Menopause changes how a woman’s body uses fuel. Estrogen, progesterone, and testosterone each play a quiet role in how cells Naturopathic practitioner respond to insulin. As those hormones fluctuate in perimenopause and settle into new baselines after the final period, the same breakfast that once kept blood sugar steady can now send it climbing. Waistlines thicken despite familiar routines. Cholesterol creeps up. Energy dips at 3 p.m. These shifts are not a character flaw. They are biology. The good news is that insulin resistance responds to targeted strategies, and the window around menopause is a powerful time to reset.
I work with women who sit across from me with a stack of normal thyroid tests and a list of stubborn symptoms. The throughline often turns out to be impaired insulin signaling layered on top of hormonal change. When we treat the whole picture — lifestyle, sleep, stress, movement, and, where appropriate, hormone therapy and medications — the physiology cooperates. Weight stabilizes. Hot flashes abate. Lab panels improve. This is not about perfection, it is about leverage points that move the needle.
Why insulin resistance becomes more common during perimenopause and menopause
Insulin is the “storage” hormone, nudging glucose into muscle and liver for later use and telling fat cells to hold on to their contents. Tissues become resistant to insulin for several reasons between the late thirties and mid fifties.
Estrogen has insulin-sensitizing effects in muscle and liver. As ovarian estradiol falls in perimenopause, muscle takes up less glucose after meals and the liver produces more glucose overnight. Visceral fat around the abdomen tends to increase with lower estrogen and higher relative androgens, and this central fat is more metabolically active, releasing free fatty acids and inflammatory signals that worsen insulin resistance. Sleep fragmentation, whether from hot flashes, night sweats, or stress, blunts insulin sensitivity in as little as one bad week. Progesterone fluctuations can add appetite swings and alter fluid balance, which some women experience as carbohydrate cravings. Reduced spontaneous movement after an injury, a job change, or caregiving demands lowers muscle glucose uptake, even if gym time stays the same.
Perimenopause symptoms are a useful clue. Irregular cycles, sleep disturbance, new anxiety, and heavier periods usually begin before fasting glucose becomes abnormal. Fasting insulin and triglycerides are often the first lab values to drift. Catching this early changes the trajectory.
How to confirm the problem before you chase it
You do not need a complex workup to start eating better or sleeping more, but a focused baseline makes treatment more precise and helps with motivation. I tend to order a fasting glucose and insulin on the same morning, a hemoglobin A1c, a lipid panel, liver enzymes, TSH, and, if triglycerides are elevated, a nonalcoholic fatty liver disease index. If someone has significant perimenopause symptoms or hot flashes, we also look at ferritin and vitamin D. Continuous glucose monitoring for two to four weeks is instructive for many women who prefer real-time feedback.
Interpreting those results demands nuance. A normal fasting glucose of 90 to 95 mg/dL with a fasting insulin of 12 to 15 µIU/mL often indicates early insulin resistance, especially if triglycerides are over 150 mg/dL or HDL is low. An A1c in the 5.5 to 5.7 percent range paired with wide post-meal spikes on a CGM is another red flag. Waist circumference above 35 inches in a woman correlates with visceral fat and increased risk. No single number defines your physiology, but the pattern tells the story.
Food timing and composition that work with menopausal physiology
Midlife metabolism cares as much about timing as it does about macros. The first change high cholesterol treatment I make often has nothing to do with cutting foods. It has to do with lifting protein and fiber and moving more calories earlier in the day.
A protein-forward breakfast with 30 to 40 grams of protein within two hours of waking steadies insulin for the rest of the day. Greek yogurt with nuts and berries, eggs with smoked salmon and spinach, tofu scramble with avocado and salsa, or a whey or soy protein smoothie with flax and frozen cherries each fit the bill. If you are not hungry in the morning, start with 20 grams and build up over two weeks. Postmenopausal women absorb protein less efficiently, so the higher target supports satiety and muscle.
Carbohydrates are not the enemy, but they benefit from context. Pair them with protein, fat, and fiber. A cup of lentils, a roasted sweet potato, or farro tossed into a salad hits differently than a baguette on its own. Cooking and cooling rice or potatoes and then reheating them increases resistant starch that blunts glucose spikes. If you enjoy fruit, eat it with nuts, yogurt, or cheese instead of alone.
Timing matters. Most women do better with a 10 to 12 hour eating window rather than longer fasts that push the first meal to lunchtime. Extended fasting can worsen hot flashes and sleep in perimenopause due to cortisol changes. Finishing dinner at least three hours before bed improves glucose overnight. The old advice to make lunch the largest meal holds up here. If you tend to graze at night, front-load nutrients earlier and plan a satisfying, deliberate evening snack if you need it, such as cottage cheese with cinnamon or edamame with sea salt.
Alcohol deserves a frank mention. A nightly glass of wine can raise triglycerides and disrupt sleep architecture, spiking early morning glucose. If hot flashes or night sweats are present, limit alcohol to two or three nights per week and avoid it within three hours of bedtime. That single tweak can shrink a 3 a.m. glucose surge.
Strength training is nonnegotiable, and it does not have to be fancy
Muscle is the largest sink for glucose. Lose muscle, and glucose lingers in the blood longer after meals. Gain or preserve muscle, and insulin resistance softens. Estrogen decline increases the speed of muscle loss, so resistance training during perimenopause is an investment with immediate metabolic dividends.
The sweet spot is two to three sessions per week that cover major movement patterns: squat, hinge, push, pull, and carry. Forty-five minutes is nice, but twenty-five deliberate minutes count. Two sets to near fatigue for each pattern is enough for beginners. I have patients who built their entire routine around dumbbells at home: goblet squats, hip hinges like Romanian deadlifts, push movements like floor presses, rows, and loaded carries with a grocery bag. Progress the load weekly if form allows. If knees complain, swap lunges for wall sits. If you have a frozen shoulder, emphasize lower body and pulling until range improves.
Do not ignore daily movement. A 10 to 15 minute walk after meals flattens postprandial glucose significantly. If you wear a CGM, you can see the difference. Women who cannot reach 8,000 steps on weekdays can still win by carving out three 12-minute walks linked to meals and standing to work in 20-minute blocks. Cardio sessions have their place, but muscle is the lever.
Sleep repair and stress load are glucose control strategies
Perimenopause often disrupts sleep: you fall asleep fine, then wake hot at 2 a.m., toss until 4, and power through the morning on coffee. That pattern alone lowers insulin sensitivity the next day by measurable percentages. It also inflates appetite and reduces satiety signals. You can fix a third of your “diet problem” by mending sleep.
Tactical steps help. Keep the bedroom cool, ideally 65 to 67 degrees. Layer breathable fabrics. Avoid heavy meals and alcohol late. If night sweats are the barrier, treat the vasomotor symptoms directly, whether with menopause treatment like low-dose estradiol, nonhormonal options, or sleep aids. Magnesium glycinate, 200 to 400 mg in the evening, helps some women fall asleep and may stabilize restless legs. If rumination spikes at bedtime, a 10-minute pen-and-paper worry dump followed by a brief breath practice works better than hours of scrolling.
Daytime stress management matters too. Cortisol and insulin interact. High, variable cortisol drives hepatic glucose release and increases visceral fat deposition. Women caring for teenagers and aging parents feel this viscerally. I do not hand out generic “relax” advice. I ask for one reliable 15-minute practice you can do four or more days per week: a brisk walk in daylight, a short-guided breathing session, a few quiet minutes with tea and no screens, or an early evening yoga flow. Use what you will actually do.
Where bioidentical hormone replacement therapy fits in
Hormone therapy is not a diet pill, yet it influences insulin and lipid metabolism in meaningful ways. When I use bioidentical hormone replacement therapy, I am usually targeting moderate to severe vasomotor symptoms, sleep disruption, and quality-of-life complaints, along with meaningful bone density or urogenital concerns. Metabolic benefits are a legitimate secondary goal.
Transdermal estradiol, typically delivered via a patch or gel, has a more favorable effect on triglycerides and clotting risk than oral estrogen. It reduces hot flashes, improves sleep, can decrease central fat accumulation, and may enhance insulin sensitivity by improving muscle glucose uptake and reducing hepatic glucose production. In women with a uterus, we pair estrogen with micronized progesterone for endometrial protection. Micronized progesterone also benefits sleep in many patients when taken at night due to its GABAergic properties.
Timing matters. Starting BHRT therapy within 10 years of the final menstrual period and before age 60 tends to carry the most favorable risk profile. In women with prediabetes or early insulin resistance, I often see fasting insulin and triglycerides improve modestly after three to six months on a transdermal regimen, assuming diet and movement also shift. Women with high cholesterol treatment needs sometimes reduce their statin dose after BHRT and lifestyle changes, but that is individualized and driven by numbers, not hope.
There are caveats. Oral estrogens can raise triglycerides and increase clot risk, which is unhelpful in insulin-resistant patients. Synthetic progestins behave differently from micronized progesterone metabolically and can blunt some benefits. Family or personal history of estrogen-sensitive cancer, clotting disorders, uncontrolled hypertension, or active liver disease may push us toward nonhormonal menopause treatment. Cost and access also affect choices. The term bioidentical hormone replacement therapy often gets conflated with custom-compounded products. Standard, FDA-approved estradiol and micronized progesterone are bioidentical without the variability of compounding. Compounded formulations have roles, but they are not a default.
Nonhormonal medications that truly help insulin resistance
Medication is not an admission of defeat. It is a tool. When a woman arrives with an A1c of 5.9 percent, triglycerides of 240 mg/dL, and a family history of type 2 diabetes, we can avert years of creep by adding the right drug while we reshape lifestyle.
Metformin is a long-standing first-line option. It reduces hepatic glucose output and improves peripheral insulin sensitivity. Most women tolerate 1,000 to 2,000 mg daily, though gastrointestinal upset is common at the start. I titrate slowly and pair it with meals. It can reduce B12 levels over time, so we monitor and supplement if needed. Metformin is inexpensive, weight neutral or slightly reducing, and synergizes with exercise.
GLP-1 receptor agonists, such as semaglutide and tirzepatide (the latter also targets GIP), slow gastric emptying, improve insulin secretion in a glucose-dependent way, and reduce appetite. For midlife women with obesity or prediabetes, these can be transformative, not only for weight but for blood pressure, triglycerides, and fatty liver markers. Side effects include nausea, constipation, and in some, reflux. Cost and access are the biggest barriers. If used, pair them with resistance training to preserve muscle. Do not rely on these alone. When stopped suddenly, hunger returns and weight can rebound if habits did not change underneath.
SGLT2 inhibitors increase urinary glucose excretion. They can lower fasting glucose and provide cardiovascular and renal benefits. Risks include genital yeast infections and, rarely, euglycemic ketoacidosis in low-carbohydrate diets. I use them selectively, often in women with stubborn fasting hyperglycemia and high cardiovascular risk.
When triglycerides are markedly elevated, even beyond insulin resistance treatment, I add omega-3 ethyl esters or icosapent ethyl in addition to statins if indicated. Elevated triglycerides during menopause often reflect a mix of dietary pattern, insulin resistance, and estrogen decline. Correcting all three works best.
The overlap with mood, PMDD history, and appetite
A fair number of my patients with perimenopause symptoms have a history of premenstrual mood issues. PMDD treatment models taught them to respect brain chemistry as physiology, not morality. That mindset helps with midlife metabolism too. Serotonin shifts during perimenopause can intensify carb cravings at certain times of the month, even with longer cycles. Knowing that helps you plan, not blame yourself.
If you notice a week where evening cravings surge, stack the deck in your favor. Raise breakfast protein to 40 grams. Pack a dense, savory snack for late afternoon: turkey roll-ups with hummus or roasted chickpeas with olive oil and salt. Move your walk to just after dinner. Keep dessert small and paired with protein, or swap for a square of dark chocolate and tea. If an SSRI is part of your PMDD treatment, monitor weight and appetite changes, then adjust nutrition accordingly. Some women do better with bupropion for mood if appetite is a concern, though that is a shared decision with a prescriber.
Real-world examples and what they teach
Two cases illustrate typical arcs.
A 51-year-old, two years postmenopause, complained of belly weight gain, night sweats, and fasting glucose of 103 mg/dL. Lipids showed LDL 148 mg/dL, HDL 46 mg/dL, triglycerides 192 mg/dL. She preferred to avoid medications. We raised protein to 120 grams per day, set an eating window of about 12 hours, and front-loaded calories. She added two 30-minute strength sessions weekly and a 12-minute walk after dinner. Night sweats were severe, so we started a low-dose estradiol patch with micronized progesterone. At three months, night sweats resolved, sleep normalized, and fasting glucose dropped to 95 mg/dL. Triglycerides fell to 148 mg/dL. At six months, waist circumference shrank by 1.5 inches and LDL moved to 132 mg/dL. She later chose a low-dose statin to hit her risk-reduction target.
A 46-year-old in perimenopause with irregular periods, migraines without aura, and strong family history of type 2 diabetes wore a CGM that showed 180 to 200 mg/dL peaks after pasta or bread. Fasting insulin was 18 µIU/mL with glucose 92 mg/dL, A1c 5.6 percent. She was already walking 10,000 steps daily but did no resistance training. We started metformin, titrating to 1,500 mg nightly, and created a two-day-per-week dumbbell plan. We replaced solo carb meals with mixed plates and cooled-starch tricks. She reduced alcohol to weekends and moved dinner earlier. After eight weeks, post-meal peaks rarely exceeded 140 mg/dL. She reported less afternoon crash and fewer migraines. We discussed BHRT for early hot flashes but opted to wait and reassess quarterly.
Neither of these women did every single thing. They did the pivotal things consistently enough.
Cholesterol, blood pressure, and body composition tend to improve together
Insulin resistance rarely travels alone. As estrogen falls, LDL often rises 10 to 20 points independent of weight. Triglycerides respond more to carbohydrates, alcohol, and insulin. Blood pressure inches up with sleep loss and stress. Tackling insulin sensitivity improves this cluster because each piece interacts with the others.
If you begin perimenopause treatment with dietary fiber averaging 12 grams per day, nudging it to 25 to 30 grams helps both glucose and LDL. Psyllium husk, 5 to 10 grams with water before a higher-carb meal, blunts the spike and lowers LDL over time. Replacing some saturated fats with extra virgin olive oil and nuts reduces LDL particles without sacrificing satiety. If you enjoy eggs, keep them, but balance with legumes and fish. When statins are indicated, do not let perfect be the enemy of good. Muscle aches occur in a subset of women. Switching statins, starting with a low dose, or using alternate-day dosing solves it for many.
Body composition is the other pillar. Scale weight can hide progress. A woman who gains two pounds of muscle and loses three pounds of fat looks and feels different even if the digital readout barely moves. A simple tape at the navel and a pair of fitted jeans are more honest than a bathroom scale when muscle enters the picture.
When to seek personalized guidance
DIY strategies go a long way. If you are doing the basics for eight to twelve weeks without traction, bring in help. A practitioner who understands menopause symptoms and metabolism can tailor a plan and order the right labs. If you have a history of gestational diabetes, polycystic ovary syndrome, premature menopause, autoimmune thyroid disease, or strong cardiovascular family history, involve your clinician sooner. If you experience sudden weight gain paired with edema or profound fatigue, do not assume it is just hormones. Rule out sleep apnea, significant thyroid dysfunction, and medication effects.
Women in larger bodies often meet stigma in healthcare. Insist on respectful, evidence-based care. Insulin resistance treatment is not a moral test. It is physiology that responds to targeted, sustainable change.
A practical starting plan for the next month
- Build two strength sessions per week covering squat, hinge, push, pull, and carry, using loads that feel challenging by the last 3 to 4 reps. Eat 30 to 40 grams of protein at breakfast, anchor each meal with protein and fiber, and finish dinner at least three hours before bed. Walk 10 to 15 minutes after one or more meals, and aim for at least 7 hours of sleep in a cool, dark room. Limit alcohol to two or three nights weekly, and skip it within three hours of bedtime; swap late sweets for protein-based snacks. If you have moderate to severe hot flashes or poor sleep, discuss BHRT or nonhormonal options; ask about metformin if fasting insulin or A1c are creeping up.
The long view
Menopause is a transition, not a decline. The same physiology that makes fat stickier around the waist also makes your body responsive to smart levers. Food quality and timing, protein and fiber at deliberate doses, muscles that actually get used, real sleep, moderated alcohol, and, when indicated, medications or BHRT, work together. Women who choose consistency over intensity win this game. They do not count out a week because of one rough dinner. They return to a plan that respects their changing biology.
I have watched women step into their fifties stronger than they were at thirty-eight, with better labs, clearer heads, and steadier moods. Their perimenopause symptoms settle, their menopause symptoms feel manageable, and they stop apologizing for needing structure. Strategy replaces struggle. That is the goal.
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https://totalhealthnd.com/
Total Health Naturopathy & Acupuncture is a professional naturopathic and acupuncture clinic in London, Ontario.
Patients visit Total Health Naturopathy & Acupuncture for natural support with chronic health concerns and more.
Call (226) 213-7115 to contact Total Health Naturopathy & Acupuncture in London, Ontario.
You can reach the clinic by email at [email protected].
Learn more online at https://totalhealthnd.com/.
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The clinic provides natural, holistic solutions for Weight Loss, Pre- & Post-Natal Care, Insomnia, Chronic Illnesses and more. Learn more at https://totalhealthnd.com/.Where is Total Health Naturopathy & Acupuncture located?
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