Effects of menopause on blood sugar

In this article, I focus on a very important issue for women during and after menopause: blood sugar. Blood sugar, or blood glucose level, is the concentration of glucose found in the blood. Glucose is a very simple carbohydrate, which comes from breads, grains, fruits, dairy products, and some vegetables. While glucose is an important fuel for the body, if its concentration gets too high, it can be very problematic — leading to complications such as diabetes.

Age and other risk factors may contribute, but there’s evidence that the hormonal shifts of menopause may play a major role. In our clinic, we see blood sugar issues emerge or become more severe during and after menopause.

The hormone shifts behind it

So what are these hormonal shifts? Many of the challenges of menopause are due to a decrease in estrogen. Before menopause, the ovaries produce most of the body’s estrogen; afterward, they stop, and estrogen comes mostly from body fat. The primary form of estrogen before menopause is estradiol. Progesterone falls as well.

Estrogen, progesterone & insulin

Estrogen and progesterone affect the way insulin works in the body. Insulin is a hormone made in the pancreas that helps your body use glucose for energy and store the rest.

Estrogen helps optimize insulin. Premenopausal women typically have greater insulin sensitivity — and a lower incidence of type 2 diabetes — than age-matched men. After menopause, that advantage disappears, due in part to the reduction of estrogen.³ Lower estrogen can lead to insulin resistance, where the body doesn’t respond to insulin well and blood sugar rises. Progesterone’s relationship with insulin is more complex, but the drop in progesterone after menopause also affects insulin sensitivity and blood sugar.⁴

Weight gain, sleep & the post-meal slump

Weight gain and insulin

Menopausal hormone shifts change where women gain weight. Premenopausal women often gain subcutaneous fat around the thighs and buttocks; during and after menopause, weight tends to settle around the abdomen as visceral fat. This fat secretes retinol-binding protein 4, which is connected with insulin resistance, and high amounts of visceral fat can lead to type 2 diabetes.⁵ If you already have diabetes, you may notice blood sugar rising and falling more dramatically than before — so if you have diabetes or prediabetes, it’s extremely important to watch your levels through this transition.⁶

Blood sugar and sleep

Sleep issues are common in menopause thanks to hot flashes and night sweats — and sleep deprivation disrupts blood sugar handling. Poor sleep raises cortisol, a stress hormone that supplies glucose by breaking down protein stores in the liver (gluconeogenesis). That’s fine short-term, but chronically high cortisol keeps producing glucose and raising blood sugar,⁷ and drives abdominal weight gain.

It works both ways. High blood sugar (hyperglycemia) makes the kidneys flush sugar through urine — frequent nighttime bathroom trips — and pulling fluid from tissues leaves you dehydrated and thirsty, interrupting sleep further. Low blood sugar (fasting hypoglycemia) can also wake you suddenly with a surge of cortisol. Many people oscillate between the two, so getting blood sugar under control with a skilled practitioner is key to breaking the cycle.

The post-meal slump

Eating should not change your energy level. Feeling noticeably more energetic — or more fatigued and sleepy — after meals is a sign of blood sugar dysregulation, and a signal that some lifestyle changes are needed.

The blood sugar–Alzheimer’s link

Alzheimer’s has been referred to as “type 3 diabetes,” because blood sugar appears to play a role in its neurological impairment. In one study comparing patients with and without Alzheimer disease, type 2 diabetes was far more prevalent in the Alzheimer group — in fact, 81% of the 100 Alzheimer patients had either type 2 diabetes or impaired fasting glucose (IFG).⁸ People with IFG have blood sugar above normal but below the diabetes threshold, and are at significant risk of developing diabetes without lifestyle changes.

Insulin resistance plays a big role in Alzheimer’s development. Insulin is crucial in the brain too: it regulates cognition and memory, supports the growth of neurons and synaptic plasticity, prevents cell death, and aids neurotransmission. When the body can’t use insulin effectively, the brain suffers.⁹ Alzheimer’s is multifactorial, but insulin resistance is a tremendously large risk factor. Because menopause makes blood sugar harder to manage, an unaddressed shift can raise the risk of blood sugar issues — and, in turn, the risk of developing Alzheimer disease.¹⁰

How to manage blood sugar during and after menopause

Now that you know the complications, what do you do about it? These are the levers that make the biggest difference — ideally combined and personalized to you.

Controlling blood sugar is so important for health and wellness throughout our lives. I would love to work with you to build a plan catered specifically to your needs during this important transition.