As most women are well aware, menstrual hormones have the power to affect just about every aspect of the body. One area where this is certainly true is blood sugar. The amount of estrogen, progesterone, and other sex hormones in the bloodstream has a notable effect on how the body processes glucose and produces insulin.
Given the connection between hormones and blood sugar, we believe there is untapped potential for continuous glucose monitors (CGMs) in the wearable FemTech market. From women trying to conceive to those suffering from hormone imbalances, CGMs could play a vital role in helping people take control of their reproductive health.
Below, we look at how different sex hormones affect blood sugar levels, how these changes trend throughout the month, and how CGMs could be used in connected applications to help women and menstruating people around the world.
How Menstrual Hormones Affect Blood Sugar
Glucose uptake and insulin resistance both play a part in ensuring the body is ready for pregnancy. As the body moves toward ovulation, glucose uptake needs to be high to ensure the body has enough energy to support implantation. Once implanted, insulin resistance must increase to ensure enough glucose cycles through the blood to feed the fetus.
These changes in blood sugar and insulin resistance are all regulated by menstrual hormones.
For menstruating women, there are five different hormones that help regulate these factors throughout the month. They are estrogen, progesterone, luteinizing hormone, follicle stimulating hormone, and testosterone.
Estrogen
Estrogen makes the body more sensitive to insulin. When estrogen levels are high, cells are able to easily uptake glucose from the bloodstream. This results in lower average blood glucose levels compared to when other hormones are peaking in the body. In some women, high estrogen levels can even result in hypoglycemia.
Progesterone
Progesterone has a far more complicated effect on blood sugar than estrogen. It tends to make the body more resistant to insulin, which results in higher blood sugar levels. At the same time, progesterone stimulates the liver to release stored glucose into the bloodstream, further increasing blood sugar levels. But, this hormone also stimulates higher insulin production in the pancreas.
This action has a balancing effect in many women. But for those with impaired insulin function, high progesterone levels can cause significant increases in blood sugar levels during certain times of the month.
Luteinizing Hormone
Luteinizing hormone (LH) plays an important role in ovulation and spikes immediately before the release of an egg. This phase of the menstrual cycle is associated with a sudden spike in blood sugar levels. This is true despite estrogen also being highest at this time of the month. While the exact role LH plays in blood sugar regulation is unclear, it stands to reason that high LH or high LH combined with high follicle stimulating hormone (FSH), counteracts the insulin sensitivity caused by estrogen.
Furthermore, LH production is reduced when subcutaneous glucose levels fall. This demonstrates how hormones that affect blood sugar levels can also, in turn, be affected by blood sugar levels. In this case, chronic hypoglycemia caused by high estrogen or low glucose consumption can result in abnormally low LH levels and amenorrhea.
Follicle Stimulating Hormone
The relationship between blood glucose and follicle stimulating hormone (FSH) is another complicated one that has not been well studied. Just as with LH, blood glucose tends to spike when FSH is highest during the month. This would indicate that it has some blood glucose-raising effects.
Interestingly, though, low levels of FSH have been associated with a higher risk of developing diabetes. In these studies, researchers found that women with low FSH had greater insulin resistance and higher obesity rates. However, this may be a case of blood glucose levels affecting hormone levels rather than the other way around.
Testosterone
Testosterone exists in women at lower levels than in men. But just as with other sex hormones, it rises and falls throughout the menstrual cycle. We know from studies into male diabetes risk and testosterone levels that low testosterone is associated with increased blood glucose, insulin resistance, and diabetes risk.
In women, testosterone tends to peak around the same time as estrogen and plays a role in making the body more sensitive to insulin. Women with higher testosterone levels are more likely to see a dip in average glucose levels during certain points in their cycle.
Hormone Changes Throughout the Month
Each of the five hormones above rises and falls throughout the menstrual cycle. With these changes comes changes in average blood glucose as well as changes in how quickly blood sugar spikes in response to carbohydrates.
Understanding the pattern of hormone change throughout the menstrual cycle can help us understand how these fluctuations might be reflected in blood glucose trends. Monitoring these trends with a CGM has the power to identify what phase of menstruation a person is in and if any hormone abnormalities exist.
Monthly Hormone and Blood Sugar Trends
The menstrual cycle can be broken down into four phases defined by the differing levels of the five hormones we looked at above.
- Day 1-10: Estrogen, progesterone, LH, and testosterone are all low and stable. FSH gently rises from day 1 to 6 and then gently falls until the next phase. Blood sugar levels are generally stable and normal through this phase.
- Day 11-14: Progesterone stays stable through most of this phase while testosterone and estrogen start to rise early and spike along with FSH and LH. The early days of this phase tend to show lower blood sugar trends while the day of ovulation typically comes with a blood sugar spike.
- Day 15-20: Estrogen, testosterone, and LH quickly fall back to low levels while FSH slowly declines. Estrogen begins to rise again almost immediately. Progesterone begins to rise at a similar rate to estrogen. This results in relatively stable, normal blood sugar.
- Day 21-28: Progesterone continues to rise as estrogen levels peak and level out. This along with relatively low testosterone levels and stable FSH and LH causes insulin resistance to increase. Most women will experience higher than normal blood sugar during this phase as well as glucose spikes following carb-heavy meals.
Opportunities for CGM Use in Hormone Monitoring
Blood sugar levels tracked throughout the month provide a unique glimpse of how hormones are rising and falling behind the scenes. Utilizing a CGM to see these trends could easily provide women and menstruating people a window into their hormone and reproductive world. When connected to other monitoring devices and tracking software, these devices could be utilized for a number of different applications.
Cycle Tracking
Hundreds of menstrual cycle tracking applications exist. They use everything from user symptom logs to body temperature to help determine where a woman is in her cycle. Adding CGM data to the mix would only increase the accuracy of these apps while also giving them the power to identify hormone changes that could signal an issue.
After a few months worth of data, software algorithms could use glucose information to interpret which hormones are rising and falling and use that information to pinpoint where the user is in their cycle. Deviations from normal patterns could flag changes that might indicate disease, premenopause, missed ovulation, or pregnancy far earlier than other monitoring options.
Fertility
Blood glucose data has the unique ability to provide real-time information about hormone levels in the body. For women looking to get pregnant, this could be invaluable for identifying peak fertility windows. It could also help women struggling to conceive to see undiagnosed hormone imbalances and changes facilitated by hormone therapy.
For those looking to avoid pregnancy, CGMs could offer a more accurate picture of ovulatory windows based on real-time hormone levels rather than the day of the month.
Premenopause
During menopause, estrogen, testosterone, and progesterone hormones drop, causing a range of uncomfortable symptoms. But changes in these hormones can be detected long before menopause symptoms begin. Because these hormones tend to sputter out with abnormal rises and falls before steadily decreasing, blood tests aren’t always helpful in detecting premenopause. A CGM, on the other hand, could easily detect hormone trend changes from month to month.
Earlier menopause detection would allow women more time to plan their fertility options and treat symptoms to ease the transition. CGM-connected devices would continue to be helpful through the years of perimenopause and menopause as hormones continue to fluctuate and change.
Hormone Imbalances
Hormone imbalances can be caused by a number of different factors. Serious issues such as ovarian cancer and polycystic ovary syndrome often cause hormone changes long before more detectable symptoms occur. CGM-connected applications could easily detect these changes long before serious complications arise.
These same applications could be just as helpful for women on birth control and hormone replacement therapy. In both cases, a CGM would provide a means to track hormone changes to optimize dosing and detect problems before they begin.
Prediabetes
A number of studies have shown a connection between certain hormone imbalances and a higher risk of diabetes. Using a CGM has obvious benefits for those likely to develop diabetes. But for women in this category, using a CGM-connected hormone tracking app could give earlier insight into the likelihood of developing this disease.
On the flip side, CGM-connected hormone apps could help those already living with diabetes monitor their hormone levels. Both type 1 and type 2 diabetes are associated with lower fertility rates and early menopause. While many women with these diseases use CGMs, the associated apps lack the connectivity to provide insight into hormonal changes that could signal a problem.
Developing Connected Blood Sugar Tracking Applications
CGM-connected software capable of interpreting glucose data to shed light on hormone levels has obvious applications in the wearable FemTech market. But developing this kind of technology requires extensive knowledge about device-connected and interoperable software. For applications such as diagnosing hormonal disease or guiding treatment decisions in hormone therapy or fertility treatment, you’ll need to understand SaMD and the process of getting mobile medical applications approved by governing bodies.
Having a knowledgeable partner with years of experience building connected applications and medical software is vital when developing this kind of tech. Sequenex is a platform and product development company focused on helping developers create connected devices. Our software systems are built for device connectivity and interoperability, and are exactly what your company needs to create an application that utilizes CGM data.
If you need a partner to help turn your CGM-connected app into a reality, connect with us today.