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Metabolic Health

How Does Insulin Sensitivity Change With Menopause?

Written by: Sarah Jayawardene, MS

Reviewed by: Emily J., MSc RD

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6 minutes

Menopause is characterized by hormonal changes that can impact insulin sensitivity, glucose metabolism, body composition, and weight. Although it may increase the risk of metabolic health complications, women can adopt preventative strategies to manage symptoms of menopause and associated health outcomes.

The onset of menopause triggers a cascade of hormonal changes that can affect several areas of women’s health, including fertility, bone density, and even metabolic rate. 

By adopting healthy habits around nutrition, exercise, sleep, and stress as early as possible, women can better prepare their bodies and minds for these changes and reduce their risk of developing metabolic health complications linked to menopause [1]. Continuing these habits throughout and after menopause can help women maintain their metabolic health, extend their healthspan, and improve their quality of life.

What is menopause?

Menopause is a natural biological process in women, characterized by a decrease in the production of the hormones estrogen and progesterone and a cessation of ovary function [2]. These reductions in hormone levels eventually lead to a permanent loss of menstrual cycle — and can also lead to changes in metabolic health, such as increased insulin resistance and poor glucose regulation.

During the initial stages of menopause, a woman's body undergoes several changes due to the decrease in estrogen and progesterone. The drop in hormone levels leads to a range of physical and emotional changes. 

Common symptoms of menopause include [4]: 

Women may also experience symptoms such as fatigue, joint pain, anxiety, depression, varying libido, hair thinning, and memory problems [5]. As the body adjusts to these hormonal shifts, women experience changes in their reproductive system, such as a decrease in fertility (and eventual infertility), and changes in their musculoskeletal system, such as decreases in bone density and muscle mass. 

Menopause marks the end of a woman's reproductive years and is a natural part of the aging process. While it can be accompanied by a range of symptoms, women can manage these shifts through lifestyle habits and mitigate negative health consequences by understanding individual metabolic responses.

What’s the relationship between menopause and insulin resistance?

During menopause, many women experience an increased risk of developing insulin resistance and glucose intolerance, which can lead to weight gain, the development of Type 2 diabetes, and cardiovascular disease [6].

One major factor that contributes to this increased risk is the decrease in estrogen levels. Estrogen plays a critical role in glucose metabolism by regulating the production and release of insulin, the hormone responsible for controlling blood glucose levels. Estrogen also helps to enhance insulin sensitivity, which means that it helps the body to use insulin more effectively to lower blood glucose levels.

Other factors during menopause that contribute to the increased risk of insulin resistance include aging, weight gain, and sedentary lifestyle. 

These factors can all lead to one of the most significant body composition changes during menopause: the redistribution of body fat, particularly the accumulation of fat around the abdomen. This type of fat, known as visceral fat, is more metabolically active than subcutaneous fat, and is heavily associated with insulin resistance (and related weight gain), Type 2 diabetes, and cardiovascular disease.

Menopause is also associated with sarcopenia, an age-related condition where muscle mass and strength declines [7]. Sarcopenia can lead to a decrease in physical activity and a sedentary lifestyle, which further exacerbates the risk of obesity and metabolic health complications.

Polycystic Ovarian Syndrome (PCOS) increases the likelihood of insulin resistance — when women with PCOS go through menopause, they are at higher risk of developing type 2 diabetes and cardiovascular disease.

How to prevent or reverse insulin resistance related to menopause

To manage these body composition and hormonal changes and reduce the risk of obesity, type 2 diabetes, and other metabolic health complications during menopause, women can adopt several healthy lifestyle habits. Key strategies to focus on are:

1. Regular exercise

Physical activity can help to maintain muscle mass, improve insulin sensitivity, and decrease the severity of physiological symptoms of menopause (like hot flashes) [8]. Aim for at least 150 minutes of moderate-intensity aerobic exercise or 75 minutes of vigorous-intensity aerobic exercise per week, as well as at least two days of strength-training exercises per week. Exercise can include a mix of cardio and strength training activities, such as brisk walking, jogging, cycling, weightlifting, or yoga. Exercise during menopause has also been shown to increase mental health and quality of life [9, 10].

2. Nutrition

Eating a balanced diet that is high in fiber and low in processed and refined foods can help to prevent insulin resistance. Women in their 40s and 50s should aim to eat plenty of vegetables, fruits, lean proteins, and healthy fats — such as these foods that help combat insulin resistance.

3. Portion control

Menopause can lead to a decrease in metabolic rate, which means that the body burns fewer calories at rest. Therefore, it is important to control portion sizes and avoid overeating. Excess weight can contribute to insulin resistance and other metabolic health complications, thus maintaining a healthy weight through menopause is important [11].

4. Adequate sleep

Since sex hormones impact sleep, the decline in estrogen and progesterone with menopause can decrease sleep quality [12]. Getting enough sleep is essential for overall health and can improve insulin sensitivity [13]. Women in their 40s and 50s should aim to get 7-8 hours of sleep per night and maintain a consistent sleep schedule.

5. Stress management and social connection

Menopause can be a stressful time for women, and chronic stress can lead to weight gain and insulin resistance. Stress management techniques such as yoga, meditation, deep breathing exercises, and fostering social connections during menopause can help to lower stress levels [14].

6. Avoid smoking and excessive alcohol consumption

Smoking and excessive alcohol consumption can increase the risk of metabolic health complications during menopause.

7. Hormone replacement therapy (HRT)

For some women, hormone replacement therapy (HRT) may be an option to manage menopausal symptoms and reduce the risk of metabolic health complications [15]. However, the decision to use HRT should be made in consultation with a healthcare provider and should take into account individual risks and benefits.

By adopting these lifestyle strategies, women in their 40s and 50s can prevent or reverse insulin resistance and improve their overall metabolic health during and after menopause. However, it is important to develop an individualized plan that is tailored to your specific needs and health concerns.

Key Takeaways

By implementing strategies before, during, and after menopause, women can better navigate the hormonal changes associated with menopause and maintain their overall health.



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