Menopause is associated with several changes we might be familiar with—loss of fertility and hot flashes come to mind—but there are other side effects that can emerge following the reduction of estrogen that comes with menopause: weight gain and insulin resistance.

What is menopause?

As women age, their hormone cycles change; and during menopause monthly menstruation ends. Menopause is defined as the absence of a period (menstruation) for 12 consecutive months and generally occurs around ages 45-55 years. Prior to menopause, a carefully regulated cycle of multiple hormones (think: estrogen, progesterone, and others) regulates the female reproductive system, stimulating ovulation (the release of an unfertilized egg in preparation for fertilization and pregnancy) and culminating in menstruation.

What is the role of estrogen (or lack of) in menopause?

The major change associated with menopause is a decrease in the levels of estrogen, a female sex hormone produced by the ovaries. Over time, the ovaries begin to produce less estrogen which can lead to irregular or no periods, plus other symptoms including weight gain. In fact, the reduction of estrogen that occurs with menopause can impact body composition and may lead to a redistribution of body fat, including an increase in the amount of abdominal fat. The latter might be due to insulin resistance.

Cropped mid section of an obese woman trying to close the buttons of her jeans against a white background
Estrogen decreases during menopause, which can lead to increased abdominal fat and increased risk of type-2 diabetes.

What is the connection between menopause and increased risk of insulin resistance?

It all comes back to estrogen.

But first, let’s review insulin resistance and why it’s bad.

When we eat a meal, the food we ingest is broken down into its molecular components. In particular, glucose is a sugar molecule that is released upon the breakdown of carbohydrates and acts as a fuel source for the body’s tissues. Insulin is a hormone released by beta cells in the pancreas that signals to other cells in the body (most commonly cells in the liver and fat tissue) to take up glucose from the blood. Thus, insulin acts as the master regulator of blood glucose levels.

Insulin resistance occurs when cells have a reduced or impaired response to insulin, despite normal or increased insulin levels in the blood. This results in an inability of cells to take up circulating glucose, resulting in high blood glucose levels. High blood glucose (called hyperglycemia) can have damaging effects on the body, including to the eyes, kidneys, heart, and other organs. Over time, insulin resistance may lead to type 2 diabetes. 

In addition to being a key regulator of the reproductive system in females, estrogen also plays a role in energy metabolism and body fat distribution. In premenopausal women, estrogen is thought to have a protective effect against insulin resistance, obesity, and type 2 diabetes. In support of this, prior to menopause, the incidence of type 2 diabetes is lower in women than in men of the same age, while after menopause, this protective effect is lost due to decreased estrogen levels.

One of the main drivers of insulin resistance is thought to be obesity and the accumulation of visceral fat in the abdominal area. Insulin resistance after menopause may therefore be a secondary effect of fat distribution changes resulting in increased levels of abdominal visceral fat, which is the fat type most associated with greater health risks.

The increased risk of weight gain and insulin resistance following menopause is obviously not ideal, but there are some ways of combating these side effects.

A beautiful black woman using weights during her workout.
Diet and exercise can help reduce the negative effects of low estrogen during menopause.

How can lifestyle impact postmenopausal weight gain and insulin resistance?

No matter the age, exercise is a key factor in maintaining a healthy lifestyle. However, for postmenopausal women who experience weight gain, exercise is particularly important to help prevent additional body fat. In particular, high-intensity exercise training and regular endurance exercise may also help to increase peripheral insulin sensitivity by reducing visceral abdominal fat.

As with any discussion about maintaining a healthy lifestyle, diet is also important in managing risk for weight gain and insulin resistance after menopause. Dietary recommendations for managing insulin resistance include reducing carb intake, as well as paying attention to the glycemic index of foods in the diet. For postmenopausal women in particular, an increased protein intake and a Mediterranean diet may be beneficial.

 Menopause is a natural process that women undergo as estrogen levels decrease. Although a risk for weight gain and insulin resistance exists, diet and exercise may be used to balance these changes.