Metformin During Menopause: Can It Help You Live Longer?

Odds are you’ve heard of metformin as a way to treat Type 2 diabetes, but if you’ve never considered metformin for menopause, you may want to. This prescription medication has a long and well-researched history of not only managing insulin resistance and age-related weight gain, but reducing inflammation, improving symptoms of menopause (such as fatigue), and even promoting longevity. 

Those are no small benefits, which is why some experts have called it a “wonder drug.” But is it? And could it be right for you? Read on to learn more about metformin for menopause, including where the science stands and all the pros and possible cons you should consider.

Understanding Menopause and Blood Sugar

During perimenopause and menopause, estrogen and progesterone fluctuate and decline until they both bottom out and mark the end of your reproductive years. While you may associate this hormonal downshift with hot flashes, night sweats, and maybe even some mood changes, estrogen also plays a key role in how our bodies regulate insulin. So when these hormones tank, it can raise your risk of cardiovascular disease and insulin resistance.

“We’ve known for decades that the depletion of estrogen and progesterone during midlife is strongly associated with worsening insulin sensitivity and rising blood sugars,” says Kathleen Jordan, MD, Chief Medical Officer at Midi. “And now we know that elevated blood sugars are associated with poor cellular repair, increased inflammation and more cardiovascular disease—which is the number one killer of women. It's time to take a look at optimizing blood sugar management in menopause, and metformin can be a very powerful tool.”

A study in The American Journal of Pathology found that when muscle, liver, and fat tissues don’t respond as well to insulin, it can lead to an increased risk for type 2 diabetes, abdominal fat (also known as visceral fat, which is a big risk factor for heart disease and other chronic conditions), high blood pressure, and high cholesterol. It also, of course, can up the odds of cardiovascular disease.

What Is Metformin?

Metformin has been prescribed for the treatment of diabetes in Europe since the 1950s, and then later in the U.S. since 1995. It is the most widely prescribed medication for people living with diabetes, for whom diet and exercise has not been able to keep blood sugar under control.

”Research shows that if you take metformin, you have a third less chance of progressing to full type 2 diabetes,” says Dr. Jordan. 

Potential Benefits of Metformin During Menopause

As is common with many medications, researchers have discovered additional benefits of metformin. It has been prescribed off-label during menopause to: 

• Treat polycystic ovary syndrome (PCOS)
• Manage obesity and facilitate mild weight loss
• Reduce risk factors for stroke, cardiovascular disease, and certain cancers—including breast, colon, and pancreatic cancers
• Stave off cognitive decline 
• Slow aging

Research on Metformin's Longevity Benefits for Women

The anti-aging properties of metformin have to do with its ability to reduce inflammation, improve insulin sensitivity, and prevent DNA damage. 

How can metformin safeguard your cellular function? Well, at the ends of each strand of DNA in your body, you have telomeres. They’re often equated to caps on the end of shoelaces. Over time, your telomeres can break down and make your DNA vulnerable to disease. Metformin has been shown to protect telomeres (along with the other benefits), reduce cellular death, and ultimately have an anti-aging effect.

A study in Nature, for example, assessed the gene expression of 79 tissues and organs and found that metformin impacted age-related pathways and improved DNA repair related to longer lifespan.

Pros and Cons of Metformin During Menopause

Here are some of the pluses and minuses to keep in mind when considering metformin.

Pros:

• Improved insulin levels and metabolic health, which can reduce the risk of diabetes and improve current cases of type 2 diabetes 
• Improved heart health
• Reduced risk of certain cancers
• Potential for longer lifespan
• Inexpensive (metformin is generic)

Cons:

• Potential side effects, including nausea, gas, and diarrhea (though for most it’s well tolerated)
• May have contraindications (make sure your clinician knows other medications and supplements you take) 
• Metformin can cause blood glucose levels to drop too low, so monitoring is key. 

Who Should Consider Metformin During Menopause?

If you are living with diabetes, experiencing insulin resistance or prediabetes, then metformin might be a good option for you. Having a family history of diabetes may also make you a good candidate for this medication. And if you’ve been experiencing metabolic shifts, including weight gain, metformin could be something to consider. 

Bring it up with your healthcare provider, or a Midi clinician, who’s knowledgeable about the benefits during menopause and can help you determine if it’s right for you.

Dr. Jordan advises having your blood glucose levels checked regularly if you do begin taking metformin. It’s also possible that high amounts of this medication could decrease B12 intake, so you’ll want to track that too. 

Alternatives and Complementary Approaches to Metformin

HRT vs. Metformin

In addition to metformin, you may want to consider hormone replacement therapy (HRT).

Research suggests that when hormone replacement therapy (HRT) is individualized to your needs, age, and family history, it’s the most effective treatment for the hot flashes and night sweats, as well as genitourinary symptoms (e.g. increased need to pee). These issues can mess with your sleep, promoting weight gain and potentially insulin resistance. 

Research does suggest HRT holds a lot of promise for promoting a healthier body composition. It’s been associated with a decrease in total fat mass and dangerous abdominal fat, and women who receive HRT often have improvements in insulin resistance and blood lipid levels such as cholesterol. 

Lifestyle Changes

There are other lifestyle changes that could improve your insulin levels and other symptoms related to hormonal changes during menopause—whether in conjunction with metformin or on their own.

• Eating a healthy diet rich in fruits, vegetables, healthy fats like olive oil, nuts and avocado, and lean proteins (read: Mediterranean, DASH, and similar diet plans) has been shown to promote longevity.  
• Regular exercise is important. Studies show physical activity reduces inflammation, stimulates levels of human growth hormone, and aids DNA repair that promotes longevity.
• Sleep is another key lifestyle issue. Research has found that getting an adequate night’s rest (meaning seven hours of both the quality and quantity of sleep) can add two years to a woman’s life.
• Supplements, including NAD, along with vitamins and nutrients, such as vitamin D, vitamin K, magnesium, and omega-3s, could help with menopause symptoms and healthy aging.

Key Takeaways

• Metformin can help during menopause to improve insulin levels and metabolic health, which can reduce the risk of diabetes and improve current cases of type 2 diabetes.
• Metformin is used off-label to address menopause-related weight gain, as well as age-related conditions such as heart disease, breast cancer, and cognitive decline.
• Metformin has a long track record of safety and efficacy, and minimal side effects.

Frequently Asked Questions (FAQs)

Can you take metformin for menopause?

Yes, you can take metformin for menopause. Even though it was originally approved to treat type 2 diabetes, metformin has been shown to help with insulin resistance, which can become an issue during menopause due to hormonal shifts. It may support weight control, reduce cognitive decline, and slow aging, along with other health advantages. 

Can menopause make your blood sugar high?

Yes, menopause can make your blood sugar levels trend higher. When estrogen and progesterone decline during midlife, it can cause your blood sugar levels to rise, increasing your risk of weight gain and type 2 diabetes.

What is the best treatment for menopause?

The best treatment for menopause depends on the symptoms you’re dealing with. Metformin and hormone replacement therapy (HRT) are options, as are various supplements and herbal treatments and lifestyle tweaks, such as improved sleep, exercise, and eating a healthy diet. It comes down to having a meaningful conversation with your healthcare provider to work up a plan that will best address your needs. 

Does metformin help balance hormones?

The idea of balancing hormones is a myth. Think of it as a medical unicorn. But you can control certain levels, such as insulin, with metformin.