If you are a woman dealing with perimenopause, prediabetes is probably not top of mind, what with the hot flashes, mood swings, and erratic menstrual cycles you are enduring. But the menopause transition brings with it many health impacts beyond those pertaining to your cycle, including a higher risk of developing insulin resistance and prediabetes.
Does this news surprise you? You’re probably not alone in that regard.
As most women know, menopause is not a subject that gets much attention at the doctor’s office. My perimenopause journey ended about six years ago, give or take, and I cannot recall any substantive discussion with my health care provider about “the change” and its effect on my overall health, nor any suggestions for mitigating potential impacts like prediabetes.
The topic of menopause has since gained some cultural currency, with a few celebrities opening up about their struggles, publishing books, and creating products to help women deal with this period of transition. But back when I was going through perimenopause it was not really talked about unless a woman was experiencing severe physical symptoms, in which case hormone therapy might be suggested.
I didn’t even know to associate some of what was happening to me with menopause – like insomnia and very alarming levels of brain fog – so I just muddled through without asking questions. As I would learn a few years after my menopause transition was complete, what you don’t know about menopause can hurt you.
How Menopause Increases Prediabetes Risk
When I need information related to women’s health I turn first to Dr. Jen Gunter, a Canadian obstetrician/gynecologist who has written three books about women’s bodies and reproductive health, including The Menopause Manifesto. (I highly recommend this book for women aged 30 and up. It’s never too early to learn what’s in store once you hit your 40s and 50s.)
In writing about menopause, Dr. Gunter sought to arm women with information about this important transition, a subject, she notes in her introduction, that had always been “shrouded in secrecy” and viewed negatively.
While her book came out a little too late for me, I decided to read it anyway to understand what my body had experienced and whether there was anything I needed to be concerned about as I moved into the post-menopausal stage of life.
I learned a lot that I wished I had known a few years earlier, but as far as type 2 diabetes risk, it comes down to some key physical changes: loss of muscle mass, weight gain, and increases in visceral fat. From further research, I learned that hormonal fluctuations can also affect how our bodies respond to insulin.
As we age, everyone experiences a drop in muscle mass, but this loss accelerates for women in perimenopause. (It returns to normal after.) Because muscles use a lot of energy, the reduction in muscle mass can slow the body’s metabolism. A slower metabolism can mean weight gain if calorie consumption is not adjusted.
Loss of muscle mass is also associated with insulin resistance, which occurs when the body loses the ability to use the insulin it produces. Sugar then builds up in the blood instead of being transferred to cells and used for energy. According to Dr. Gunter, the body may produce more insulin to compensate for the body’s resistance, increasing hunger and, possibly, weight gain. This combination of weight gain and insulin resistance, she notes, “is one of the reasons menopause increases a woman’s risk of developing type 2 diabetes.”
During and after the menopause transition, women also become more prone to gaining visceral fat. Unlike subcutaneous fat, which sits beneath the skin, visceral fat surrounds the organs. Dr. Gunter notes that this type of fat is “metabolically active in harmful ways” and associated with many serious diseases and conditions, including insulin resistance and type 2 diabetes.
One further note for women who experience moderate to severe hot flashes, or “flushes” as Dr. Gunter calls them: the factors that predispose women to severe hot flushes also appear to predispose them to heart disease. It is also possible that hot flushes are caused by something other than menopause, including, perhaps, diabetes. For both of these reasons, Dr. Gunter advises women with moderate to severe hot flushes to get regular checks on heart health, cholesterol, and blood sugar levels/diabetes.
Now about those hormones. Both estrogen and progesterone, which decline during the menopause transition, can affect blood sugar. Drops in estrogen can make cells less responsive to insulin, potentially causing sugar to build up in the bloodstream. Lower progesterone levels can lead to a weaker stress response which increases cortisol levels, and higher cortisol can bump up blood sugar levels. (Source: Diabetes Digital)
With so much going on behind the scenes, so to speak, awareness and vigilance about the physical changes of perimenopause and their impact on blood sugar are critical.
Get Regular Blood Tests to Monitor Your Health
Because insulin resistance can arrive with no warning signs, it’s important to get regular blood tests and physicals to keep an eye on things.
My experience is illustrative of this point: although I had none of the symptoms typically associated with diabetes, like excessive thirst and urination, I had an A1C score of 6.5 on my first post-menopausal blood test which is on the border between prediabetes and diabetes. Had I not gone for routine bloodwork, I would not have known I had a problem nor made the lifestyle changes I needed to bring that number down.
Those lifestyle changes started with my diet and involved a lot of education about the foods and nutrients I needed to focus on. I’ll share what I learned in the remaining posts in this series, starting with a discussion about carbohydrates.
Sources
Fernandez, Jenny. The Truth About Perimenopause: What Your Body Is Trying To Tell You. Diabetes Digital. June 24, 2025.
Gunter, Jen. The Menopause Manifesto: Own Your Health with Facts and Feminism. Toronto: Penguin Random House, 2021, pp. 73, 80-81, 89, 97, 104.
Additional Resources
Genazzani A.,Petrillo T.,Semprini E.,Aio C.,Foschi M.,Ambrosetti F.,et al. Metabolic syndrome, insulin resistance and menopause: the changes in body structure and the therapeutic approach. GREM Gynecological and Reproductive Endocrinology & Metabolism (2024); Volume 4 – 2/2023:086-091 doi: 10.53260/grem.234026.
Wyne, Kathleen. The link between menopause and diabetes. Ohio State Health & Discovery. March 4, 2025.
To read this entire series, visit the Prediabetes Series page.
Disclaimer: Please note that while I have worked with a dietitian and conducted research, I am not a medical professional. I am sharing my experience in hopes that it will help women recognize the importance of routine bloodwork to monitor blood sugar levels, especially as they enter perimenopause, but nothing I say here is a replacement for advice from a medical professional. Always consult with a doctor or dietitian before making any lifestyle changes for prediabetes or any other condition.
Photo of stethoscope and blood pressure cuff by Immo Wegmann on Unsplash.