Maybe your jeans fit differently around the middle, even though you haven't changed how you eat. Maybe you're hungrier, more tired after meals, or your last lab work came back with a blood sugar that was "a little high." If any of that sounds familiar, you're not imagining it, and you haven't done anything wrong. We hear this from women every day, and insulin resistance is often part of the story.

"Insulin resistance" has become a social media buzzword. Here's what it actually means, why the menopause transition raises your risk, and what you can do about it.

What is insulin resistance?

When you eat, your body breaks food down into glucose (sugar), your main source of fuel. Insulin, a hormone made by your pancreas, works like a key. It lets glucose move out of your bloodstream and into your muscles and other cells, where it's used for energy.

With insulin resistance, your cells stop responding well to that key. Your pancreas makes more and more insulin to keep up, and over time your blood sugar starts to creep up. Left unchecked, insulin resistance can lead to prediabetes, type 2 diabetes, high blood pressure and heart disease.

Why does menopause raise the risk?

Estrogen helps your body use insulin well. As estrogen declines in perimenopause and menopause, several things shift at once:

• Fat moves to your middle. As the balance between estrogen and testosterone changes, your body stores more fat around your belly and organs (called visceral fat). That kind of fat makes insulin resistance worse.
• You lose muscle. Lean muscle declines during the transition, and muscle is where most of your blood sugar gets used.
• Your liver releases more glucose, while your muscles take up less.
• Your metabolism slows. Lower estrogen is linked to burning less energy, even at rest.

Together, these changes can create a "perfect storm" for insulin resistance, even if your habits haven't changed at all.

How do you know if you have it?

Insulin resistance doesn't always cause symptoms you'd notice. Some clues are weight gain around your waist, energy crashes or strong cravings after meals, and dark, velvety patches of skin on your neck or underarms (called acanthosis nigricans).

Lab work gives us the clearest picture. Your care team may check:

• Hemoglobin A1c, your average blood sugar over about three months. A result of 5.7% to 6.4% is in the prediabetes range.
• Fasting glucose. A result of 100 to 125 mg/dL is in the prediabetes range.
• Fasting insulin, sometimes used to calculate a score called HOMA-IR. These can be helpful, but there's no single agreed-upon cutoff, so we read them alongside your other results.

Your waist measurement, blood pressure and cholesterol help round out the picture.

Can hormone therapy help?

Here's some encouraging news. A 2025 meta-analysis (a study that pools the results of many trials) looked at 17 randomized controlled trials in postmenopausal women without diabetes. Both estrogen alone and estrogen combined with a progestogen significantly reduced insulin resistance. The findings were presented at The Menopause Society's 2024 Annual Meeting.

Large studies have also found fewer new cases of type 2 diabetes in women using hormone therapy. To be clear, The Menopause Society doesn't recommend hormone therapy solely to prevent diabetes. But if you're already considering it for hot flashes, night sweats, bone health, or poor sleep, this is a meaningful added benefit worth knowing about.

What about medication?

For some women, medication makes sense. Metformin, a long-trusted diabetes medication, works mainly by lowering the amount of glucose your liver releases and by helping your body respond better to insulin. The American Diabetes Association lists it as an option for some people with prediabetes, especially those at higher risk. Using it for insulin resistance alone is off-label, meaning outside its official FDA approval. Using medication off-label is still an option in this case, and it's something your menopause specialist can talk through with you.

GLP-1 medications, such as semaglutide and tirzepatide, also lower blood sugar and support weight loss, which in turn improves insulin sensitivity. Whether either option is right for you depends on your labs, your health history, and your goals.

What can you do starting today?

Your hormones shifting is out of your control, but your daily habits make a real difference, with or without medication. Here's what the evidence supports:

• Strength train at least two days a week. This is the big one. Muscle is your body's biggest user of blood sugar.
• Move at least 150 minutes a week at a moderate pace. Brisk walking counts, and breaking up long stretches of sitting helps too.
• Eat Mediterranean-style: vegetables, fruit, beans, whole grains, fish, nuts and olive oil.
• Get at least five servings of fruits and vegetables a day.
• Choose nutrient-dense carbs that are rich in fiber and low in added sugars, sodium, and saturated fat.
• Aim for about 21 to 25 grams of fiber a day. Adding psyllium husk is an easy way to get there.
• Cut back on sugary foods and sweetened drinks.
• Limit alcohol. Less is better for your blood sugar.

The bottom line

Insulin resistance is common in midlife. It isn't your fault, and it's very treatable, especially when it's caught early. If you've noticed changes in your waistline, your energy or your labs, book a virtual visit. Your MyMenopauseRx care team can order the right tests, explain your results, and help you build a plan that fits your life.

This article is for educational purposes only and not meant to provide or replace your medical care.

Sources

1. Greendale GA, Sternfeld B, Huang M, et al. Changes in body composition and weight during the menopause transition. JCI Insight. 2019;4(5):e124865. doi:10.1172/jci.insight.124865
2. Mauvais-Jarvis F, Clegg DJ, Hevener AL. The role of estrogens in control of energy balance and glucose homeostasis. Endocrine Reviews. 2013;34(3):309–338. doi:10.1210/er.2012-1055
3. Li T, Jiang NS, Kaskey J, Schnatz PF, Nudy M. Hormone therapy and insulin resistance in non-diabetic postmenopausal women: a systematic review and meta-analysis. Climacteric. 2025;28(6):673–681. doi:10.1080/13697137.2025.2509844
4. The Menopause Society. New meta-analysis shows that hormone therapy can significantly reduce insulin resistance [press release]. September 2024. menopause.org
5. The 2022 hormone therapy position statement of The North American Menopause Society. Menopause. 2022;29(7):767–794. doi:10.1097/GME.0000000000002028
6. American Diabetes Association Professional Practice Committee. Standards of Care in Diabetes—2026 (Sections 2, 3 and 5). Diabetes Care. 2026;49(Suppl 1). diabetesjournals.org
7. U.S. Department of Health and Human Services. Physical Activity Guidelines for Americans, 2nd edition. 2018. health.gov
8. Institute of Medicine. Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids. National Academies Press; 2005.