Menopause can disrupt how your body manages blood sugar. As oestrogen and progesterone levels drop, insulin sensitivity decreases, increasing the risk of insulin resistance and type 2 diabetes.

Nearly 40% of women in menopause are prediabetic, and most don’t even know it. Hormonal changes also lead to blood sugar swings, fatigue, weight gain (especially belly fat), and higher risks of heart disease.

Here’s what you need to know:

• Oestrogen improves insulin sensitivity. Its decline during menopause weakens glucose regulation.
• Progesterone increases insulin resistance, and its drop can further disrupt balance.
• Visceral fat increases post-menopause, interfering with glucose processing.
• Sleep issues and stress worsen blood sugar control.

You can manage these changes by focusing on balanced meals, regular exercise (150 minutes weekly), stress management, and quality sleep.

Tools like continuous glucose monitors (CGMs) provide real-time insights into your glucose trends, helping you make informed lifestyle adjustments. Partnering with healthcare professionals ensures tailored support for long-term metabolic health.

‍Struggling with weight gain and blood sugar swings during menopause? Learn how they're connected and what you can do about it in this guide on breaking the cycle.

How hormones control blood sugar before and during menopause

Hormones play a critical role in regulating blood sugar, and understanding this connection sheds light on why menopause can disrupt glucose levels.

Oestrogen and progesterone, while primarily known for managing the reproductive cycle, are also deeply involved in glucose metabolism. Their balance is key to how the body processes sugar, and menopause brings significant changes to this system.

How oestrogen and progesterone regulate blood sugar

Before menopause, oestrogen and progesterone work together to help stabilise blood sugar levels. These hormones interact with alpha and beta cells in the pancreas, ensuring efficient glucose regulation.

Oestrogen, in particular, enhances insulin's effectiveness, making it easier for cells to absorb glucose and improving overall insulin sensitivity. This is why premenopausal women often have a lower risk of developing type 2 diabetes. As one expert explains:

Typically, premenopausal levels of oestradiol range from 30 to 400 pg/mL, while progesterone levels hover around 1.5 ng/mL. While oestrogen boosts insulin sensitivity, progesterone can counteract this by slightly increasing insulin resistance. This balancing act ensures stable glucose levels in healthy premenopausal women. However, as menopause approaches and these hormonal dynamics shift, the body's ability to regulate glucose efficiently begins to falter.

What happens when oestrogen levels drop

Oestrogen plays a central role in maintaining insulin sensitivity, and its decline during menopause disrupts this finely tuned system. As oestrogen levels drop, the body becomes less efficient at managing blood sugar, often leading to insulin resistance.

The effects of lower oestrogen go beyond insulin resistance. Oestrogen receptors are found throughout the digestive system, including in the liver and gut. When oestrogen levels plummet, lipid metabolism and the body's overall response to insulin can also be affected.

After menopause, oestradiol levels fall below 30 pg/mL, and progesterone dips below 0.5 ng/mL. These sharp changes alter how the body handles glucose. Without oestrogen's protective influence, many women experience insulin resistance for the first time, which can lead to other metabolic challenges.

The drop in oestrogen also triggers a chain reaction of metabolic shifts. These changes can influence energy levels, weight distribution, sleep patterns, and even long-term health risks. By understanding these mechanisms, women can take proactive steps to manage their metabolic health during this life stage.

‍Curious how perimenopause can affect your blood sugar? Find out what signs to watch for and how to stay ahead in this helpful breakdown.

Health risks that increase after menopause

The hormonal changes that accompany menopause do more than just disrupt glucose regulation temporarily – they bring about lasting shifts that can elevate the risk of serious health issues. Recognising these risks is an essential step toward safeguarding your health in the years ahead.

Increased risk of insulin resistance and type 2 diabetes

The drop in oestrogen during menopause plays a significant role in raising the likelihood of insulin resistance, which can eventually lead to type 2 diabetes. This link between menopause and metabolic challenges is well-documented in medical studies.

The age at which menopause occurs also matters. An earlier onset means losing the protective effects of oestrogen for a longer period, which can further impact long-term metabolic health.

Metabolic syndrome affects 20-25% of the general population, with rates climbing in those aged 50-60. Among postmenopausal women, the prevalence is even higher, ranging from 32% to 58%, depending on the group studied. This syndrome, which is a combination of high blood sugar, increased abdominal fat, high blood pressure, and abnormal cholesterol levels, greatly raises the risk of heart disease and stroke.

The cardiovascular implications are particularly alarming. Postmenopausal women with diabetes are three times more likely to experience coronary heart disease or stroke compared to women without type 2 diabetes. The decline in oestrogen removes its protective effects on the heart, compounding issues caused by blood sugar problems.

Belly fat and blood sugar challenges

One of the most noticeable changes during menopause is where fat tends to accumulate. Instead of storing fat in the hips and thighs, the body begins to favour the midsection - a shift that poses more than just aesthetic concerns.

Visceral fat, which increases from 5%-8% of total body fat before menopause to 15%-20% after menopause, is particularly problematic. This type of fat is not just stored energy - it actively disrupts glucose regulation. On average, women gain 12 pounds within eight years of menopause onset, with much of this weight accumulating around the abdomen.

Abdominal fat is metabolically active, releasing substances that interfere with insulin's ability to regulate blood sugar. For example, visceral fat secretes retinol-binding protein 4, which has been linked to insulin resistance. It also produces inflammatory cytokines, which can worsen insulin resistance and create a vicious cycle of metabolic issues.

These disruptions make managing blood sugar even harder. Unlike fat stored in other areas, belly fat releases harmful substances directly into the bloodstream, further reducing insulin sensitivity. Combined with declining oestrogen levels, this creates a challenging environment for glucose regulation.

The good news? Modest weight loss can make a big difference. Losing just 5-10% of body weight can significantly improve insulin sensitivity. For a 150-pound woman, shedding 7.5 to 15 pounds could lead to meaningful health benefits.

According to Stephanie Faubion, MD, medical director of the North American Menopause Society, women should expect these midlife changes and take proactive steps to manage them. With the right approach to diet, exercise, and regular health monitoring, these changes can be managed effectively. Up next, we’ll dive into practical lifestyle strategies to help counter these metabolic challenges.

How to manage blood sugar during menopause

Menopause brings a host of metabolic changes, but with the right strategies, you can keep your blood sugar levels steady and safeguard your health. Here’s how you can adapt to your body’s evolving needs during this phase.

Diet changes and exercise that help

As menopause increases metabolic risks, making thoughtful adjustments to your diet and exercise routine becomes essential. A good starting point is focusing on balanced meals. Using the plate method can simplify this: fill half your plate with non-starchy vegetables, a quarter with protein, and the remaining quarter with complex carbohydrates like whole grains or legumes.

Timing your meals is just as important. Space them about four hours apart and try to avoid late-night snacking. This gives your body enough time to process glucose and aligns with your natural circadian rhythms. Additionally, swapping refined carbs and added sugars for complex carbs can make a big difference.

Staying hydrated is another simple yet effective habit. Drinking water throughout the day helps your kidneys flush out excess glucose and supports overall metabolism.

Exercise plays a crucial role too. It not only burns glucose but also improves insulin sensitivity. Even a 30-minute daily walk can make a noticeable impact. Research backs this up: in a study involving 25 naturally menopausal women, both treadmill workouts and resistance training improved glucose tolerance and insulin response. Interestingly, the treadmill group showed the most significant improvement.

Managing stress and getting better sleep

Stress and poor sleep can wreak havoc on blood sugar levels, making it vital to address these areas. Elevated cortisol from stress can spike glucose levels, while insufficient sleep has been linked to insulin resistance and a higher risk of diabetes.

Sleep disturbances are common during menopause, affecting 40–69% of women, with 33–51% reporting poorer sleep quality during peri- and post-menopause. Building better sleep habits can make a big difference. Stick to a consistent bedtime routine in a cool, dark room. If night sweats are an issue, moisture-wicking pajamas might help. Reducing screen time before bed and aiming for 7–9 hours of sleep each night are also beneficial.

Evening adjustments can further improve sleep. Avoid alcohol at least three hours before bedtime, switch to decaf tea, and opt for healthier snacks like nuts or dark chocolate instead of sugary treats.

To manage stress, simple practices like mindfulness meditation or deep breathing exercises can help lower cortisol levels. Connecting with others, whether through support groups or online communities, can also provide emotional relief and encouragement during this transition.

Regular testing and health monitoring

Keeping track of your blood sugar is key, especially since early signs of glucose issues can go unnoticed. Regular glucose checks and metabolic screenings can help you spot changes and make adjustments before problems escalate.

Tests like fasting glucose and HbA1c provide a snapshot of your average blood sugar levels, but more frequent monitoring can reveal how specific foods or activities affect your glucose response. Pairing this with consistent physical activity offers additional insights into how your body reacts to different exercise intensities.

It’s also important to work closely with healthcare providers who understand the unique challenges of menopause. They can tailor screening schedules and offer personalised advice based on your hormonal changes and risk factors.

Curious how menopause impacts your mood? Learn more about the connection between menopause and mood swings.

Using Continuous Glucose Monitors during menopause

Expanding on traditional testing methods, continuous glucose monitors (CGMs) offer a more detailed view of your daily glucose patterns. Unlike fasting glucose or HbA1c tests, which provide only brief snapshots, CGMs track your glucose levels continuously, day and night, offering real-time insights into how your body handles blood sugar fluctuations. This kind of detailed monitoring can help you fine-tune your lifestyle choices.

Why real-time glucose tracking matters

CGMs don't just show your glucose levels, they reveal how quickly and drastically those levels change. This allows you to pinpoint specific triggers, like certain meals or stressful moments, that cause spikes. They also help you understand how your body uniquely reacts to foods and activities. Keeping glucose levels stable can improve insulin sensitivity and may even ease common menopause-related issues, such as weight gain and hot flashes.

Vively's CGM Program for Menopausal Women

With this information at your fingertips, you can adjust your diet and exercise routines to better align with your body’s needs. Vively’s program brings together CGM technology, nutrition coaching, and personalised insights specifically tailored for non-diabetic women navigating menopause-related metabolic changes. The program is supported by Australian Practising Dietitians who specialise in this life stage, helping you analyse glucose trends, connect data from other health apps, and receive actionable advice.

Data from Vively app users suggests encouraging results those working closely with healthcare professionals reported improvement rates of up to 55.83%. Most users were women aged 31 to 60, with the majority finding the dietitians’ advice both personalised and supportive.

The program emphasises practical strategies, such as tracking glucose over a cycle or four-week period, testing how different carbohydrate foods affect you when eaten alone or with other foods, and monitoring stress, sleep, and exercise patterns.

For women in menopause, these insights can shape decisions about resistance training, lower-carb diets, and the timing of meals and workouts to better manage glucose levels. The real-time feedback makes it easier to see how small changes impact your metabolism, helping you stick with healthier habits in the long run.

Conclusion: managing your blood sugar during menopause

Menopause brings major changes to how your body handles blood sugar, but understanding these shifts can help you stay in control. While the risks tied to menopause and blood sugar are real, they don't have to dictate your health journey.

A balanced approach is key. Focus on eating fibre-packed foods, healthy fats, and lean proteins while cutting back on refined carbs. Aim for 150 minutes of moderate exercise each week and include strength training twice weekly.

Sleep also plays a critical role, especially since 33–51% of women report poorer sleep quality during peri- and post-menopause. Strive for 7–9 hours of quality sleep, and use mindfulness or deep breathing to manage stress - both can positively influence blood sugar levels.

Regular blood sugar monitoring is another powerful tool. Whether using traditional methods or continuous glucose monitoring (CGM), tracking your levels provides the insights you need to make informed decisions. CGMs, in particular, offer real-time feedback on how food, activity, and stress affect your glucose levels, helping you tailor your lifestyle choices effectively.

It’s important to note that postmenopausal women with type 2 diabetes face three times the risk of coronary heart disease or stroke compared to those without diabetes. Managing your glucose during menopause isn’t just about feeling good now, it’s about protecting your heart and reducing the risk of long-term complications.

Partnering with your healthcare team ensures you’re supported with the right tools and strategies. Combining lifestyle changes, consistent monitoring, and professional guidance creates a well-rounded plan to tackle the unique challenges of menopause and maintain your overall metabolic health during this phase of life.

FAQs

What are the early signs that menopause might be affecting my blood sugar levels?

During menopause, hormonal shifts can affect how your body manages blood sugar. Some early signs to keep an eye on include:

• Intense hunger or cravings for carbs
• Feeling unusually fatigued after eating
• Trouble keeping blood sugar levels steady

These changes are often linked to a drop in oestrogen, which can lower insulin sensitivity and raise the likelihood of insulin resistance. Keeping track of your fasting blood sugar and staying alert to these symptoms can help catch potential issues early. 

If you’re experiencing these signs, it’s a good idea to consult your healthcare provider. Tools like continuous glucose monitors can also provide valuable insights into managing your blood sugar effectively.

What lifestyle changes can help manage insulin resistance during menopause?

Managing insulin resistance during menopause requires a few thoughtful lifestyle adjustments to support your metabolic health. Engaging in regular physical activity is a great place to start. Combining aerobic exercises like brisk walking or cycling with resistance training, such as weightlifting, can enhance your body’s ability to use insulin effectively.

Your diet also plays a big role. Aim to include plenty of fibre-rich foods, like whole grains, vegetables, and legumes, along with healthy fats from sources such as avocados, nuts, and olive oil. Cutting back on processed foods and added sugars can help keep your blood sugar levels more stable.

Other important steps include maintaining a healthy weight, steering clear of smoking, and finding ways to manage stress. Practices like mindfulness or yoga can be especially helpful in reducing stress, which is key to managing insulin resistance during menopause.

What dietary changes can help manage blood sugar fluctuations during menopause?

To keep blood sugar levels steady during menopause, focus on incorporating complex carbohydrates with a low glycaemic index into your meals. Think whole grains, legumes, and non-starchy vegetables these options release glucose gradually, helping to maintain more stable levels.

At the same time, cutting back on refined carbohydrates and sugary foods like white bread, pastries, and soda can make a big difference. These foods tend to cause quick spikes in blood sugar, which can be harder to manage. Instead, aim for meals that combine fiber-rich foods, lean proteins, and healthy fats - a combination that supports better glucose management.

Another helpful approach? Eating smaller, balanced meals more frequently throughout the day. This strategy can keep your blood sugar on an even keel while making it easier to handle the hormonal shifts that come with menopause.

What are the early signs that menopause might be affecting my blood sugar levels?

During menopause, hormonal shifts can affect how your body manages blood sugar. Some early signs to keep an eye on include:

•  Intense hunger or cravings for carbs
• Feeling unusually fatigued after eating
• Trouble keeping blood sugar levels steady

These changes are often linked to a drop in oestrogen, which can lower insulin sensitivity and raise the likelihood of insulin resistance. Keeping track of your fasting blood sugar and staying alert to these symptoms can help catch potential issues early.

If you’re experiencing these signs, it’s a good idea to consult your healthcare provider. Tools like continuous glucose monitors can also provide valuable insights into managing your blood sugar effectively.