Endocrine Abstracts

Reproductive morbidity is increased in women with diabetes, including a higher prevalence of polycystic ovary syndrome, hypothalamic amenorrhoea and premature ovarian failure. Routine discussion of reproductive and menstrual dysfunction for women with diabetes remains a peripheral feature of clinical consultations. Here we aimed to determine women’s own reproductive care experience. We surveyed women of all ages attending routine diabetes care using a detailed clinical questionnaire. Participant experience of discussion of menstrual history, contraceptive use and preconception advice in routine clinical consultations was determined. 54 women completed the survey. The median age was 37.5 years (IQR 23-51) with a median BMI 27.4 kg/m² (IQR 22.5-31.2). 44 (82%) and 10 (18%) had type 1 (T1DM) and type 2 diabetes (T2DM), respectively. Median HbA1c was 58 (IQR 53-70) mmol/mol. Patients were living with diabetes for a median of 13.2±14.0 years. 38% had Type 1 diabetes (T1DM) prior to menarche. There was no significant difference in age of menarche in those diagnosed with T1DM before menarche compared to those diagnosed after menarche (P=0.64). 65% of respondents were premenopausal (n=34). 47% of this group recalled discussing their menstrual cycle during consultation, while just 41% reported awareness of preconception advice (n=14). Oral contraceptives had been used by 68.5%. 33.2% had previously utilized contraceptive implant or injection, while an intrauterine device had been used by 23%. 16.7% of total respondents had experienced miscarriage. Overall, 77% of women reported regular menstrual cycles. Participants with T1DM reported a high prevalence of both hirsutism and acne at 38.6% and 31.8%, respectively. Consensus statements recommend greater awareness and recognition of reproductive issues facing women with type 1 diabetes. This survey highlights the need to reinforce preconception counselling. The high prevalence of hirsutism and acne in this cohort should prompt consideration for biochemical evaluation for androgen excess in this population.