Perimenopause refers to the years leading up to menopause, which can last on average between four to ten years. Addressing insulin resistance is especially important during perimenopause when women become more at risk for developing cardiometabolic conditions as their hormones decline, particularly estrogen.

But what exactly is insulin resistance? In simple terms, insulin resistance is when the body's cells stop responding to insulin as effectively, which makes it harder for the body to regulate blood sugar levels. It occurs when the cells of the muscles, fat, and liver become less responsive to insulin, one of the major hormones responsible for regulating blood glucose. When the body's cells become less resistant to insulin, the pancreas has to produce more insulin to help the body's cells absorb glucose. Over time, insulin resistance can make it harder for the body to maintain normal glucose levels, eventually causing elevated blood sugar.

Understanding insulin resistance during perimenopause is essential for maintaining long-term health. This blog will explore how hormonal shifts influence insulin sensitivity, the risks associated with insulin resistance, and practical ways to support metabolic health during this transition.

Table of Contents

Signs & Risk Factors of Developing Insulin Resistance

Someone with insulin resistance typically has no symptoms. However, certain conditions or risk factors may increase the likelihood of developing insulin resistance. Risk factors for women include:

• Being over the age of 45
• Polycystic ovary syndrome (PCOS)
• History of gestational diabetes
• Family history of type 2 diabetes
• Ethnicity
• Metabolic syndrome
• History of stroke, heart disease, or disease of the blood vessels
• Inactivity

Although there are no initial signs that a person may have insulin resistance, over time they can develop prediabetes. Signs that prediabetes may be turning into type 2 diabetes include:

• Changes in the skin, such as dark patches around the neck or underarms
• Fat accumulation around the abdomen
• Fatigue
• Feeling hungry even after eating a full meal
• Sugar cravings
• Difficulty concentrating, also referred to as “brain fog”

The Connection Between Menopause, Insulin Resistance, and Inflammation

Estrogen, the major female reproductive hormone, is known for its anti-inflammatory effects. During the transition from perimenopause to menopause, estrogen levels begin to decline, which can trigger inflammation throughout the body. Since estrogen receptors are found in almost every organ of the body, this decline in estrogen can lead to inflammation in a variety of systems, causing symptoms like:

• Leaky gut
• Worsening of skin conditions such as eczema, psoriasis, and rosacea
• Dry eye syndrome
• Swollen achy joints
• Seasonal allergies

These symptoms reflect the widespread effects that estrogen loss and resulting inflammation can have on the body. Increased inflammation can show up in a variety of surprising ways, including digestive issues and skin conditions.

But what exactly is inflammation? Inflammation is the body's biological response to injury, disease, or harmful infections such as bacteria or viruses. Acute inflammation occurs due to a viral illness such as the flu, bacterial infection, or injury. This is typically short-lived. However, chronic inflammation can last months or years, depending on the root cause.

Chronic inflammation not only contributes to insulin resistance but also increases the risk of developing certain health conditions, such as autoimmune diseases, neurodegenerative conditions, and cardiometabolic conditions such as elevated cholesterol, hypertension, fatty liver disease, prediabetes, and type 2 diabetes.

Insulin resistance is often the result of chronic inflammation, or sometimes insulin resistance causes the body to function in a pro-inflammatory state. The reciprocal relationship between inflammation and insulin resistance leads to a vicious cycle, putting women at a higher risk for developing cardiovascular disease, type 2 diabetes, and osteoporosis.

Assessing Key Markers of Inflammation & Hormone Balance Through Lab Testing

As we've seen, hormonal shifts during perimenopause and menopause can contribute to insulin resistance and chronic inflammation, increasing the risk of various health conditions. Assessing these changes through lab testing can provide valuable insights into a patient’s overall health and help identify specific areas for intervention.

Vibrant Wellness offers a variety of tests to help assess chronic inflammation, hormonal imbalances, micronutrient deficiencies, and metabolic health. These tests can be particularly useful for women experiencing symptoms related to perimenopause and menopause, as they allow for more personalized, targeted wellness strategies.

The Urinary Hormones Panel can help identify hormonal imbalances in women who are struggling with symptoms of perimenopause or menopause, such as hot flashes, fatigue, hair loss, sugar cravings, weight gain, brain fog, and many more.

The HealthSpan Assessment Panel will give you a full overview of your patient's cardiovascular, endocrine, hepatic, renal, immune, and metabolic health, along with markers of inflammation, autoimmunity, and nutrient status. This comprehensive test can help guide you in making the best health recommendations for optimal wellness and longevity.

If you have patients struggling with stubborn weight gain, stress, fatigue, dyslipidemia, and digestive issues, the Micronutrient Panel can help assess nutrient malabsorption and address any nutritional deficiencies that may be present. Proper nutrient balance is crucial for supporting metabolic health and managing inflammation.

Targeted testing allows for a deeper understanding of underlying health issues, making it possible to recommend more effective nutrition and wellness strategies to support metabolic and hormonal health during perimenopause and menopause.

Nutrition Strategies for Reducing Inflammation & Insulin Resistance During Perimenopause and Menopause

Nutrition plays a fundamental role in managing and preventing chronic conditions that are often linked to high levels of inflammation in the body. An anti-inflammatory diet emphasizes the importance of eating whole foods, such as whole grains, fruits, and vegetables, while reducing the consumption of highly processed foods, alcohol, and fatty meats.

Women in perimenopause and menopause benefit from eating a wide variety of foods to help reduce the risk of developing insulin resistance and other metabolic conditions.

1. Fiber

Fiber is essential for blood sugar regulation and satiety, making it a key nutrient for managing insulin resistance. Dietary fiber provides a wide variety of benefits, such as improving gut health, protecting against heart disease, and helping slow the absorption of glucose into the bloodstream, reducing the risk of for prediabetes and type 2 diabetes.

Two types of fiber, soluble and insoluble, play different roles in the body:

• Soluble fiber slows down digestion by forming a gel-like substance in the stomach. Soluble fiber also helps regulate blood sugar and reduces cholesterol. Foods high in soluble fiber include: oats, barley, flaxseed, apples, bananas, pears, peas, black beans, and lima beans.
• Insoluble fiber passes through the digestive tract intact, therefore it does not dissolve in water like soluble fiber. It helps improve insulin sensitivity and helps with bowel regularity by moving things along the digestive tract. Foods high in insoluble fiber include: whole wheat flour, nuts, seeds, wheat bran, and the skins of fruits such as apples or pears.

Fiber consumption is particularly important during menopause, when many women struggle with stubborn weight gain and cravings for sugary foods, which may be early warning signs of insulin resistance. Fiber can reduce the glycemic index of certain foods and help with satiety. The recommended amount of fiber for women is 25 grams per day or 21 grams per day for women over 50.

2. Protein

Protein aids in blood sugar balance by slowing down the absorption of starchy foods and helps maintain lean muscle, which is essential for metabolic health as we age. In perimenopause, many women experience difficulty maintaining their weight due to reduced lean muscle, hormonal fluctuations, increased levels of stress, and poor sleep. This makes it extra challenging to prevent weight gain, but adequate protein intake paired with strength training can help.

Women can benefit from eating foods high in animal protein, including lean cuts of beef or pork, poultry, eggs, or fatty fish. It's also important to recommend plant-based protein sources such as tofu, edamame, tempeh, beans, and legumes. These foods contain anti-inflammatory properties and may help with hormone imbalances.

Płotek et al recommend⁶ that women in perimenopause or menopause consume 1.0-1.2 grams of protein per kilogram of body weight to maintain adequate muscle and bone strength.

3. Omega-3 Fatty Acids

Omega-3 fatty acids are essential for reducing inflammation and supporting metabolic health. Unfortunately, the body cannot produce them on its own—they must be consumed through the diet. Rich sources of omega-3s can be found in fatty fish such as salmon, mackerel, herring, tuna, or sardines. Plant-based foods containing high amounts of omega-3s include flaxseeds, chia seeds, and walnuts.

These healthy fats help reduce inflammation, which as discussed previously, is closely connected to insulin resistance. Regular consumption of omega-3s not only reduces the risk of developing insulin resistance but also helps protect the heart and brain.

The National Institutes of Health (NIH) recommends⁷ an intake of 1.1 grams per day for women aged 19+.

Key Takeaways

As women transition through perimenopause and menopause, addressing insulin resistance becomes an important component of maintaining health and preventing chronic conditions. You have the unique opportunity to recommend nutrition strategies such as increasing daily intake of fiber, protein, and omega-3 fatty acids as part of your patient’s treatment plans to improve health outcomes.

Vibrant Wellness provides advanced testing backed by science for assessing chronic inflammation, hormonal imbalances, and metabolic conditions. By recommending these labs to your patients, you can provide tailored interventions that promote longevity.

About the Author

Leslie Weidner is a dedicated and passionate registered dietitian nutritionist with over a decade of experience in nutrition and dietetics. As the founder of Leslie Weidner Nutrition, a virtual nutrition coaching business, she specializes in guiding women through the complex journey of perimenopause, helping them navigate hormonal changes with personalized nutrition plans and lifestyle adjustments. Over the past five years, Leslie has empowered dozens of women to make sustainable, healthy habit changes.

References:  

1. National Institute of Diabetes and Digestive and Kidney Diseases. What is diabetes? Prediabetes & insulin resistance. Accessed November 21, 2024. https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes/prediabetes-insulin-resistance#insulinresistance
2. Mauvais-Jarvis F. The role of estrogen in insulin resistance: A review of clinical and preclinical data. Am J Obstet Gynecol. 2021;225(3):254-264. doi:10.1016/j.ajog.2021.05.056.
3. Good to know, all about insulin resistance. Clin Diabetes. 2018;36(3):263-266. Accessed November 21, 2024. https://diabetesjournals.org/clinical/article/36/3/263/31794/Good-to-Know-All-About-Insulin-Resistance
4. National Institute of Diabetes and Digestive and Kidney Diseases. Beyond hot flashes: Insulin resistance and prediabetes. Harvard Health Publishing. Accessed November 21, 2024. https://www.health.harvard.edu/womens-health/beyond-hot-flashes
5. Yoon JH, et al. The peri-menopause in a woman’s life: A systematic inflammatory phase that enables later neurodegenerative disease. J Neuroinflammation. 2020;17(1):204. doi:10.1186/s12974-020-01998-9.
6. Płotek M, et al. The importance of nutrition in menopause and perimenopause—A review. Nutrients. 2023;15(9):2028. Accessed November 21, 2024. https://pmc.ncbi.nlm.nih.gov/articles/PMC10780928
7. National Institutes of Health. Omega-3 fatty acids: Fact sheet for health professionals. Accessed November 21, 2024. https://ods.od.nih.gov/factsheets/Omega3FattyAcids-HealthProfessional/

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The general wellness test intended uses relate to sustaining or offering general improvement to functions associated with a general state of health while making reference to diseases or conditions. This test has been laboratory developed and its performance characteristics determined by Vibrant America LLC and Vibrant Genomics, a CLIA-certified and CAP-accredited laboratory performing the test. The lab tests referenced have not been cleared or approved by the U.S. Food and Drug Administration (FDA). Although FDA does not currently clear or approve laboratory-developed tests in the U.S., certification of the laboratory is required under CLIA to ensure the quality and validity of the test.