Understanding Women's Sex Hormone Physiology—A Priority in Diabetes Care

The CDE Academy is proud to invite you to register for our next Journal Club Webinar, taking place on 21 July 2026 from 19h30 to 20h30 GMT+2 (SAST/CAT). Each session is real-time, online and CPD-accredited.

All our topics are carefully selected to be of interest to all members of the wider interdisciplinary diabetes team.

Beyond a Reproductive Milestone

For millions of women navigating the intersection of diabetes, ageing and menopause, the decline in sex hormones represents far more than a reproductive transition. It is a significant metabolic recalibration that may influence insulin sensitivity, glucose regulation, body composition, cardiovascular risk and overall wellbeing.

This Journal Club invites the interdisciplinary diabetes team to look beyond the glucose meter and recognise women's sex hormone physiology as an important component of metabolic stability and long-term diabetes care.

Estradiol, Insulin Sensitivity and Cardiometabolic Risk

The decline in estradiol during menopause may have wide-ranging effects on insulin sensitivity, lipid metabolism, vascular health and cardiometabolic risk. Despite this, hormonal status is not always given sufficient consideration when clinicians assess changing glucose patterns or unexplained metabolic instability in women approaching or progressing through menopause.

During this session, we will examine current evidence surrounding Menopausal Hormone Therapy (MHT), including its potential influence on mortality, cardiovascular outcomes, cognitive health and quality of life when prescribed appropriately and individualised to the patient.

The discussion will also revisit concerns that emerged from the original Women's Health Initiative studies and consider how subsequent research has reshaped our understanding of the relationship between the timing, formulation and route of hormone therapy and its potential benefits and risks.

Moving Beyond a One-Size-Fits-All Approach

A critical focus of the session will be the considerable inter-individual variation in response to hormone therapy. Emerging real-world evidence suggests that some women using even the highest licensed doses of transdermal estradiol may continue to experience sub-therapeutic hormone levels because of variable absorption.

This challenges clinicians to move beyond standardised dose escalation and adopt a more individualised approach that considers the patient's age, symptoms, treatment route, dose, metabolic profile and clinical response. It also raises important questions about when serum estradiol monitoring may be valuable in guiding treatment decisions.

Menopause as a Vital Sign of Women's Health

Rather than viewing menopause solely as a state of hormonal deficiency, clinicians may need to recognise it as an important indicator—or “vital sign”—of a woman's broader metabolic and cardiovascular health.

Understanding the hormonal changes underlying menopause can help diabetes professionals interpret changing glucose patterns, identify previously overlooked contributors to metabolic instability and engage in more informed discussions with patients about their treatment options.

This session is not simply about managing the symptoms of menopause. It is about recognising sex hormone physiology as an important clinical consideration in diabetes care and empowering women to make informed, individualised decisions about their health during midlife and beyond.

Expert Guest: Professor Trudy Smith

Professor Trudy Smith is an Obstetrician, Gynaecologist and Gynaecological Oncologist with the qualifications MBBCh, FCOG(SA) and Certificate in Gynaecological Oncology.

She graduated from the University of the Witwatersrand and currently practises at the Wits Donald Gordon Medical Centre. She is actively involved in the teaching and training of undergraduate medical students, future gynaecologists and gynaecological oncologists through the University of the Witwatersrand.

Professor Smith has published several academic papers, contributed chapters to undergraduate textbooks and regularly provides obstetric and gynaecological expertise through television and radio programmes. She is also deeply committed to the prevention of cervical cancer and improving women's access to essential gynaecological care.