How Menopause Estrogen Levels Affect Your Blood Sugar

Keeping blood sugar in a healthy range isn’t just a concern for people with diabetes. Chronically high blood glucose levels and uncontrolled fluctuations can affect anyone and, over time, lead to weight gain, cardiovascular disease, and dementia. ^{1 2 3} And if you’re in or approaching menopause, you should pay special attention.

Hormonal shifts significantly impact how your body manages blood sugar during perimenopause and menopause. One study found that, compared to premenopausal women, postmenopausal women had 6 percent higher fasting blood glucose levels and 42 percent higher glucose spikes after eating. ⁴

The connection? Estrogen plays a powerful role in regulating blood sugar. As it declines, your ability to manage glucose can shift, raising the risk of insulin resistance and type 2 diabetes.

But there’s a silver lining: understanding how hormones like low estrogen affect your blood sugar can help you improve your blood sugar and ease other menopause symptoms along the way.

About the Experts

Steven Wise, M.D., is an endocrinologist who specializes in thyroid disease, parathyroid disorders, and adrenal disorders.

Robin Noble, M.D., FACOG, is a Yale-educated OBGYN and the Chief Medical Advisor of Let’s Talk Menopause. She is board-certified in both Obstetrics & Gynecology and Lifestyle Medicine, with Menopause Society (NAMS) certification.

Christina Enzmann, M.D., is a board-certified OBGYN and a certified menopause practitioner with the American Menopause Society.

Disha Narang, M.D., is an endocrinologist and Director of Obesity Medicine at Endeavor Health.

Why Changing Hormone Levels in Menopause Affect Blood Sugar

Low estrogen levels in menopause can disrupt your body’s ability to manage blood sugar, driving up the risk of insulin resistance and high blood sugar.

Your body depends on glucose as its main source of energy. When you eat carbohydrates and sugars, your body breaks them down into glucose, which is carried by the blood to cells to use for fuel. In response, your pancreas releases insulin, a hormone that helps your cells absorb glucose and prevents blood sugar levels from getting too high. Insulin also regulates a process called gluconeogenesis, by which your body creates glucose from protein and fat when needed.

If your cells become less responsive to insulin (insulin resistance), glucose lingers in the bloodstream, leading to high blood sugar. Over time, that can damage blood vessels, raising your risk of heart disease, kidney damage, eye disease, dementia, stroke, and more. ⁵

Estrogen plays a surprisingly powerful role in this system. It works closely with a protein known as Foxo1 to maintain balanced glucose levels. ⁶ It also boosts the activity of GLUT4, a protein that ferries glucose into the muscles, preventing levels from rising too high. ⁷ This likely explains why premenopausal women are less likely to develop type 2 diabetes than men of the same age.

Estrogen’s protection from high blood sugar fades with menopause. A 2007 study by researchers in Japan found that menopause—not age—was an independent risk factor for rising fasting glucose levels. ⁸

As estrogen declines, insulin sensitivity worsens. That means your body needs to produce more insulin to get the same job done. High insulin levels, in turn, can make it harder to break down fat, leading to menopause and perimenopause weight gain. ⁹

Weight gain—especially around the midsection, where menopause weight tends to collect is in itself a strong risk factor for high blood sugar, insulin resistance, and type 2 diabetes, says Robin Noble, M.D., a Yale-educated ob-gyn and certified menopause expert. ¹⁰

Experts aren’t sure exactly why, but they suspect that visceral fat (the kind that accumulates as “menopause belly”) releases adipokines, compounds that interfere with the body’s ability to use insulin. In fact, 2023 research in the journal Frontiers in Nutrition found that normal-weight people with higher levels of belly fat have a similar risk of diabetes as people whose BMI classifies them as obese. ¹¹

Left unchecked, insulin resistance can increase your risk of type 2 diabetes, cardiovascular disease, and dementia. ^{12 13 14}

“We don’t want to portray it as a doom and gloom, downhill effect, but I see patients every day who say, ‘I’m eating the same way, I’m exercising, I’m doing all the right things, and yet I keep gaining weight in the middle,’” Noble says. Knowing that hormones affect blood sugar gives them answers—and a roadmap.

High Blood Sugar Might Also Worsen Menopause Symptoms

Menopausal hormone changes can cause blood glucose to climb, which may contribute to worsening menopause symptoms.

Does high blood sugar contribute to menopause weight gain?

High blood sugar can contribute to menopause weight gain by prompting the pancreas to release more insulin to try to keep glucose in check. But another part of insulin’s job is storing energy, and higher insulin leads to excess glucose being stored in fat cells, according to a 2023 study in the journal Frontiers in Endocrinology.

Insulin also affects hormones that regulate hunger and fullness, such as leptin and ghrelin, making it harder to self-regulate calorie intake. ¹⁵

While high blood glucose plays a role in menopausal weight gain, it isn’t the only driver. On average, women gain about a pound a year during the menopause transition. ¹⁶ This may be a result of age-related changes—such as a loss of muscle mass and being less physically active—as well as hormone changes and rising blood sugar.

In menopause, high blood sugar and weight gain can become a cycle: High glucose leads to weight gain, which then drives glucose even higher.

Does high blood sugar cause hot flashes?

High blood sugar doesn’t directly cause hot flashes in menopause, but it may increase your chances of experiencing them.

Declining estrogen in menopause might contribute to hot flashes it makes your hypothalamus (your body’s internal thermostat) more sensitive to temperature changes, lowering the threshold at which you experience a vascular response (that is, flushing and sweating), per a 2024 study in Gynecological Endocrinology. ¹⁷

Excess body fat—especially visceral fat—may amplify this effect. Research shows people with higher BMIs are more likely to experience hot flashes.

Animal studies suggest high insulin levels may even trigger genes that increase core body temperature. ¹⁸ Elevated body temperature from high blood sugar could create the sensation of a hot flash or worsen actual hot flashes, says Christina Enzmann, MD, an OBGYN and certified menopause practitioner.

It may go both ways: common menopause symptoms like night sweats and poor sleep can also impact blood sugar. One large study in the journal Menopause found that people who experience hot flashes and night sweats have an 18 percent higher risk of diabetes. ¹⁹ The study authors point to the fact that night sweats disrupt sleep, which is thought to cause hormone changes that lead to weight gain, poor blood sugar control, and diabetes.

Does high blood sugar affect mood?

People in menopause often report feeling more anxious, low, irritable, or foggy, symptoms typically attributed to hormonal changes. But high blood sugar may also impact mood.

“When people have high blood sugars, they don’t feel good,” says endocrinologist Disha Narang, M.D. “Your brain swims, you feel more tired, and your thinking is impaired.” Many chalk this up to menopause itself. But it might be unstable glucose.

How to Manage Blood Sugar in Menopause

The first step to managing blood sugar in menopause is to monitor for insulin resistance. Two common tests that medical providers recommend are the fasting glucose test and the hemoglobin A1c test. Talk to your doctor about which test is right for you.

1. Fasting glucose: Measures your blood sugar after an 8-hour fast.
   • 70-99 mg/dL = normal
   • 100-125 mg/dL = prediabetes
   • 126+ mg/dL = diabetes ²⁰
2. Hemoglobin A1c: Measures your average glucose over the past 2-3 months. No fasting required.
   • <5.7% = normal
   • 5.7-6.4% = prediabetes
   • 6.5%+ = diabetes ²¹

Lifestyle changes to manage blood sugar in menopause

Committing to these basic healthy practices may help reduce high blood sugar levels in menopause:

• Increase fiber: It slows digestion, prevents glucose spikes, and improves insulin sensitivity. ²² Aim for about 25 grams daily, though some experts recommend more. Plant foods like vegetables, fruit, beans, nuts, seeds, and whole grains are good sources.
• Move more: Movement causes muscle cells to use glucose, lowering blood levels and boosting insulin sensitivity. ²³ A 30-minute walk after eating can help, according to a 2021 review in Sports Medicine. ²⁴
• Maintain a healthy weight: If weight loss is part of your plan, talk with your doctor. They may suggest dietary changes, medications like GLP-1s, or other strategies.

Medication Options for High Blood Sugar in Menopause

In addition to lifestyle changes, many research-backed medications and supplements can help maintain a healthy blood sugar range.

HRT can relieve menopause symptoms and may help balance blood sugar

Hormone replacement therapy (HRT, also called menopausal hormone therapy or MHT) may support glucose metabolism and lower overall blood sugar by restoring insulin sensitivity. A 2023 meta-analysis of 19 studies found that HRT had a neutral-to-beneficial impact on blood sugar regulation in women with type 2 diabetes. ²⁵

Preliminary evidence suggests HRT may reduce menopause-related weight gain—particularly in the midsection—though results are mixed.²⁶

Vitamins D and K may support insulin sensitivity

There’s evidence that vitamins K and D can reduce insulin resistance, possibly by improving the function of the pancreas’s beta cells, which release insulin, or by calming inflammation, which can interfere with insulin function. ^{27 28} Check with a doctor before supplementing.

Metformin regulates blood glucose

Metformin reduces blood glucose production in the liver and has been used safely for decades.²⁹ Endocrinologist Steven Wise, M.D., notes that while the drug is helpful at reining in increased glucose production, it doesn’t directly treat insulin resistance. “Adding exercise to lower insulin resistance can greatly increase the effectiveness of metformin for lowering glucose,” he adds.

About the author

Mirel Zaman is a seasoned health journalist with over 15 years of experience reporting on wellness, fitness, nutrition, and healthcare disparities. She's committed to evidence-based reporting and a focus on underrepresented topics including hormone imbalances.

About the reviewer

Natalie Kunsman, M.D., is a board certified physician specializing in functional, anti-aging, and regenerative medicine. She is a fellow of the American Academy of Anti-Aging medicine and the American Academy of Family Physicians.