During perimenopause and menopause, when female sex hormone levels drop, insulin sensitivity can change, affecting how well your blood sugar is controlled. When insulin sensitivity decreases, it can lead to high blood sugar levels or hyperglycemia. This can increase your chances of developing type 2 diabetes, so it is important for women going through perimenopause and menopause to monitor their blood sugar levels and take steps to maintain healthy blood sugar control.
What is Menopause?
Menopause is when a woman has not had a period for at least 12 consecutive months. It is a natural biological process that marks the end of a woman's reproductive years. It occurs when the ovaries stop producing eggs, and estrogen, progesterone, and other hormone levels decline. Menopause typically happens between the ages of 40 and 58, but it can come sooner or later, depending on a variety of factors.1
Progesterone and estrogen production both decline after menopause. The effects of low estrogen can be felt throughout the body. Symptoms of menopause vary, but common ones include hot flashes, night sweats, irregular periods, vaginal dryness, and changes in mood and sleep patterns. Some of these effects are due to blood glucose spikes and insulin resistance.
A drop in estrogen levels is also associated with an increase in total body fat, especially abdominal (belly) fat, and a decrease in lean body mass. When you lose muscle, your metabolism slows, so you need fewer calories to sustain bodily functions.4,5 Weight gain, increased abdominal fat, and fluctuations in estrogen and progesterone levels can all trigger insulin spikes and resistance.
If you are not in perimenopause, estrogen and progesterone can still impact your blood sugar.
Menopause is a natural part of aging and is not a disease, but some women may experience symptoms that are severe enough to interfere with their daily activities. In this case, they might think about treatments like hormone therapy to help them deal with their symptoms. If you have concerns about how menopause is affecting you, talk to your healthcare provider.
Menopause and Insulin Resistance
Declines in estrogen and progesterone levels after menopause increases insulin resistance, a condition in which the body becomes less sensitive to the effects of insulin. Insulin resistance can lead to high blood sugar (hyperglycemia) and increase the risk of developing type 2 diabetes.
Estrogen is found in three main forms: estradiol, estrone, and estriol. Estradiol is the primary estrogen during perimenopause. When the ovaries stop producing estrogen around menopause, estrone produced by fat cells rises in importance. Typical ranges for premenopausal and postmenopausal estrogen and progesterone:1,6,7
Estrogen has a protective effect on insulin sensitivity and blood sugar control. When estrogen levels decline during menopause, insulin sensitivity may also decrease, leading to insulin resistance, weight gain, and an increased risk for type 2 diabetes.8 Estrogen stabilizes blood glucose levels by increasing glucose uptake into the muscle and liver and slowing the conversion of other nutrients to glucose in the liver.9 Progesterone also affects how sensitive cells are to insulin, and low progesterone levels during menopause may contribute to insulin resistance.
Weight gain is common during menopause when hormones fluctuate, and excess body fat can further increase the risk of developing insulin resistance and type 2 diabetes. Research suggests that estrogen inhibits hunger signals, and when estrogen levels decline around menopause, women experience more intense hunger, contributing to weight gain. Increased body fat, especially in the abdomen, is associated with high blood pressure, cardiovascular disease, and diabetes.8
6 Ways Menopause Influences Blood Glucose
Menopause symptoms are caused by a drop in estrogen and progesterone and an increase in insulin resistance. Menopause influences how your body uses glucose, and increased blood glucose worsens some menopausal symptoms.
Hormonal Fluctuations and Imbalances
During menopause, the ovaries stop producing estrogen and progesterone, two hormones that play important roles in the menstrual cycle and fertility. As a result, women may experience many physical and emotional symptoms due to hormonal imbalances, including:1
- Hot flashes,
- Night sweats,
- Vaginal dryness,
- Decreased libido,
- Mood changes,
- Trouble sleeping,
- Weight gain, and
- Bone loss.
Hormonal imbalances during menopause can also increase the risk of certain health conditions. Insulin resistance increases the risk of type 2 diabetes, obesity, and metabolic syndrome.
Weight Gain and Visceral Fat
Estrogen and progesterone impact hunger, weight gain, and fat distribution. When estrogen levels decrease with menopause, many women experience more intense hunger, which can trigger overeating and weight gain.
Premenopausal women preferentially store fat under the skin around the hips, thighs, and buttocks. Postmenopausal women store visceral fat in the abdomen. Visceral fat is more metabolically active than subcutaneous fat. It is more likely to release fatty acids into the bloodstream that can cause inflammation, insulin resistance, and an increased risk of type 2 diabetes, metabolic syndrome, and cardiovascular disease.10-12
Hot flashes are sudden feelings of warmth often accompanied by skin flushing or redness. During a hot flash, the blood vessels in the skin widen, causing increased blood flow and a sensation of warmth. Sweating, palpitations, and a rapid heartbeat can also occur. Hot flashes can range in severity and duration and occur at any time of day or night. They can be mild and brief or severe and last for several minutes.
The exact cause of hot flashes is unknown, but they are thought to be related to decreased estrogen during menopause. Hot flashes can interfere with sleep, which can harm overall health and quality of life.13
Researchers surveyed 3,075 perimenopausal and menopausal women to learn more about the potential association between hot flashes and cardiovascular disease. They found that hot flashes are associated with higher blood glucose levels and increased insulin resistance. This link was not considered secondary to increased body weight or changes in estrogen or other hormone levels. Women who had hot flashes showed signs that their heart structure and function had changed, and they were more likely to get blood clots.14
Hot flashes, night sweats, and waking up at night to urinate can all disrupt your sleep. Sleep disruption is associated with weight gain and increased stress hormone release, which can cause blood sugar spikes. High blood sugar causes increased thirst, urination, and hunger, contributing to sleep problems.
Increased Risk of Diabetes
Compared to men of the same age, premenopausal women are more sensitive to insulin and are less likely to get type 2 diabetes. However, after menopause, when estrogen levels decline, this advantage is lost. Clinical trials comparing insulin resistance, blood glucose levels, and type 2 diabetes risk in postmenopausal women receiving hormone therapy versus those who aren’t suggesting a direct relationship between estrogen and insulin sensitivity.9
Increased Risk of Vaginal and Urinary Infections
Menopause and estrogen deficiency can cause vaginal dryness, irritation, burning, and urinary symptoms such as pain when you urinate and the need to urinate quickly or more often. Because of these changes, urinary tract infections are more common after menopause.1
High blood sugar provides nutrients for pathogens, which increase the risk of urinary and vaginal infections. This risk increases after menopause, when estrogen levels drop, and many of its protective effects on the urinary system and vagina are lost.
What Are Normal Blood Sugar Levels for Women Aged 40+?
Normal blood sugar levels are different for people with and without diabetes. For women over age 40 without diabetes, normal blood sugar levels are:15
- Fasting: 70-99 mg/dL
- Before eating: 80—130 mg/dL
- 1-2 hours after eating: 80-140 mg/dL
- Target hgA1C: Below 5.7%
8 Tips to Manage Blood Sugar During and After Menopause
Hormones can affect your weight-loss efforts. You can reduce your risk of type 2 diabetes, metabolic syndrome, and obesity by tracking and managing your blood sugar and weight during and after menopause.
Consuming foods with fewer carbohydrates or a lower glycemic index may help you stabilize your blood sugar and prevent weight gain, especially if you have insulin resistance. Adding more protein to your diet can also help.16
Other dietary tips for managing your blood sugar:
- Eat a variety of nutrient-dense, whole foods.
- Include healthy monounsaturated and polyunsaturated fats in your diet.
- Increase fiber consumption.
- Limit intake of saturated and trans fats.
- Use whole-grain cereals and bread.
Aerobic and resistance exercise can frequently slow the loss of lean muscle mass during menopause and increase calorie burn throughout the day.
For health and fitness benefits and to stabilize your weight, the Centers for Disease Control and Prevention (CDC) recommends choosing one of the following options:
- Exercising at a moderate intensity for 30 minutes a day, five days a week, for a total of 150 minutes of exercise per week.
- Exercising at a vigorous intensity for seventy-five minutes per week.
- Doing a combination of moderate and vigorous-intensity exercise.
If you don't have a gym membership or exercise equipment, walking can help with weight loss and improve overall cardiovascular health.
Address Hormonal Imbalances
Hormone therapy can help alleviate some of the symptoms of menopause, such as hot flashes and night sweats, and may also help lower the risk of certain health conditions. However, hormone therapy is not without risks and may not be suitable for everyone. Some potential risks of hormone therapy include an increased risk of breast cancer, blood clots, and stroke.
Talk to your doctor about hormone therapy's potential risks and benefits based on your medical history, symptom profile, and alternative treatment options. Ask your doctor if you need thyroid hormone testing. Thyroid disease is more common after menopause.
Prolonged and especially unresolved stress increases cortisol and other stress hormones, which can increase insulin resistance and weight gain.
To manage stress:
- Try to schedule exercise into your day.
- Use relaxation techniques such as deep breathing, meditation, and progressive muscle relaxation.
- Set boundaries and prioritize tasks.
- Spend time with family, friends, and pets.
- Spend time outdoors.
- Practice good sleep hygiene.
Dehydration can increase insulin resistance, cause electrolyte imbalances, and trigger your body's stress response. Every chemical reaction in your body needs water. To support weight loss, control your appetite, and stabilize your blood sugar, drink plenty of water.18 If you feel the urge to eat, see if you can be satisfied with a glass of water.
Reduce Sugar Intake
Pay attention to the amount of added sugar in foods. The American Heart Association recommends that women consume no more than six teaspoons (24 grams) of added sugars daily and men consume no more than nine teaspoons (36 grams) daily.
To decrease your daily sugar intake:
- Choose whole foods rather than processed foods whenever possible.
- Use natural sweeteners in moderation.
- Limit sugary drinks, such as soda, sports drinks, and sweetened coffee and tea, which can add sugar to your diet without your knowledge. Try to limit or avoid these drinks and opt for water, unsweetened tea, or coffee instead.
Get High-Quality Sleep
Poor sleep habits can make it harder to control your blood sugar and appetite and keep your weight stable. It can also make menopause symptoms worse.
For better sleep:
- Stick to a regular sleep schedule.
- Schedule time for relaxing activities before bedtime.
- Sleep in a cool, quiet, dark room.
- Avoid screens before bedtime.
- Limit caffeine and alcohol intake in the afternoon and evening.
- Try deep breathing, meditation, and progressive muscle relaxation to relax before bedtime.
Reduce Exposure to Endocrine Disruptors
Endocrine disruptors, chemicals that can affect hormone levels, can include:
- Bisphenol A (BPA)
- Perfluoroalkyl and polyfluoroalkyl substances (PFAS)
- Polybrominated diphenyl ethers (PBDE)
- Polychlorinated biphenyls (PCB)
Learn More About Blood Sugar Management and Control with Signos.
Metabolic changes are common during menopause. Tracking and early detection of blood sugar spikes and impending glucose resistance give you time to make lifestyle changes that may reduce your risk for chronic diseases such as diabetes, heart disease, and obesity. Signos can improve your health by arming you with data about your blood sugar levels and their response to lifestyle factors and diet.
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Topics discussed in this article:
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- Lee H-R, Kim T-H, Choi K-C. Functions and physiological roles of two types of estrogen receptors, ERα and ERβ, identified by estrogen receptor knockout mouse. lar. 06 2012;28(2):71-76. doi:10.5625/lar.2012.28.2.71
- Bitoska I, Krstevska B, Milenkovic T, et al. Effects of Hormone Replacement Therapy on Insulin Resistance in Postmenopausal Diabetic Women. Open Access Maced J Med Sci. Mar 15 2016;4(1):83-8. doi:10.3889/oamjms.2016.024
- Leeners B, Geary N, Tobler PN, Asarian L. Ovarian hormones and obesity. Human reproduction update. 2017/05// 2017;23(3):300-321. doi:10.1093/humupd/dmw045
- Kapoor E, Collazo-Clavell ML, Faubion SS. Weight Gain in Women at Midlife: A Concise Review of the Pathophysiology and Strategies for Management. Mayo Clinic Proceedings. 2017;92(10):1552-1558. doi:10.1016/j.mayocp.2017.08.004
- Mayo Clinic Laboratories. TEST ID : EEST. Accessed December 18, 2022. https://www.mayocliniclabs.com/test-catalog/overview/81816#Clinical-and-Interpretive
- Mayo Clinic Laboratories. TEST ID : PGSN. Accessed December 18, 2022. https://www.mayocliniclabs.com/test-catalog/overview/8141#Clinical-and-Interpretive
- Chopra S, Sharma K, Ranjan P, Malhotra A, Vikram N, Kumari A. Weight management module for perimenopausal women: A practical guide for gynecologists. Review Article. J Midlife Health. 2019;10(4):165-172. doi:10.4103/jmh.JMH_155_19
- Yan H, Yang W, Zhou F, et al. Estrogen Improves Insulin Sensitivity and Suppresses Gluconeogenesis via the Transcription Factor Foxo1. Diabetes. 2018;68(2):291-304. doi:10.2337/db18-0638
- Lee Jane J, Pedley A, Hoffmann U, Massaro Joseph M, Fox Caroline S. Association of Changes in Abdominal Fat Quantity and Quality With Incident Cardiovascular Disease Risk Factors. Journal of the American College of Cardiology. 2016/10/04 2016;68(14):1509-1521. doi:10.1016/j.jacc.2016.06.067
- Gastaldelli A. Abdominal fat: does it predict the development of type 2 diabetes? The American Journal of Clinical Nutrition. 2008;87(5):1118-1119. doi:10.1093/ajcn/87.5.1118
- Després J-P, Lemieux I. Abdominal obesity and metabolic syndrome. Nature. 2006/12/01 2006;444(7121):881-887. doi:10.1038/nature05488
- Dormire S, Howharn C. The effect of dietary intake on hot flashes in menopausal women. J Obstet Gynecol Neonatal Nurs. May-Jun 2007;36(3):255-62. doi:10.1111/j.1552-6909.2007.00142.x
- Thurston RC, El Khoudary SR, Sutton-Tyrrell K, et al. Vasomotor symptoms and insulin resistance in the study of women's health across the nation. J Clin Endocrinol Metab. Oct 2012;97(10):3487-94. doi:10.1210/jc.2012-1410
- Draznin B, Aroda VR, Bakris G, et al. 6. Glycemic Targets: Standards of Medical Care in Diabetes-2022. Diabetes Care. Jan 1 2022;45(Suppl 1):S83-s96. doi:10.2337/dc22-S006
- Pittas AG, Das SK, Hajduk CL, et al. A low-glycemic load diet facilitates greater weight loss in overweight adults with high insulin secretion but not in overweight adults with low insulin secretion in the CALERIE Trial. Diabetes Care. Dec 2005;28(12):2939-41. doi:10.2337/diacare.28.12.2939
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