Insulin Resistance and Menopause
Before menopause, women have lower rates of heart disease and diabetes than men, but after menopause, female risk rises considerably. Menopause itself becomes a risk factor for cardiometabolic disease. If you’re in midlife, you may already notice some changes, such as weight gain or high cholesterol.
But what exactly happens during the menopause transition to account for this risk? That’s what I’ll discuss today: insulin resistance.
From the functional medicine perspective, I want to understand the root cause of symptoms, how hormones influence metabolism, and what we can do to maintain a healthy metabolism in menopause and with age. Let’s make the connections and dive in.
What is Insulin Resistance?
Let’s start with insulin. Insulin is a hormone made in the pancreas that serves many metabolic functions. One of which is to move glucose (sugar) from the bloodstream into cells where it’s used as fuel.
Insulin resistance is a state where cells have a reduced response to insulin, especially fat, liver, and muscle cells. The result is high insulin levels, as the pancreas produces more insulin in an attempt to get the cells to “listen,” leading to high blood sugar. Insulin resistance drives chronic disease, including metabolic syndrome, diabetes, and heart disease.
It turns out that insulin resistance is adaptive. It’s how animals (and our human ancestors) put on fat to survive the winter when food is scarce. But for many of us in modern times, food scarcity never comes. The modern food environment offers calorie-rich, yet nutrient-poor, options, making it easy to overeat and store fat. Pair that with a sedentary job, and you can see how insulin resistance develops over time in this environment. Low estrogen accelerates the development.
Metabolic Changes in Perimenopause/Menopause – The Role of Estrogen
Estrogen is protective for many body systems, including metabolic and cardiovascular health. As estrogen (estradiol) declines, this protection declines, and insulin resistance increases. In fact, research links hot flashes with insulin resistance and disease risk.
Perimenopause isn’t just a reproductive transition, but a cardiometabolic one. The body undergoes a dramatic change in its ability to metabolize food into energy, the metabolic rate declines, and fat redistributes.
Metabolic and cardiovascular symptoms associated with menopause include:
Increased visceral fat (belly fat)
Weight gain
Muscle loss
Elevated cholesterol and lipid imbalances
Increased inflammation
Vascular dysfunction
High blood pressure
Further, the risk increases for:
Prediabetes
Diabetes
Obesity
Fatty liver
The good news is that you can reestablish some level of cardiometabolic protection and lower disease risk with hormone replacement therapy.
Functional Solutions for Insulin Resistance
The menopause hormonal landscape changes your metabolism, so if you feel like your nutrition and exercise habits are no longer working, they probably aren’t. To reverse insulin resistance and optimize metabolic health, we need to reverse the contributing factors, which often means updating your diet and exercise routine. Additionally, some women will need to lose weight (fat) to reverse insulin resistance.
In my practice, I take a personalized, whole-woman approach, which means your protocol and plan will be unique to you. We’ll identify and uncover your root causes, focusing on any cardiometabolic imbalances. Then, we’ll work from the ground up to optimize your hormones and metabolism.
Here are some of the functional medicine tools I draw from in my practice:
Increase muscle mass – To counteract the body composition changes of menopause, you’ll need to maintain and even build new muscle. This goal involves strength training, meeting your protein needs, and sometimes supplementation.
Balance blood sugar – What and how you eat is a primary factor in blood sugar balance and how much insulin the body produces. Balanced blood sugar means choosing whole foods and eating balanced meals with protein, healthy fats, and fiber-rich carbs. Additionally, lifestyle habits, stress, and sleep also influence blood sugar.
Supplements – Targeted supplements, such as inositol, berberine, and creatine, can help with metabolic and body composition goals. Still, other supplements like phytoestrogens or adaptogens can support hormonal communication. I have lots of tools in my supplement toolkit.
Bioidentical hormone replacement therapy – Estrogen promotes insulin sensitivity and cardiometabolic protection, and we can discuss the best approach for you. I’ve found that replacing bioidentical estradiol often promotes weight maintenance and a healthy metabolism when combined with other tools.
GLP-1 Medication – This category of medications mimics the glucagon-like peptide-1 hormone your body makes. GLP-1 slows the movement of food through the digestive system and decreases hunger and food intake. However, it does more, improving insulin sensitivity and reducing inflammation. It’s even considered cardio-protective.
In conventional medicine, GLP-1 medications are primarily used for diabetes and obesity management. However, the low-dose options I use in my clinic can help offset some of the negative effects of estrogen loss, supporting metabolism and body composition, without the side effects. A 2024 study even suggests women respond to GLP-1 medications better in terms of weight loss when combined with hormone therapy.
Insulin resistance helps explain many cardiometabolic changes that occur in menopause with the decline in estrogen. It’s a great example of how body systems are connected and interdependent. One change throws off the whole system, but luckily, this understanding gives way to the solutions.
Improving insulin sensitivity in menopause comes down to optimizing nutrition and lifestyle habits, along with other interventions, such as supplements, bioidentical hormones, and GLP-1s. If you notice new symptoms and weight changes, I can help you connect the dots and address your concerns, safely and effectively.
References
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