There has been a tremendous amount of research evaluating the relationship between the use of hormonal replacement therapy (HRT) and a diagnosis of cataracts in post-menopausal women with diabetes. This article will discuss the evidence for this connection.

What is Menopause?

Menopause is defined as a permanent cessation of menstrual cycles. This condition occurs when women are in their 40s or 50s and have a loss of ovarian follicular activity. Before menopause, women go through perimenopause for some time. The entire process can take up to 10 years.

This transition phase brings about a wide range of symptoms associated with hormonal changes; such as hot flashes, sleep disturbances, mood changes, and urogenital issues including urinary tract infection. These problems can have a significant impact on a woman’s quality of life.

According to the Mayo Clinic, the primary reason for these symptoms developing is a decline in hormones. The ovaries produce less estrogen and progesterone, and fertility begins to decline. At this point, many women consider whether they should try Hormone Replacement Therapy (HRT).

Hormone Replacement Therapy and the History of Safety in Menopause Treatment

One treatment for a decline in hormone levels is taking synthetic hormones. If you haven’t had a hysterectomy, you are usually prescribed both estrogen and progestin. This is due to the fact the estrogen alone can increase your risk of endometrial cancer, although only if you take it for more than 10 years [1].

While HRT was once widely used to treat menopausal symptoms, its use has been significantly reduced in the past two decades since the publication of studies that found links between HRT and the risk of certain cancers, heart disease, and stroke. It should be noted, though, that other studies published around the same time showed that it can be safely used for short-term relief of symptoms.

More recent studies have found that some of these risks are rather low. Studies of heart disease and HRT have found either a low or no increase in the chance of developing this condition [2].

A study of stroke and HRT published in Climacteric found that the risk is low for women under the age of 60 and only increases after that time. Although there is some increase in the risk of stroke with HRT, research has discovered that the chances are much less if you deliver estrogen via a patch or cream [1].

According to a recent, large scale population-based study done across Canada, long-term use of hormone therapy in patients with type 2 diabetes was associated with a 2.44-fold increased risk of cataracts than in those with type 2 diabetes who never used hormone therapy [3].

The study evaluated 15,320 Canadian women between the ages of 45 and 85 years. The information about their menopausal status, HRT use, diabetes, and eye disease diagnoses were all collected by self-report. The authors of the study stated that the findings were not certain. They said that they needed

further confirmation with longitudinal studies before women with type 2 diabetes using hormonal therapy should be advised that they may be at a higher risk of cataract.

hrt and risk cataracts

Cataracts and Diabetes

A cataract is an opacity within the clear lens of the eye. When the lens is not clear, the amount of light entering the eye is reduced, resulting in deterioration of vision. It is the major cause of blindness worldwide. Cataracts are the most common ocular complication of diabetes mellitus [4]. The prevalence of cataracts is three to four times more in patients with diabetes mellitus. Several mechanisms have been proposed to explain this link.

The reduction of glucose into sorbitol via an enzyme called aldose reductase is one of the important pathways leading to cataracts. Accumulation of sorbitol induces osmotic stress, which in turn induces stress in the endoplasmic reticulum. This disrupts protein synthesis and results in the formation of reactive oxygen species called free radicals. These substances can result in oxidative stress that can damage the lens fibers.

Does HRT Increase Risk of Cataracts in Menopausal Women with Diabetes?

Women have a higher incidence of most types of cataracts than men, and the lack of estrogen in menopausal women has been linked with a risk of developing them.

Although current research has found a link between estrogen replacement therapy for menopausal women and a greater risk of developing cataracts, some past studies came to the opposite conclusion. They found that HRT reduced the risk of developing cataracts or had a protective effect. The reasons for these divergent results aren’t clear [5].

There is also more recent research that discovered the same result. A 2013 study published in PLOS ONE looked at the effects of postmenopausal hormone use on cataracts and found that it protected women from developing them. Besides, naturally occurring estrogen is thought to protect the eyes from cataracts.

Cataracts and Diabetes

Among the large-scale studies that found an association between long-term HRT use and cataracts was a study of more than 30,000 women in Sweden. The HRT usage over 10 years was related to a higher risk of cataract extraction [6)].

In terms of menopausal women with diabetes, a  study on Menopause found that they have 2.44 higher odds of getting cataracts in compression than women with diabetes who had not done HRT. They advised that menopausal women with diabetes should be informed of this risk.

Regarding why and how hormone therapy use could be harmful to the lens; especially in patients with type 2 diabetes, are unknown. Estrogen and progesterone receptors are present throughout the eye. One-way damage to the lens could happen if you trigger inflammatory proteins such as C-reactive protein with the use of hormone therapy in women with type 2 diabetes.

Other Methods of Reducing Menopause Symptoms

There are some natural lifestyle changes you can make that will lessen menopause symptoms and improve your quality of life. These include:

    • Following a Nutritious Diet: Eat a diet high in protein and fruits and vegetables. Keep it low in processed foods and sugars because they can cause a decline in your blood sugar and make you tired and irritable. Include plenty of foods with phytoestrogens in your diet. These mimic estrogen in the body; they can raise your levels and eliminate symptoms. These include soy, beans, sesame seeds, and flaxseed.
    • Stay an Average Weight: Women often gain weight during menopause due to the shifting hormones. Mood swings can also lead to eating extra calories, which can pack on the pounds. Being overweight is bad for your health, and it may even make menopause symptoms worse. A study published in Menopause found that women who lost 10 pounds or more had a
      significant reduction in their symptoms.
diet for menopause woman
  • Drinking Water/Cold Drinks: The decrease in estrogen levels during menopause can cause some level of dehydration; so it is important to drink a lot of water. Also, cold drinks in general can cool down your body temperature. This technique may lessen the chance of having a hot flash. Also, it will make you feel a little better when you do.
  • Exercising Regularly: Although there’s no direct connection between exercise and diminishing menopause symptoms, working out improves your general health, your mood, and your sleep. In this sense, exercise is great for making menopause easier. Plan a regular routine doing something active that you love several times a week.
  • Taking an Organic Supplement: There are plenty of organic supplements on the market that can provide a lot of help with lessening menopausal symptoms. They are generally high in phytoestrogens, which balance your hormones and get rid of symptoms like hot flashes and night sweats. They also have anti-inflammatory agents, which can lessen bloating. Talk to your doctor about adding a supplement to your health regimen.
  • Doing Yoga and Breathing Exercises: Yoga and breathing exercises relax you psychologically, which is helpful during menopause. They can have a beneficial impact on your mood. In addition to that, research has found it may do even more for your condition. A review published in the Journal of Midlife Health concluded that yoga is effective for reducing some symptoms of menopause.

Conclusion – HRT and Cataracts

Menopause is accompanied by some unpleasant symptoms that some women find disrupt their daily life significantly. For this reason, many consider Hormone Replacement Therapy as an option. The concern for many women is the possible health risks that have been associated with this treatment in the past, such as the risk of stroke or heart attack.

More recent findings have discovered that these risks are not as large as previously thought. However, there is some evidence that for women with diabetes, this treatment has a greater chance of leading to the development of cataracts.

There is some evidence to support this finding, although some past studies have actually found that the opposite is true. Based on the strength of recent research, it is better for women with diabetes to avoid this possibility and try a different treatment for menopause.