, T. J., et al. Association of age at diabetes complication diagnosis with age at natural menopause in women with type 1 diabetes: The Pittsburgh Epidemiology of Diabetes Complications (EDC) Study. J Diabetes Complications. 2021;35(3):107832. DOI: 10.1016/j.jdiacomp.2020.107832.
26. Kahvecioğlu Mungan T, Büyükuslu N. Menopoz ve Metabolik Sendrom İlişkisi. İzmir Katip Çelebi Üniversitesi Sağlık Bilimleri Fakültesi Dergisi. 2024;9(2):307–12. DOI: 10.61399/ikcusbfd.1297953.
27. Akdağ S, Kaner G, Ayer Ç. Menopoz döneminde beslenmenin yönetimi. İzmir Katip Çelebi Üniversitesi Sağlık Bilimleri Fakültesi Dergisi. 2022;7(1):191–7.
28. Yazdkhasti M, Jafarabady K, Shafiee A, Omran S.P, Mahmoodi Z, Esmaeilzadeh S et al. The association between age of menopause and type 2 diabetes: a systematic review and meta-analysis. Nutr Metab (Lond). 2024;21(1):87. Published 2024 Nov 7. DOI: 10.1186/s12986-024-00858-0.
29. Guo C, Li Q, Tian G, Liu Y, Sun X, Yin Z et al. Association of age at menopause and type 2 diabetes: A systematic review and dose-response meta-analysis of cohort studies. Prim Care Diabetes. 2019;13(4):301-9. DOI: 10.1016/j.pcd.2019.02.001.
30. Goossens GH, Jocken JWE, Blaak EE. Sexual dimorphism in cardiometabolic health: the role of adipose tissue, muscle and liver. Nat Rev Endocrinol. 2021;17(1):47-66. DOI: 10.1038/s41574-020-00431-8.
31. Greendale GA, Sternfeld B, Huang M, Han W, Karvonen-Gutierrez C, Ruppert K et al. Changes in body composition and weight during the menopause transition. JCI Insight. 2019;4(5):e124865. Published 2019 Mar 7. DOI: 10.1172/jci.insight.124865.
32. Samargandy S, Matthews KA, Brooks MM, Barinas-Mitchell E, Magnani JW, Janssen I, Kazlauskaite R et al. Abdominal visceral adipose tissue over the menopause transition and carotid atherosclerosis: the SWAN heart study. Menopause. 2021;28(6):626-33. Published 2021 Mar 1. DOI: 10.1097/GME.0000000000001755.
33. Pu D, Tan R, Yu Q, Wu J. Metabolic syndrome in menopause and associated factors: a meta-analysis. Climacteric. 2017;20(6):583-91. DOI: 10.1080/13697137.2017.1386649.
34. de Mutsert R, Gast K, Widya R, de Koning E, Jazet I, Lamb H et al. Associations of Abdominal Subcutaneous and Visceral Fat with Insulin Resistance and Secretion Differ Between Men and Women: The Netherlands Epidemiology of Obesity Study. Metab Syndr Relat Disord. 2018;16(1):54-63. DOI:10.1089/met.2017.0128.
35. Janssen I, Powell LH, Kazlauskaite R, Dugan SA. Testosterone and visceral fat in midlife women: the Study of Women's Health Across the Nation (SWAN) fat patterning study. Obesity (Silver Spring). 2010;18(3):604-10. DOI: 10.1038/oby.2009.251
36. Progetto Menopausa Italia Study Group. General and medical factors associated with hormone replacement therapy among women attending menopause clinics in Italy. Menopause. 2001;8(4):290-5. DOI: 10.1097/00042192-200107000-00012.
37. Brand JS, van der Schouw YT, Onland-Moret NC, Sharp SJ, Ong KK, Khaw KT et al. Age at menopause, reproductive life span, and type 2 diabetes risk: results from the EPIC-InterAct study. Diabetes Care. 2013;36(4):1012-9. DOI: 10.2337/dc12-1020.
38. Shen TY, Strong C, Yu T. Age at menopause and mortality in Taiwan: A cohort analysis. Maturitas. 2020;136:42-8. DOI: 10.1016/j.maturitas.2020.04.008.
39. Sekhar TV, Medarametla S, Rahman A, Adapa SS. Early Menopause in Type 2 Diabetes - A Study from a South Indian Tertiary Care Centre. J Clin Diagn Res. 2015;9(10):OC08-OC10. DOI: 10.7860/JCDR/2015/14181.6628.
40. Appiah D, Winters SJ, Hornung CA. Bilateral oophorectomy and the risk of incident diabetes in postmenopausal women. Diabetes Care. 2014;37(3):725-33. DOI:10.2337/dc13-1986.
41. Mishra SR, Waller M, Chung HF, Mishra GD. Epidemiological studies of the association between reproductive lifespan characteristics and risk of Type 2 diabetes and hypertension: A systematic review. Maturitas. 2022;155:14-23. DOI: 10.1016/j.maturitas.2021.09.009.
42. Yağmur S. Kadınların bazı özelliklerinin ve menopoz semptomlarının menopozal tutuma etkisi [yüksek lisans tezi]. Malatya: İnönü Üniversitesi; 2018.
43. Greendale GA, Sowers M, Han W, Huang MH, Finkelstein JS, Crandall CJ et al. Bone mineral density loss in relation to the final menstrual period in a multiethnic cohort: results from the Study of Women's Health Across the Nation (SWAN). J Bone Miner Res. 2012;27(1):111-8. DOI: 10.1002/jbmr.534.
44. Kim HK, Kang SY, Chung YJ, Kim JH, Kim MR. The Recent Review of the Genitourinary Syndrome of Menopause. J Menopausal Med. 2015;21(2):65-71. DOI: 10.6118/jmm.2015.21.2.65.
45. Çiftçi H, Yeni E. Diyabetes mellitus’un kadın cinsel fonksiyonlarına etkisi. Kadın Cinsel Sağlığı. 2012;(5):83–6.
46. Gray KE, Katon JG, LeBlanc ES, Woods NF, Bastian LA, Reiber GE et al. Vasomotor symptom characteristics: are they risk factors for incident diabetes?. Menopause. 2018;25(5):520-30. DOI: 10.1097/GME.0000000000001033.
47. Herber-Gast GCM, Mishra GD. Early severe vasomotor menopausal symptoms are associated with diabetes. Menopause. 2014;21(8):855-60. DOI:10.1097/GME.000000000000017.
48. Thurston RC, Chang Y, Mancuso P, Matthews KA. Adipokines, adiposity, and vasomotor symptoms during the menopause transition: findings from the Study of Women's Health Across the Nation. Fertil Steril. 2013;100(3):793-800. DOI: 10.1016/j.fertnstert.2013.05.005.
49. Reeves AN, Elliott MR, Brooks MM, Karvonen-Gutierrez CA, Bondarenko I, Hood MM et al. Symptom clusters predict risk of metabolic-syndrome and diabetes in midlife: the Study of Women's Health Across the Nation. Ann Epidemiol. 2021;58:48-55. DOI: 10.1016/j.annepidem.2021.02.011.
50. Danforth KN, Townsend MK, Curhan GC, Resnick NM, Grodstein F. Type 2 diabetes mellitus and risk of stress, urge and mixed urinary incontinence. J Urol. 2009;181(1):193-7. DOI: 10.1016/j.juro.2008.09.007.
51. Ergenoğlu AM, Yeniel AÖ, Akdemir A, Akman L, Aşkar N, İtil İM. Diabetus Mellituslu Kadınlarda Üriner İnkontinansın Şiddeti ve Hayat Kalitesi Üzerine Etkilerinin Değerlendirilmesi. Kocaeli Tıp Dergisi. 2012;1(1):1-5.
52. Erkal E. Üriner inkontinansı olan ve olmayan diyabetli kadınlarda yaşam kalitesinin değerlendirilmesi [yüksek lisans tezi]. Manisa: Manisa Celal Bayar Üniversitesi; 2018.
53. Koç A, Çakmak B, Genç B. Menopoz dönemindeki diyabetik kadınlarda yaşanılan semptomların yaşam kalitesi parametreleri üzerindeki etkisinin incelenmesi (Prospektif Tek Grup Çalışma). Turk J Diabetes Obes. 2021;5(2):137–45. DOI:10.25048/tudod.861243.
54. Terzi H. 18 yaş üstü kadınlarda üriner inkontinans sıklığı ve etkileyen faktörler. Ege Tıp Dergisi. 2013;52(1):15–9.
55. Zhu D, Chung HF, Dobson AJ, Pandeya N, Giles GG, Bruinsma F et al. Age at natural menopause and risk of incident cardiovascular disease: a pooled analysis of individual patient data. Lancet Public Health. 2019;4(11):e553-64. DOI: 10.1016/S2468-2667(19)30155-0.
56. Ma Y, Hébert JR, Balasubramanian R, Wedick NM, Howard BV, Rosal MC et al. All-cause, cardiovascular, and cancer mortality rates in postmenopausal white, black, Hispanic, and Asian women with and without diabetes in the United States: the Women's Health Initiative, 1993-2009. Am J Epidemiol. 2013;178(10):1533-41. DOI: 10.1093/aje/kwt177.
57. Wang Y, O'Neil A, Jiao Y, Wang L, Huang J, Lan Y et al. Sex differences in the association between diabetes and risk of cardiovascular disease, cancer, and all-cause and cause-specific mortality: a systematic review and meta-analysis of 5,162,654 participants. BMC Med. 2019;17(1):136. Published 2019 Jul 12. DOI: 10.1186/s12916-019-1355-0.
58. Yetkin E, Topal E, Erguzel N, Senen K, Heper G, Waltenberger J. Diabetes mellitus and female gender are the strongest predictors of poor collateral vessel development in patients with severe coronary artery stenosis. Angiogenesis. 2015;18(2):201-7. DOI: 10.1007/s10456-015-9460-y.
59. Yoshida Y, Chen Z, Baudier RL, Krousel-Wood M, Anderson AH, Fonseca VA et al. Early Menopause and Cardiovascular Disease Risk in Women With or Without Type 2 Diabetes: A Pooled Analysis of 9,374 Postmenopausal Women. Diabetes Care. 2021;44(11):2564-72. DOI: 10.2337/dc21-1107.
60. Shanbhogue VV, Mitchell DM, Rosen CJ, Bouxsein ML. Type 2 diabetes and the skeleton: new insights into sweet bones. Lancet Diabetes Endocrinol. 2016;4(2):159-73. DOI: 10.1016/S2213-8587(15)00283-1.
61. Chen FP, Kuo SF, Lin YC, Fan CM, Chen JF. Status of bone strength and factors associated with vertebral fracture in postmenopausal women with type 2 diabetes. Menopause. 2019;26(2):182-8. DOI: 10.1097/GME.0000000000001185.
62. Bonds DE, Larson JC, Schwartz AV, Strotmeyer ES, Robbins J, Rodriguez BL, et al. Risk of fracture in women with type 2 diabetes: the Women's Health Initiative Observational Study. J Clin Endocrinol Metab. 2006;91(9):3404-10. DOI: 10.1210/jc.2006-0614.
63. Paul, J., Devarapalli, V., Johnson, J. T., Cherian, K. E., Jebasingh, F. K., Asha, H. S., et al. Do proximal hip geometry, trabecular microarchitecture, and prevalent vertebral fractures differ in postmenopausal women with type 2 diabetes mellitus? A cross-sectional study from a teaching hospital in southern India. Osteoporos Int. 2021;32(8):1585-93. doi:10.1007/s00198-021-05855-0
64. Dytfeld J, Michalak M. Type 2 diabetes and risk of low-energy fractures in postmenopausal women: meta-analysis of observational studies. Aging Clin Exp Res. 2017;29(2):301-9. DOI: 10.1007/s40520-016-0562-1.
65. Almutlaq N, Neyman A, DiMeglio LA. Are diabetes microvascular complications risk factors for fragility fracture?. Curr Opin Endocrinol Diabetes Obes. 2021;28(4):354-9. DOI: 10.1097/MED.0000000000000642.
66. Thong EP, Milat F, Enticott JC, Joham AE, Ebeling PR, Mishra GD, et al. The diabetes-fracture association in women with type 1 and type 2 diabetes is partially mediated by falls: a 15-year longitudinal study. Osteoporos Int. 2021;32(6):1175-84. DOI: 10.1007/s00198-020-05771-9.
67. Bargiota A, Dimitropoulos K, Tzortzis V, Koukoulis GN. Sexual dysfunction in diabetic women. Hormones (Athens). 2011;10(3):196-206. DOI: 10.14310/horm.2002.1309.
68. Rockliffe-Fidler C, Kiemle G. Sexual function in diabetic women: a psychological perspective. Sex Relatsh Ther. 2003;18(2):143–59. DOI: 10.1080/1468199031000099415.
69. Park K, Ahn K, Chang JS, Lee SE, Ryu SB, Park YI. Diabetes induced alteration of clitoral hemodynamics and structure in the rabbit. J Urol. 2002;168(3):1269-72. DOI: 10.1016/S0022-5347(05)64638-1.
70. Giraldi A, Kristensen E. Sexual dysfunction in women with diabetes mellitus. J Sex Res. 2010;47(2):199-211. DOI: 10.1080/00224491003632834.
71. Baldassarre M, Alvisi S, Berra M, Martelli V, Farina A, Righi A, Meriggiola MC. Changes in vaginal physiology of menopausal women with type 2 diabetes. J Sex Med. 2015 Jun;12(6):1346-55. DOI: 10.1111/jsm.12906.
72. Mazzilli R, Imbrogno N, Elia J, Delfino M, Bitterman O, Napoli A, et al. Sexual dysfunction in diabetic women: prevalence and differences in type 1 and type 2 diabetes mellitus. Diabetes Metab Syndr Obes. 2015;8:97-101. DOI: 10.2147/DMSO.S71376.
73. Stuenkel CA, Davis SR, Gompel A, Lumsden MA, Murad MH, Pinkerton JV, et al. Treatment of Symptoms of the Menopause: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2015;100(11):3975-4011. DOI: 10.1210/jc.2015-2236.
74. Salpeter SR, Walsh JM, Ormiston TM, Greyber E, Buckley NS, Salpeter EE. Meta-analysis: effect of hormone-replacement therapy on components of the metabolic syndrome in postmenopausal women. Diabetes Obes Metab. 2006;8(5):538-54. DOI:10.1111/j.1463-1326.2005.00545.x.
75. Shufelt CL, Manson JE. Menopausal Hormone Therapy and Cardiovascular Disease: The Role of Formulation, Dose, and Route of Delivery. J Clin Endocrinol Metab. 2021;106(5):1245-54. DOI: 10.1210/clinem/dgab042.
76. Wang B, Zhang Y, Wang X, Ma Y, Zhang L, Jin D, et al. Unmasking Fracture Risk in Type 2 Diabetes: The Association of Longitudinal Glycemic Hemoglobin Level and Medications. J Clin Endocrinol Metab. 2022;107(4):1390-1401. DOI 10.1210/clinem/dgab882.
77. Almourani R, Chinnakotla B, Patel R, Kurukulasuriya LR, Sowers J. Diabetes and Cardiovascular Disease: an Update. Curr Diab Rep. 2019;19(12):161. DOI: 10.1007/s11892-019-1239-x.
78. American Diabetes Association. 9. Pharmacologic Approaches to Glycemic Treatment: Standards of Medical Care in Diabetes-2021. Diabetes Care. 2021;44(Suppl 1):111-24. doi:10.2337/dc21-S009.
79. Ghaemi F, Yazdanpanah L, Rezaei H, Mozaffari-Khosravi H, Movahedi M. Effects of a Mediterranean diet on the development of diabetic complications: A longitudinal study from the nationwide diabetes report of the National Program for Prevention and Control of Diabetes (NPPCD 2016-2020). Maturitas. 2021;153:61-67. DOI: 10.1016/j.maturitas.2021.08.003.
80. Bozkurt ÖD, Sevil Ü. Menopoz ve cinsel yaşam. Celal Bayar Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi. 2016;3(4):235–42.
81. Özcan L, Polat EC. Diyabet ve cinsel yaşam. Okmeydanı Tıp Dergisi. 2015;31(Ek sayı):57–62. doi:10.5222/otd.2015.057.
82. Pelit Aksu S, Şentürk Erenel A. Menopozal dönem semptomları ve hemşirelik bakımı. Gazi Sağlık Bilimleri Dergisi. 2023;8(1):1–10. doi:10.52881/gsbdergi.984642.