Insulin Resistance and Menopause: What Every Woman Needs to Know

Insulin resistance might not be on your radar—but if you’re over 40 and in the menopausal transition, it could be affecting you.

If you’ve noticed weight gain without changing your diet, along with fatigue, brain fog, mood swings, insomnia, or headaches, insulin resistance might be part of the picture.

Here’s what it is, why it’s more common during menopause, and most importantly—practical steps you can take to protect your health.

What is insulin resistance?

Insulin is a hormone produced by the pancreas. Its primary role is to regulate blood sugar (glucose) levels in the body. When we eat foods containing carbohydrates, our blood sugar rises.

Insulin helps our cells absorb glucose from the bloodstream, allowing them to use it for energy or store it for later use. Insulin is often described as the key that unlocks the door to the cell.

Glucose can’t get into the cell without insulin. Insulin resistance is when the key gets stuck in the lock and can’t open the door to let the energy in.

The body compensates by producing more and more insulin, causing you to have higher levels of both blood glucose and insulin. This excess insulin production can contribute to the development of something called metabolic syndrome.

Metabolic syndrome is characterized by a group of conditions, including high blood pressure, high blood glucose levels, abdominal weight gain, high triglycerides, and low HDL(good) cholesterol.

Does menopause cause insulin resistance?

Menopause doesn’t directly cause insulin resistance, but the hormonal changes that come with it can make it more likely. As estrogen and progesterone levels drop, your cells may not respond to insulin as well as they once did. This makes it harder for your body to move glucose (sugar) from your blood into your cells for energy.

On top of that, menopause often brings shifts in body composition—like losing muscle mass and gaining more fat around the abdomen—which can further reduce insulin sensitivity.

Of course, hormones aren’t the only factor. Genetics, certain medications, and health conditions such as polycystic ovary syndrome (PCOS) can also increase your risk.

In postmenopausal women, an increase in the insulin resistance is associated with an increased risk of diabetes, heart disease, and breast cancer.

Symptoms of Insulin Resistance in Menopause

Insulin resistance can show up in subtle ways at first, and many of its signs can easily be mistaken for “just menopause.” Here are some clues to watch for:

• Persistent fatigue – Feeling wiped out, even when you’re sleeping well.
• Increased hunger and carb cravings – Especially for sweets or starchy foods.

Related: How to Stop Menopause Sugar Cravings

• Unexplained weight gain – Often around the belly, even if your eating and activity habits haven’t changed much.
• Frequent urination – Needing to go more often, especially during the night.
• Brain fog – Trouble concentrating, forgetfulness, or feeling mentally “sluggish.”
• Higher blood pressure – Numbers creeping up without another clear cause.
• Changes in cholesterol – Especially elevated triglycerides.
• Skin changes – Dark, velvety patches on the neck or armpits (acanthosis nigricans) or new skin tags.

How do I know I have insulin resistance?

The most accurate test for insulin resistance is complex and mostly used in research studies—not something your doctor will typically order. Instead, healthcare providers rely on simpler blood tests and your overall health picture to get a good sense of your risk.

Fasting Blood Glucose Test: This test measures blood glucose levels after a fast, typically overnight. A fasting blood sugar level less than 100 mg/dL (5.6 mmol/L) is normal.

Hemoglobin A1c Test: This test reflects average blood sugar levels over the past three months. While usually used to diagnose diabetes, it can also indicate insulin resistance if the result is consistently higher than normal. An A1c level below 5.7% is considered normal.

Less common approaches include:

Oral Glucose Tolerance Test (OGTT): This test involves fasting overnight, consuming a glucose drink, and then measuring blood glucose levels at specific intervals. It helps assess how well your body handles glucose over time.

Homeostasis Model Assessment (HOMA-IR): This is a mathematical formula using fasting glucose and fasting insulin levels to estimate insulin resistance.

Your doctor may also look beyond lab results. They’ll consider your health history, family history, and other risk factors. For example, you may be at higher risk if:

• You have a family history of type 2 diabetes
• You had gestational diabetes during pregnancy
• You have high blood pressure
• You tend to carry more weight around your middle (apple-shaped body)

As a dietitian, I usually assume that most women in menopause will have at least some degree of insulin resistance—even without a formal test.

The good news? The nutrition and lifestyle changes that help improve insulin sensitivity are the same ones I recommend for overall midlife health. So even if you’ve never been tested, the strategies you use to protect your long-term health will also work in your favor here.

How to stop insulin resistance in menopause?

Managing (and even reversing) insulin resistance during menopause is absolutely possible. It usually comes down to the right mix of lifestyle habits—and sometimes medical support if needed. Here are some of the most effective strategies:

Prioritize a Mediterranean-style way of eating.
Fill your plate with high-fiber whole grains, lean proteins, healthy fats (like olive oil, nuts, and seeds), and plenty of colorful vegetables. Keep added sugars and refined carbs to a minimum. This way of eating not only supports insulin sensitivity—it also benefits heart, brain, and bone health during menopause.

Move your Body Regularly. Both aerobic activities (like walking, cycling, or swimming) and strength training are important. Your muscles are the biggest consumers of glucose in your blood, so keeping them active makes a big difference. High-Intensity Interval Training (HIIT), even in short bursts, has been shown to be especially effective for improving insulin sensitivity in midlife women.

Manage Stress. Chronic stress increases cortisol, which can interfere with insulin sensitivity. Try practices like meditation, yoga, deep breathing, or even simple daily walks to help calm your nervous system.

Get Enough Sleep. Insufficient sleep is associated with insulin resistance. Poor sleep makes it harder for your body to regulate blood sugar and can increase cravings for high-carb, high-sugar foods. Aim for 7–9 hours of restful sleep and keep a consistent bedtime routine. Easier said than done, I know.

The habits that help improve insulin resistance are the same ones that support overall midlife health. Small, consistent changes can have a big impact.

Insulin Resistance diet

Following a Mediterranean-style way of eating, like we talked about above, is one of the most effective approaches for reducing insulin resistance. Within that framework, these key nutrients deserve extra attention:

Fiber: High-fiber foods—especially cereal fibers and whole grains—help improve insulin sensitivity and keep blood sugar levels steadier.

Check out this FREE printable list of high fiber foods.

Plant proteins: Several large studies have shown that high meat consumption is linked with a greater risk of type 2 diabetes. Swapping even a small portion of animal protein for plant protein (just 5% of total energy intake) was associated with a 23% lower risk. Think beans, lentils, tofu, tempeh, and edamame.

Antioxidants: Women with who eat foods high in anthocyanin and flavones have lower rates of insulin resistance and inflammation. Load your plate with berries, oranges, pears, grapes, peppers-and don't forget the tea, its packed with flavonoids.

Monounsaturated fats: Foods that are high in monounsaturated fats, such as olive oil, avocados, and nuts, may help improve insulin sensitivity.

Magnesium: Low levels of magnesium have been linked to insulin resistance. Boost your intake with foods like almonds, cashews, pumpkin seeds, spinach, and Swiss chard.

Chromium: Chromium is a trace mineral that may help improve insulin sensitivity and blood sugar control. Good sources include whole grains, nuts, broccoli, and green beans.

Does HRT help Insulin resistance?

According to the North American Menopause Society, the main reasons for prescribing hormone replacement therapy (HRT) are to relieve menopausal symptoms—such as hot flashes, night sweats, and vaginal dryness—and to help prevent osteoporosis.

Its effect on insulin resistance isn’t fully clear. Research results are mixed: some studies show improvement, while others find no significant change. In one small study of 40 postmenopausal women with diabetes, HRT use was linked to lower fasting glucose, improved A1C, and reduced insulin levels—but larger, long-term studies are still needed.

Understanding and addressing insulin resistance is one of the best things you can do for your long-term health in menopause and beyond. The good news? Many of the same lifestyle habits that support your overall well-being—like eating a Mediterranean-style diet, moving your body regularly, managing stress, and getting quality sleep—also help improve insulin sensitivity.