Menopausal Hormone Therapy for Weight and Glucose Management

Key Takeaways

• Menopausal hormone therapy (MHT) replaces key hormones that decline during menopause, helping ease symptoms like hot flashes, mood swings, and sleep issues.
• Beyond symptom relief, MHT can support metabolic health and weight management, especially when started within 10 years of menopause or before age 60.
• Continuous glucose monitors (CGMs) offer insights into how your body responds to food, stress, and sleep, empowering personalized choices throughout the menopause transition.
• Because MHT isn’t suitable for everyone, particularly women with a history of hormone-sensitive cancers, liver disease, stroke, or heart attack, it’s essential to discuss your health history with your provider before starting treatment.

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Your 40s, 50s, and beyond should be a time to fully enjoy the life you’ve built, whether that’s picking up new hobbies, traveling more, or simply feeling confident in your own skin. But if low energy, restless nights, mood swings, or stubborn belly weight are holding you back, your body may be signaling it’s time to look deeper, especially if these changes are tied to menopause-related shifts in metabolism.

Menopausal hormone therapy (MHT) is one of the most effective ways to restore balance. By supporting healthier glucose regulation and rebalancing key hormones, MHT can ease many of the most disruptive symptoms of menopause. When combined with foundational habits (balanced nutrition, consistent movement, and stress management), it can help you feel more like yourself again.

How Menopause Affects Metabolism and Glucose

Most women transition from perimenopause to menopause in their mid-40s to 50s. This stage is driven by a sharp drop in estrogen and progesterone, which can trigger hot flashes, night sweats, and joint pain, but the effects don’t stop there. These hormonal shifts also influence how your body stores fat, responds to insulin, and regulates appetite.

Fat storage
At optimal levels, estrogen helps guide fat storage to the hips, thighs, and buttocks. When estrogen declines, testosterone becomes more dominant, shifting fat accumulation toward the abdomen.¹ This visceral fat surrounds organs like the liver and intestines, disrupts metabolic function, and increases insulin resistance, making weight gain during menopause more likely.

Insulin sensitivity
Estrogen helps your cells respond to insulin, so your body doesn’t need to produce as much to keep blood sugar stable. As estrogen levels fall, your cells may become less responsive, forcing the body to make more insulin.² This can progress to insulin resistance, a key driver of weight gain, elevated blood sugar, and type 2 diabetes risk.²

Appetite and satiety hormones
Estrogen also plays a role in appetite control by amplifying signals from hormones like leptin that tell your brain you’re full. When estrogen drops, those signals weaken, making you feel hungrier, less satisfied after eating, and more prone to overeating.

Metabolic changes can begin even before the hallmark signs of menopause show up. Using a continuous glucose monitor (CGM) during perimenopause and beyond can help spot early shifts in glucose patterns, empowering you to take proactive steps to protect your health and keep your metabolism working for you.

What is Menopausal Hormone Therapy (MHT)?

Menopausal hormone therapy (also called hormone replacement therapy) helps restore key hormones, primarily estrogen and progesterone, that naturally decline with age and the onset of menopause.

Your doctor will tailor treatment based on your health history:

• Estrogen alone if you’ve had a hysterectomy (uterus removed)
• Estrogen plus progesterone if your uterus is intact; progesterone protects against endometrial cancer

MHT comes in a variety of forms (oral tablets, skin patches, topical gels and creams, and vaginal creams, tablets, or rings) allowing for a personalized approach. Beyond symptom relief, the right therapy can support metabolic health, weight management, and overall well-being.

How MHT Supports Metabolic Health

In one small study of 32 postmenopausal women, half received daily hormone therapy (1 mg estradiol plus 0.125 mg trimegestone) for six months, while the other half received no treatment.³ The women on hormone therapy maintained stable body fat levels, while the control group gained fat, especially around the midsection. The therapy group also saw improvements in cholesterol, including lower total and LDL cholesterol.³

These results echo findings from the larger Women’s Health Initiative (WHI) Estrogen-Alone Trial, which looked at postmenopausal women who had undergone hysterectomy.⁴ Women on estrogen-only therapy had a 14 to 19% lower risk of developing type 2 diabetes compared to those who didn’t take hormones.⁴ Many also experienced relief from hot flashes and night sweats.⁴

While mild changes in insulin sensitivity were seen during the first year of treatment, they didn’t persist, suggesting that estrogen-only therapy may offer metabolic benefits without long-term negative effects on blood sugar control.

What CGMs Reveal About Glucose in Midlife

Menopause is a natural stage of life, but the changes it brings can sometimes feel disruptive. This is where continuous glucose monitors (CGMs) can provide real clarity.

A CGM offers a window into your body’s inner shifts, often before you notice symptoms like fatigue, mood changes, or cravings. As estrogen and progesterone levels decline, insulin sensitivity can change, leading to greater glucose fluctuations. By tracking your glucose in real time, you can spot these early patterns and take action sooner.

Beyond hormones, CGMs quietly capture the impact of your daily choices: how specific meals, snacks, stress levels, or even a poor night’s sleep influence your blood sugar. With this feedback, you can adjust nutrition, activity, and lifestyle habits to maintain steadier energy, support metabolic health, and lower your risk of insulin resistance or type 2 diabetes.

What the Research Shows

In a large study of 1,002 adults (categorized as premenopausal, perimenopausal, and postmenopausal), researchers used CGMs to track blood sugar responses over a six-hour period after meals.⁵ 

The findings were clear:⁵

• Fasting glucose was ~6% higher in postmenopausal women compared to premenopausal women.
• Post-meal glucose spikes were ~42% higher in postmenopausal women, as measured by the 2-hour postprandial glucose area under the curve (AUC).
• Post-meal insulin levels rose ~4%, suggesting the body had to work harder to bring glucose back down.

These insights highlight how menopause can reshape metabolic function and how valuable CGMs can be in navigating these changes. Whether you’re considering menopausal hormone therapy (MHT) or focusing on lifestyle strategies, CGM data helps you make decisions with confidence.

Realistic Expectations for Weight Loss With MHT

Menopausal hormone therapy (MHT) can help improve insulin sensitivity and reduce fat accumulation tied to low estrogen, but it isn’t a stand-alone solution for weight loss. By restoring hormonal balance, MHT creates a more favorable environment for healthy weight regulation. It can help curb fat redistribution to the abdomen and support better insulin response, both of which contribute to metabolic stability.

When paired with balanced nutrition, regular physical activity, and other healthy lifestyle choices, MHT can be a powerful ally in managing weight and supporting overall health during and after menopause.

Who Might Benefit Most From MHT

MHT is often most effective for women who are in the menopause transition or already experiencing symptoms such as hot flashes, night sweats, sleep disruption, or mood changes.^6,7

• Best timing: Starting MHT within 10 years of menopause, or before age 60, can provide the most benefit while keeping risks lower. This window is associated with fewer complications because blood vessels are less likely to have plaque buildup that could increase the risk of stroke, heart attack, or blood clots when exposed to estrogen.
• Additional benefits: Early initiation can help ease hot flashes, improve sleep quality, stabilize mood, and support metabolic health.

Who Should Avoid or Use Caution With MHT

Like any medical treatment, MHT has potential risks, particularly for women with certain health histories or conditions.⁷ You may be advised to avoid MHT if you:

• Have a history of hormone-sensitive cancers (e.g., breast or endometrial cancer), where added hormones could increase the risk of recurrence
• Have experienced a stroke, heart attack, or blood clots, as estrogen, especially in pill form, can raise clotting risk
• Have active liver disease, since the liver plays a key role in processing hormones
• Are over 60 or more than a decade past menopause, where starting MHT may raise the risk of cognitive decline, including dementia

For women in the right window, MHT can be an important tool for symptom relief and metabolic support. But it works best as part of a holistic approach to menopause health, anchored in nutrition, movement, stress management, and regular health monitoring.

Talking to Your Provider

Whether you’re approaching menopause or already navigating its impact on your mood, energy, or overall health, the right information can make all the difference, especially if you’re considering menopausal hormone therapy (MHT).

A continuous glucose monitor (CGM) can be a valuable part of that conversation. Your CGM data can reveal whether mood swings, fatigue, or irritability tend to follow post-meal blood sugar spikes, early signs of insulin resistance, or disrupted sleep patterns.

By spotting these connections, you can ask more targeted questions, such as:

• Could estrogen therapy help stabilize my glucose swings?
• Does my CGM data suggest I’m becoming insulin resistant?
• How can we balance symptom relief with my long-term metabolic health?

The Bottom Line

MHT can be a powerful ally for managing symptoms, supporting metabolic health, and helping regulate blood sugar, but it’s just one piece of the puzzle. CGMs offer personalized insights that help you and your provider create a plan tailored to your needs, so you can feel your best through menopause and beyond.

Learn More With Signos’ Expert Advice

Want to dive deeper into understanding your body’s responses? Signos can help you make smarter choices by connecting nutrition insights with your personal health data. Learn more about glucose levels on the Signos blog.