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Hormone Therapy and Insulin Resistance: A Game-Changer for Menopausal Metabolic Health
Anna Harrelson • February 11, 2025

Menopause, Metabolism, and Hormones: How Estrogen Impacts Insulin Resistance and Why It Matters

As a menopause specialist, lifestyle medicine physician, and a perimenopausal woman with a family history of metabolic syndrome, I have a deep, personal and professional investment in the role of metabolic health during menopause. Preventing insulin resistance and diabetes is not just a clinical goal—it’s something I think about daily. 

A groundbreaking meta-analysis recently published by The Menopause Society sheds light on an area that has long been debated: the relationship between hormone therapy (HT) and insulin resistance. This research reviewed 17 randomized controlled trials encompassing over 29,000 participants, finding that menopausal hormone therapy—including both estrogen alone and estrogen plus progestogen—can significantly reduce insulin resistance in healthy postmenopausal women. 

This study is not just an academic curiosity. It has real, actionable implications for midlife women who are trying to navigate the complex landscape of hormonal changes, weight shifts, and metabolic health challenges. Let’s break down what this means, why it matters, and how we can apply this research to both clinical decision-making and personal wellness.

Understanding Insulin Resistance and Menopause

Insulin resistance is a condition where cells in the body become less responsive to insulin, leading to elevated blood glucose levels, increased fat storage (especially around the midsection), and a greater risk for developing type 2 diabetes. Estrogen plays a key role in regulating glucose metabolism, insulin sensitivity, and fat distribution, which is why the transition into menopause—when estrogen levels drop—often correlates with increased abdominal fat and metabolic dysfunction.

Many women find themselves frustrated, feeling like they’re doing everything right from a lifestyle perspective, only to see weight accumulate in their midsection. What used to work no longer does, and this can be incredibly disheartening. While medications exist that may seem like a quick fix, understanding the role of hormones and lifestyle remains critical in long-term metabolic health.

What the Study Found

This meta-analysis provides strong evidence that hormone therapy may not only alleviate traditional menopause symptoms but could also serve as a protective factor against insulin resistance. Here’s what stood out:

- Reduction in Insulin Resistance: HT was associated with a statistically significant reduction in insulin resistance markers across all included studies.
- Estrogen Alone vs. Estrogen + Progestogen: While both forms of HT improved insulin sensitivity, estrogen-only therapy showed slightly more pronounced benefits.
- Route of Administration Matters: Both oral and transdermal (patches, gels) routes showed efficacy, but different formulations may impact metabolic outcomes uniquely.
- No Increased Diabetes Risk: Contrary to outdated concerns, this research did not find an increased risk of diabetes with hormone therapy use. 

The Bigger Picture: Cortisol, Stress, and Metabolic Dysfunction

While estrogen clearly plays a key role in metabolic regulation, it’s not the only factor at play. Stress—and its impact on cortisol—also significantly influences insulin sensitivity. Chronic stress, disrupted circadian rhythms, poor sleep, and lifestyle factors all contribute to increased insulin resistance, making menopause an even more vulnerable period for metabolic dysfunction. 

Additionally, many women unknowingly exacerbate metabolic issues by under-eating and over-exercising. Chronic caloric restriction and excessive cardio without adequate strength training can drive up cortisol levels, leading to worsened insulin sensitivity, increased fat storage, and hormonal imbalances. 

One of the most powerful tools for metabolic health is muscle. Muscle acts as a “sink” for glucose, helping regulate blood sugar and improve insulin sensitivity. The more muscle mass we maintain, the better our glucose control. For those struggling with insulin resistance or unexplained weight gain, a two-week trial using a continuous glucose monitor (CGM) can provide valuable insights into how their body processes glucose, helping them make more informed dietary and lifestyle decisions. Keeping blood sugar balanced and avoiding spikes is key to reducing insulin resistance and maintaining optimal metabolic health.

What Does This Mean for You?

If you are a perimenopausal or postmenopausal woman concerned about metabolic health, here are key takeaways:

1. Hormone Therapy Isn’t Just for Hot Flashes – If you’re struggling with weight gain, insulin resistance, or metabolic shifts, HT may be a powerful tool to help stabilize your metabolism and improve insulin sensitivity.
2. Individualized Care is Essential – This study reinforces the importance of personalized medicine. The “best” HT formulation varies by individual risk factors, medical history, and metabolic profile.
3. Lifestyle Still Matters– HT can be part of the solution, but optimizing metabolic health also requires dietary adjustments, regular strength training, sleep hygiene, and stress management.
4. Not Everyone Can or Should Take HT– While HT has clear benefits, not all women are candidates. That doesn’t mean they are destined for insulin resistance or diabetes. Genetics, lifestyle, and overall metabolic health play major roles, and there are still many ways to reduce risk without hormone therapy.
5. Advocacy is Key – Many clinicians still view HT through the outdated lens of the Women’s Health Initiative (WHI) study from the early 2000s. You deserve care informed by current science. If your doctor dismisses HT outright, it may be time for a second opinion.

Final Thoughts: Staying Ahead of the Research

This research reinforces what I—and many other menopause specialists—have suspected for years: the impact of estrogen on metabolic health extends far beyond its traditional role in symptom management. For those of us who are determined to prevent insulin resistance, diabetes, and metabolic disease in midlife and beyond, these findings should be front and center in our healthcare discussions.

As a menopause physician who tries to stay up to date with the latest research, I am here to provide informed, evidence-based guidance. If you’re navigating perimenopause or menopause and want to take a proactive approach to your health, I’d love to help you explore your options, including whether hormone therapy could be beneficial for you.

Because menopause isn’t just about surviving the transition—it’s about thriving in midlife and beyond.


WonderCreek Health Blog

By Anna Harrelson March 30, 2025
Let’s start with this: there is nothing shameful or trivial about wanting a healthy sex life. If you're in your 30s, 40s, 50s, or beyond and wondering where your libido went, why sex feels different (or uncomfortable), or why no one ever warned you about vaginal dryness, you’re not alone. And you’re not imagining it. At Wondercreek Health, I talk to people every week who feel confused, dismissed, or ashamed about the sexual changes happening in their bodies. Many are thriving in every other area of life—careers, caregiving, health—but when it comes to intimacy, they feel stuck or unseen. So let’s say this together: sexual health is part of whole-person health. And pleasure is not optional . It’s a reflection of nervous system safety, hormonal balance, connection, and self-awareness. It belongs to you. What Happens to Sexual Health in Midlife and Beyond? Hormonal shifts during perimenopause and menopause can affect every part of your sexual experience. But so can chronic stress, birth control, antidepressants, trauma, and the weight of daily responsibilities. This is never just one thing. Common symptoms include: Vaginal dryness, burning, or itching (genitourinary syndrome of menopause, or GSM) Pain with sex (dyspareunia) Loss of libido or arousal Less intense or harder-to-reach orgasms Urinary urgency or UTIs Pelvic floor tension or dysfunction These changes aren’t "just in your head" and they’re not a moral failure. They reflect real shifts in tissue, blood flow, hormones, and brain chemistry. Sex Isn’t Just for Someone Else’s Benefit Let’s say the quiet part out loud: many of us were raised to believe that sex was about someone else's pleasure. That we should be desirable, responsive, available—regardless of how we felt. That conditioning runs deep. But sex isn’t about performance. It’s about connection, intimacy, and pleasure—for you. Pleasure is your birthright. Intimacy can be tender, playful, spiritual, or wild— but it should never feel like pressure. Your desire may look different than someone else's, and that’s okay. This is true whether your partner is male, female, nonbinary, or you're navigating intimacy solo. There is no one-size-fits-all experience. Why Your Desire Might Feel "Off" Sexual changes can happen at any age. Oral contraceptives (OCPs) can suppress libido by lowering free testosterone. SSRIs and other antidepressants are well known to impact arousal and orgasm. Perimenopause often starts in the mid-30s, long before you notice hot flashes. Chronic stress and the mental load of caregiving, multitasking, and decision fatigue can leave no room for desire. Because here’s the reality: desire doesn’t live in your genitals. It starts in your brain . And when your brain is overloaded with to-dos, responsibilities, or unspoken resentment, it’s nearly impossible to shift into a space of curiosity, connection, and arousal. Unwinding the mind can be hard. For some of us, it means learning to use tools like mindfulness, breathwork, somatic practices, therapy, or just having space and time away from the demands of the world. Creating room for desire isn’t selfish. It’s a form of self-trust and reclamation. The Good News: This Is Treatable Sexual health doesn’t have to decline just because estrogen does. There are safe, effective, empowering ways to reconnect with your body and reclaim your pleasure. 1. Local vaginal estrogen (or DHEA or testosterone): Restores tissue health, lubrication, and blood flow Improves comfort, arousal, and pelvic health Safe for most people, even those with a history of breast cancer (with appropriate guidance) 2. Systemic hormone therapy: Can improve libido, mood, sleep, and confidence Testosterone therapy (when indicated) can support arousal and orgasm 3. Pelvic floor physical therapy: Addresses pain, tension, and coordination issues Supports better sensation and comfort 4. Nervous system regulation: Practices like breathwork, somatic therapy, or trauma-informed care help shift from "fight or flight" into connection When the nervous system feels safe, desire can return 5. Sex therapy or coaching: Helps explore personal blocks, relationship dynamics, and pleasure mapping Let’s Talk About Desire You might notice you don’t feel spontaneous desire anymore— but that doesn’t mean you’re broken . For many people, responsive desire (desire that follows arousal) becomes the norm in midlife. And it’s perfectly valid. Touch, connection, and intimacy may need more warming up. But your ability to experience pleasure is still intact—and it can grow deeper, richer, and more grounded as you reconnect with your body on your own terms. Final Thoughts You don’t need to be fixed. You deserve to be heard. You deserve to feel good in your body. Sexual health is not about keeping up with anyone else’s timeline or expectations. It’s about reclaiming what intimacy and connection mean to you in this season of life. At Wondercreek Health, I’m here to help you connect the dots, reduce shame, and support you with science-backed, judgment-free options that honor your experience. Because this is not the end of your sexual story. It might just be the beginning of the most powerful chapter yet.
By Anna Harrelson March 30, 2025
Let’s be honest: midlife can feel like your body is changing the rules without warning. You’re doing what used to work, but the results aren’t the same. The scale doesn’t budge, your sleep is disrupted, your energy is inconsistent, and your moods might feel like a rollercoaster you didn’t sign up for. And while hormone therapy, supplements, and nutrition are powerful tools for navigating perimenopause and menopause, movement—especially strength training and nervous system-aware exercise—is one of the most underutilized forms of medicine. As a lifestyle medicine physician and menopause specialist, I talk about this daily with my patients. Movement isn’t just about burning calories. It’s about retraining your stress response, building metabolic resilience, preserving muscle, and improving insulin sensitivity. Why Movement and Muscle Matter in Midlife During perimenopause and menopause, we experience natural declines and fluctuations in estrogen, progesterone, and testosterone. These shifts impact far more than reproduction—they affect how we regulate blood sugar, manage stress, build muscle, sleep, and recover from daily life. In this stage of life: Muscle mass declines more rapidly if not actively maintained Insulin sensitivity drops, raising the risk for metabolic syndrome and weight gain Cortisol levels rise and become harder to regulate, especially in women with high stress or trauma histories Nervous system resilience weakens, making it harder to bounce back from emotional or physical stressors Movement is the antidote to all of this. What the Research Shows Muscle is a metabolic organ. It stores glucose, improves insulin sensitivity, regulates inflammation, and even contributes to hormone production and detoxification. Building and maintaining muscle in midlife is one of the most powerful ways to protect against: Type 2 diabetes and insulin resistance Cognitive decline Cardiovascular disease Falls, fractures, and osteoporosis And beyond the physical? Movement is critical for regulating the autonomic nervous system, which influences: Your ability to sleep Your mood and anxiety levels Your response to daily stressors Your digestive and immune function Not Just Any Movement This isn’t about hitting the gym for 90 minutes or going hard every day. It’s about intentional movement that supports your biology. Here’s what I recommend: 1. Prioritize strength training. 2–3 times per week of bodyweight, resistance bands, dumbbells, or machines Focus on form, tempo, and functional movement—not just reps or weight 2. Include low-impact, nervous-system regulating movement. Walking, mobility flows, Pilates, yoga, or tai chi Think of this as your recovery and resilience training 3. Move throughout the day. Break up sedentary time with stretching, light movement, or standing tasks Movement snacks matter for metabolic health 4. Don’t overtrain. Too much high-intensity exercise can increase cortisol, disrupt sleep, and worsen hormonal symptoms Listen to your body and focus on consistency over intensity It’s Not About Looking Fit. It’s About Feeling Well. This phase of life isn’t just about managing symptoms—it’s about building your future resilience. Every time you lift something heavy, take a walk, or stretch with intention, you are: Supporting your insulin and glucose balance Reinforcing your bone, brain, and cardiovascular health Regulating your nervous system Building muscle that keeps you independent and active for decades to come Movement is medicine, & muscle is your midlife superpower. Final Thoughts If you feel like your metabolism has shifted, your sleep is off, or your body feels unfamiliar—you’re not alone. But you’re not broken. You’re evolving. And your body is still responsive to thoughtful support. Start small. Lift something. Go for a walk. Move in a way that honors your nervous system, builds strength, and reminds you that this phase of life is not a decline—it’s a recalibration.
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