Menopause and Diabetes: How Menopause Affects Blood Sugar

Menopause marks the end of reproductive years when your ovaries gradually reduce their production of estrogen and progesterone. While some women might celebrate the end of periods (goodbye, monthly visitors!), these hormonal changes can trigger a domino effect on your metabolism, including how well your body processes sugar.

Understanding The Menopause-Diabetes Connection

Estrogen plays a key role in insulin sensitivity—that's your body's ability to respond to insulin and process glucose efficiently. As estrogen levels decline during menopause, insulin resistance often increases, making your cells less responsive to insulin's efforts to escort glucose from your bloodstream into your cells. "Many women don’t realize that there are estrogen receptors in the digestive system, including the liver and gut,” explains Kathleen Jordan, MD, Chief Medical Officer at Midi Health. “When estrogen levels decline during menopause, it can disrupt lipid metabolism and alter the body’s response to insulin—contributing to insulin resistance.”

Why Your Risk of Diabetes Increases During Menopause

Menopause isn't just about hot flashes and mood swings—this time can also be a significant risk factor for developing type 2 diabetes, especially if you're already carrying extra weight or have a family history of the disease. Early menopause also appears to be a risk factor. In one study, women who started menopause before 40 had a 32% higher risk of developing type 2 diabetes than women who went through menopause between 50 and 54.

4 Factors That Increase Your Risk of Type 2 Diabetes During Menopause

• An Incredible Expanding Waistline: Many women experience changes in body composition during menopause, with fat redistributing to the abdominal area, also known as “meno belly.” This isn't just any fat—it's metabolically active, visceral fat that produces inflammatory compounds that promote insulin resistance.
• Hormone Havoc: As estrogen and progesterone levels fluctuate and decline, insulin resistance can increase. As a result, your pancreas works overtime producing more insulin to overcome this resistance, eventually leading to elevated blood sugar levels. "Most people don't understand that menopause challenges and changes our sugar metabolism," says Dr. Jordan. "It's not new or controversial—we have known for decades that menopause increases the development of diabetes and prediabetes.” About 40% of women in the US are diagnosed with prediabetes during menopause—and 8 in 10 of them don't even know it. Some don't get screened, or worse, their clinician advises them that their labs are “normal” because it's not full diabetes, when in fact the prediabetes result brings with it its own risks and should be addressed, says Dr. Jordan. Not to mention that one-third of the time, this will turn into full diabetes if not addressed. Our mantra at Midi is to screen and intervene in order to optimize health and sustained wellness.
• The Metabolism Slowdown: As you age, your metabolism naturally slows down, making it easier to gain weight and harder to lose it. This slowdown is often due to a combination of decreased muscle mass and reduced physical activity. As body fat—especially around the abdomen—increases, your body's cells can become less responsive to insulin. 
• Sleep Disruptions: Night sweats and insomnia are common during menopause, and poor sleep has been linked to insulin resistance and increased diabetes risk. 

The Two-Way Street: Diabetes Can Affect Menopause Too

While menopause can increase your type 2 diabetes risk, the relationship goes both ways. Women with type 1 or type 2 diabetes often experience menopause differently:

• It may start earlier: Research suggests that type 2 diabetes diagnosed between ages 30-39 is associated with earlier menopause, while diagnosis at 50+ correlates with later menopause.
• It can intensify symptoms: Hot flashes can be more frequent or severe and contribute to increased fatigue, mood changes, and sleep disturbances. It's like adding fuel to an already blazing hormonal fire.

Symptom Confusion: Is It Menopause or Diabetes?

Many symptoms of menopause and diabetes overlap, creating a confusing constellation of complaints that might have you wondering whether to blame your hormones or your blood sugar.

Common overlapping symptoms include:

• Fatigue and low energy
• Mood changes and irritability
• Sleep disturbances
• Bladder and vaginal infections
• Sexual dysfunction

The best way to get the bottom of what you’re feeling is to connect with a healthcare professional, like a Midi clinician, who can screen you for diabetes (more on that below) and get you on the right care plan, where that’s to manage your type 2 diabetes or address your menopause symptoms.

The hypoglycemia-hot flash conundrum

Hot flashes can sometimes be confused with hypoglycemia (low blood sugar) symptoms, as both can cause sweating, heart palpitations, and dizziness. If you're experiencing these symptoms, checking your blood sugar can help determine which culprit is responsible.

Perimenopause and Type 2 Diabetes: Blood Sugar's Wild Rollercoaster

Before menopause officially arrives, you'll likely spend several years in perimenopause—a transitional stage marked by unpredictable estrogen fluctuations that can cause blood sugar levels to swing up and down.

Early signs of insulin resistance during perimenopause include:

• Increased hunger and carb cravings
• Fatigue after meals
• Difficulty concentrating
• Weight gain despite maintaining the same diet and exercise habits

Catching these early warning signs can help you take proactive steps to prevent or delay diabetes development. Consider it your body's not-so-subtle hint that something's brewing beneath the surface.

Heart Health: The Triple Threat of Menopause, Type 2 Diabetes, and Cardiovascular Disease

Postmenopausal women with diabetes face a triple threat when it comes to heart health. Estrogen has protective effects on the cardiovascular system, so when levels decline during menopause, heart disease risk increases. Add type 2 diabetes to the mix, and the risk climbs even higher. A 2021 study found that postmenopausal women with type 2 diabetes are three times more likely to experience coronary heart disease or stroke than women without type 2 diabetes.

Postmenopausal women with diabetes are at significantly higher risk for:

• Stroke
• High blood pressure
• High cholesterol

This isn't meant to scare you—it's a call to action. Understanding these risks empowers you to take proactive steps to protect your heart health during and after menopause.

Managing Blood Sugar During Menopause: Your Action Plan

Now for the good news: You're not powerless against the menopause-diabetes connection. With the right strategies, you can maintain healthy blood sugar levels even as estrogen begins its descent.

Dietary Strategies with Menopausal Metabolism in Mind

Your dietary needs can change during menopause, and you may find you need to take a more thoughtful approach to eating for blood sugar control:

• Focus on fiber-rich foods that slow sugar absorption, including whole grains, legumes, fruits, and vegetables. Think of fiber as your blood sugar's best friend—it helps glucose enter your bloodstream gradually rather than all at once.
• Embrace healthy fats from sources like avocados, nuts, seeds, and olive oil. These fats help stabilize blood sugar and keep you feeling satisfied longer. Plus, they're good for your heart—a win-win for menopausal women.
• Prioritize lean protein at each meal to help maintain muscle mass and stabilize blood sugar. Options include poultry, fish, tofu, legumes, and plain Greek yogurt. Protein helps prevent the post-meal blood sugar roller coaster that can leave you craving sweets soon after eating.
• Minimize refined carbohydrates and added sugars that can cause rapid blood sugar spikes. This doesn't mean you can never enjoy dessert again—just lean into moderation.

Movement Matters: Exercise for Insulin Sensitivity

Exercise is one of the most powerful tools for improving insulin sensitivity and managing blood sugar during menopause. "Exercise becomes so important in midlife," emphasizes Dr. Jordan. "It can help counteract the bone and muscle loss that comes with both aging and menopause, as well as insulin sensitivity, sleep, stress management, and overall mood and well-being."

Aim for at least 150 minutes of moderate activity weekly, but remember that any movement is better than none. Even a 10-minute walk after dinner can help lower blood sugar levels.

Incorporate strength training at least twice weekly to maintain muscle mass, which naturally declines during menopause. More muscle means better glucose metabolism. Think of your muscles as glucose sponges—the more muscle you have, the more glucose gets absorbed from your bloodstream, which means less work for insulin.

Consider gentler forms of exercise like yoga, tai chi, or swimming if joint pain or hot flashes make high-intensity workouts challenging. These activities still improve insulin sensitivity while being kinder to your changing body.

Stress Management: Your Blood Sugar's Best Friend

Stress hormones like cortisol can raise blood sugar levels, making stress management essential during menopause:

• Practice mindfulness meditation or deep breathing exercises to activate your body's relaxation response. Even five minutes daily can make a difference in both stress levels and blood sugar control.
• Prioritize sleep hygiene by maintaining a consistent sleep schedule and creating a cool, dark bedroom environment. Consider moisture-wicking pajamas if night sweats disrupt your sleep. Remember: good sleep is non-negotiable for blood sugar management.
• Connect with others experiencing similar challenges through support groups or online communities. Sometimes knowing you're not alone in your menopause-diabetes journey can help dial down how overwhelming it may feel.

Medical Management: When Lifestyle Changes Aren't Enough

For many women, lifestyle modifications alone may not be sufficient to manage blood sugar during menopause. Don't hesitate to explore medical options with a healthcare professional, like a Midi clinician. 

Monitoring and Medication Adjustments

If you’re living with diabetes, perimenopause and menopause can significantly impact blood sugar control due to fluctuating hormone levels. These shifts may require adjustments to your medications and a more proactive approach to monitoring.

Frequent blood sugar checks—or even better, using a continuous glucose monitor (CGM)—can help you track how hormonal changes affect your glucose levels throughout the day and night. CGMs provide real-time insights, which can be especially useful during the unpredictable ups and downs of perimenopause.

It's important to work closely with your healthcare team to fine-tune your treatment plan, whether that involves changing insulin doses, adjusting oral medications, or managing other health factors like weight and stress. Don't try to navigate these changes alone—your providers are essential partners in keeping your diabetes well-managed during this transition.

Hormone Therapy Considerations

Hormone replacement therapy (HRT) is not approved for treating diabetes, but there have been large studies that suggest that HRT can play a role in delaying the onset of type 2 diabetes. Other studies have shown that HRT actually increases insulin sensitivity—that’s a good thing—but more research is needed before HRT becomes any sort of diabetes prevention or treatment. As always, the decision about HRT should be individualized, weighing personal health risks, family history, menopause symptoms, and diabetes status. This isn't a one-size-fits-all decision—what works for your friend might not be right for you.

Emerging Treatments: GLP-1s for Diabetes Management During Menopause

“GLP-1s (Ozempic, Wegovy, Zepbound) have been a game changer in this area,” notes Dr. Jordan. Originally developed to treat type 2 diabetes, GLP-1 receptor agonists are now gaining recognition for their broader benefits—including in people with prediabetes, obesity, or those at risk during menopause-related metabolic shifts. 

These medications don’t just treat diabetes, they can help change the trajectory of metabolic health. For women in or approaching menopause, they may represent a powerful option for prevention and risk reduction, not just treatment.

Research has shown that GLP-1s can:

• Delay or even prevent the progression from prediabetes to full-blown type 2 diabetes.
• Support sustained weight loss, which directly improves insulin sensitivity.
• Lower A1C levels and help stabilize blood sugar, even in individuals with fluctuating hormone levels during perimenopause and menopause.
• Reduce the risk of cardiovascular complications, such as heart attack and stroke—both of which are more common in women after menopause.

Additionally, newer GLP-1/GIP dual agonists like tirzepatide (Zepbound) are showing great promise in both weight management and glucose control, offering another tool for those navigating midlife metabolic changes.

Of course, GLP-1s aren't for everyone, and they can come with side effects. It's essential to discuss with a healthcare provider, like a Midi clinician, whether they’re appropriate for your individual health profile and goals.

When to Seek Medical Advice

At Midi, we recommend regular A1C screenings for all our patients, because the earlier you understand your glucose control, the earlier you can act if things are trending in the wrong direction. 

A1C, also known as hemoglobin A1C or glycated hemoglobin, gives a long-range view of your blood sugar control, showing the average blood sugar (glucose) levels over two to three months. 

When sugar (glucose) circulates in your blood, it attaches to a protein in red blood cells called hemoglobin. The more glucose in your blood, the more “glycated” hemoglobin you’ll have—and that’s what the A1C test measures. 

Generally, an A1C level of less than 5.6% is considered normal. Levels between 5.7% and 6.4% indicate prediabetes, and 6.5% or higher indicates diabetes. For people with diabetes, keeping A1C below 7% is typically recommended to help manage the condition and reduce long-term health risks.

It’s important to monitor A1C levels regularly (at least annually, if within normal range) as your number will be used to diagnose diabetes or prediabetes, guide treatment management, and predict risk of complications related to diabetes, such as heart disease, kidney disease and eye problems.

Key Takeaways

• Menopause and diabetes are interconnected through hormonal changes that affect insulin sensitivity and glucose metabolism.
• Early screening and monitoring can help identify blood sugar changes during perimenopause and menopause.
• A comprehensive approach including diet, exercise, stress management, and appropriate medical care optimizes both menopause and diabetes management.
• Working with healthcare providers who understand the menopause-diabetes connection ensures personalized care tailored to your unique needs.

Frequently Asked Questions (FAQs)

How does menopause affect diabetes?

Menopause affects diabetes primarily through declining estrogen levels, which may increase insulin resistance and make blood sugar management more challenging. Hormonal fluctuations during perimenopause and menopause can cause unpredictable blood sugar levels, and metabolic changes like increased abdominal fat can further complicate glucose regulation.

How does an endocrinologist help with menopause?

An endocrinologist can help monitor how hormonal changes during menopause affect blood sugar levels and adjust diabetes treatment plans accordingly. They can recommend appropriate testing, medication adjustments, and lifestyle modifications to optimize blood sugar control during this transitional period. For women with both diabetes and menopause symptoms, coordination between an endocrinologist and gynecologist provides comprehensive care.

Does cutting out sugar help menopause?

Reducing added sugar intake can have a positive impact on many menopause symptoms and reduce diabetes risk by preventing blood sugar spikes, supporting weight management, and potentially reducing hot flashes and mood swings. While cutting out sugar isn't a cure-all (or all that sustainable) for menopause symptoms, it's a helpful strategy for overall health during this life stage, especially for women concerned about diabetes risk.

Can low estrogen cause diabetes?

While low estrogen alone doesn't directly cause diabetes, declining estrogen levels during menopause may play a role in increased insulin resistance, which is a key factor in type 2 diabetes development. Estrogen plays a role in glucose metabolism and insulin sensitivity, so the hormonal changes of menopause can contribute to elevated blood sugar levels and increased diabetes risk in some women.

Can menopause lead to diabetes?

Menopause itself doesn't directly cause diabetes, but the hormonal, metabolic, and lifestyle changes that can occur during menopause can increase the risk of developing type 2 diabetes, especially in women with other risk factors like family history, overweight or obesity, or a history of gestational diabetes. Proactive management of these risk factors during menopause can help prevent or delay diabetes onset.

How can I control my blood sugar during menopause?

To control blood sugar during menopause, focus on a balanced diet rich in fiber, lean protein, and healthy fats while limiting refined carbohydrates and added sugars. Regular physical activity, stress management, and adequate sleep are also crucial. Working with healthcare providers to monitor blood sugar patterns and adjust treatments as needed helps maintain stability during hormonal fluctuations.