Insulin resistance and perimenopause


In this article we cover everything you need to know about insulin resistance in perimenopause and menopause.

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What is insulin resistance?

Insulin is a hormone made in the pancreas that stimulates the cells in the body to take up glucose. When the cells no longer respond to insulin, we have what is known as insulin resistance (chronically elevated levels of insulin).

Insulin resistance signifies dysfunction of the cell’s metabolic processes that are supposed to turn food into energy. This metabolic dysfunction can result in less energy, more inflammation and an increased tendency to gain fat, especially around the waist. It can also cause high cholesterol, high triglycerides and fatty liver (fat accumulation in the liver).

Why does insulin resistance risk increase in perimenopause?

Firstly, our changing hormone levels can play a role. For example, estrogen improves insulin sensitivity and during perimenopause our estrogen levels are initially wildly fluctuating and then start to drop. 

Secondly, we see changes in the stability of the HPA axis begin to occur, which can lead to a decreased ability to handle stress. This is in part because of the drop in progesterone and progesterone stabilise the HPA axis. The HPA axis plays a role in blood glucose management and HPA axis dysregulaton can lead to poorer blood glucose management. 

Thirdly, sleep disturbances during this time can also increase the risk for or worsen insulin resistance. We may have sleep problems during perimenopause and menopause because of the decreased ability to handle stress, symptoms such as hot flushes and low progesterone.

Check your perimenopause symptoms now

Do I have insulin resistance?

Signs and symptoms of insulin resistance

  • Weight gain
  • History of (or current) PCOS
  • Sugar cravings
  • High triglycerides on a blood test 
  • High cholesterol
  • Fatigue
  • Skin tags
  • Fatty liver
  • Signs of testosterone dominance

The main sign is weight gain around the waist. High insulin levels actually block stored fat from being broken down and used for energy. Insulin resistance specifically causes apple-shaped obesity, so the larger your waist circumference, the more likely you are to have insulin resistance. Your waist should be less than half your height.

How to measure your waist to height ratio

This simple measurement compares your waist to height ratio. 

  • Measure the smallest point on your waist (cm)
  • Divide that by your height (cm)
  • = your waist to height ratio
  • A ratio of more than 0.5 is linked to increased risk in developing health problems.

However, you don’t need to be overweight or have physical signs to have insulin resistance!

Can you test for insulin resistance?

You can test fasting insulin, which is extremely helpful, but not commonly done. 

At FUTURE WOMAN, we assess your risk of insulin resistance by looking at your diet, weight and markers for inflammation, androgens and androgen metabolites.

Read more about androgen metabolism.

How does insulin resistance affect perimenopause?

Insulin resistance is really important to consider during perimenopause and menopause, because it can worsen all symptoms.

When we have higher insulin levels, we likely have reduced metabolic flexibility, which is when our cells can’t efficiently switch from using glucose for energy to using fat. Insulin blocks our ability to burn fat and lowering insulin is key to gaining metabolic flexibility and losing weight.

High insulin increases inflammation in the body, which can interfere with the communication of the brain with the rest of the body and block hormone receptors.

Insulin resistance can contribute to heavy periods because it stimulates the growth of the uterine lining and can decrease progesterone (which lightens periods).

It can also contribute to brain fog, hot flushes, and more. 

insulin resistance and perimenopause

Testosterone and insulin resistance

Our testosterone levels naturally begin to decline with age. This is due to the decreased production of testosterone from the ovaries, although the adrenal glands continue to produce some. However, although testosterone lowers over time and with age, it also can have a period of increase during the transition from perimenopause to menopause. 

At the same time, estrogen and progesterone lower, and this can result in a testosterone dominant picture. This can contribute to and increase the risk of insulin resistance and is linked to increased weight gain.

At the same time, if we have high insulin, this can increase testosterone. Insulin can directly cause the theca cells in the follicle of the ovaries to increase the production of testosterone. Too much insulin stimulates the pituitary to make more LH (increased LH pulsatility), which stimulates more androgens. Too much insulin also lowers SHBG, which leads to more free/unbound testosterone.

What can happen then is that relatively high androgens including testosterone increase the risk for insulin resistance and insulin resistance can increase androgens. This can lead to abdominal weight gain and even symptoms such as increased facial hair (hirsutism).

Read more about high testosterone. 

How to avoid insulin resistance in perimenopause

The good news is that reversing insulin resistance and balancing blood sugar can improve nearly all perimenopausal symptoms! 

Lowering insulin and improving insulin sensitivity will improve metabolic function and help you to lose weight, especially abdominal fat.

Here are 5 evidence based strategies to reverse insulin resistance.

1. Balance blood sugar

Because blood sugar spikes are a major cause of insulin resistance, the first step to preventing or addressing insulin resistance is to balance your blood sugar. 

A great way to do this is to prioritise protein at every meal, especially breakfast. If you’re in perimenopause or menopause, you may do well on a no-carb breakfast. For example, eggs and veggies or a protein smoothie. This can promote satiety by balancing your blood sugar for the rest of the day and reducing cravings. 

At FUTURE WOMAN, we suggest that you focus on sources of animal protein at this stage of life because they are incredibly satiating, are nutrient-dense, and are very low carbohydrate compared to plant sources of protein. Meat, fish, shellfish, organ meats, and eggs are all great options. Nuts, seeds, buckwheat, quinoa, and fermented soy products such as tempeh and natto (unless you have histamine issues) are the best plant sources.

2. Support circadian rhythm

Poor or disrupted sleep can have a big impact on how we handle our glucose the next day. Our circadian rhythm (body clock) has a profound effect on glucose metabolism and insulin sensitivity. We know that your sleep may be disrupted during this time but there is lots we can do to help get a better night sleep, such as avoiding alcohol and not eating too close to bedtime. And if your sleep is disrupted because of symptoms such as hot flushes, balancing blood sugar and lowering insulin can improve these symptoms!

3. Try resistance training and weights

In the later stages of perimenopause, losing estrogen can lead to losing muscle mass (sarcopenia), which is a risk factor for insulin resistance. Regular exercise in menopause is therefore one of the best ways to increase insulin sensitivity because it builds muscle AND helps move sugar from the blood into the muscles and promotes an immediate increase in insulin sensitivity. 

What type of exercise? 

Resistance training and weight training are the best forms of exercise for bone health and insulin resistance. We also recommend low-intensity exercise which includes walking, cycling, swimming, pilates, and yoga.

4. Eat three meals a day, without snacking in between

Studies have shown the benefits of eating three meals a day in order to balance blood sugar, support a healthy weight, and balance mood and energy in comparison to eating smaller meals 4-6 times a day. Reduced meal frequency and regular fasting periods may reduce inflammation, improve circadian rhythm, increase autophagy and stress resistance, and modulate the gut microbiota.

What is a proper meal? All our meals should contain the following for satiety and sustained energy throughout the day: protein, adequate fat, complex carbohydrates (most of your carbs should come from non-starchy vegetables), and fibre.

5. Eat within a 10-hour window

For example, eating breakfast at 9am and dinner at 7pm is a 10-hour window. This can also be referred to as gentle intermittent fasting (IF). IF is defined as alternating between a period of fasting and a period of eating. 

Why? Studies have shown the benefits of both balancing blood sugar and intermittent fasting on reversing and improving insulin resistance in those with perimenopause. Intermittent fasting can improve metabolic flexibility, which means we can easily switch between burning fat and burning glucose for energy.

Key takeaways

    • The main sign of insulin resistance is weight gain around the waist, but there are other signs and symptoms like sugar cravings, skin tags and fatigue.
    • Insulin resistance can worsen any symptom of perimenopause and menopause. 
    • There is a connection between insulin resistance and high androgens: relatively high androgens (including testosterone) increase the risk for insulin resistance and in turn insulin resistance can increase androgens. 
    • Reversing insulin resistance and balancing blood sugar can improve nearly all perimenopausal symptoms. 
    • Balancing blood sugar, supporting circadian rhythm, resistance training, reducing snacking and eating within a 10 hour window can all be beneficial in reducing insulin resistance. 

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