While you’re probably aware of many of the side effects and symptoms that can come alongside perimenopause – the irritability, hot flashes, weight gain, hormonal changes – another potential complication many people aren’t aware of is your increased risk of developing insulin resistance when you enter perimenopause.

What is insulin resistance?

Insulin is a hormone produced in your pancreas. Its role is to move glucose (a sugar produced from the food you eat) out of your bloodstream and into your body’s individual cells, so your cells can use it as fuel and energy. This helps ensure your blood sugar levels stay within a safe range, and that your cells can get the energy they need to function

However, with insulin resistance your cells become less responsive or sensitive to insulin, meaning they no longer receive the glucose they need to provide your body with energy. Instead, glucose remains in your bloodstream and starts to build up over time, causing high blood sugar levels.

Symptoms of insulin resistance include low energy levels, weight gain (especially around your stomach), sugar cravings, increased risk of cardiovascular disease and metabolic syndrome and problems concentrating.

When your body stops responding to insulin as effectively as it should, your pancreas tries to compensate by producing more and more insulin. This, of course, leads to high blood insulin levels (also known as hyperinsulinemia) as your body tries to regulate your blood sugar levels. However, excessive production of insulin actually makes insulin resistance worse and can result in further weight gain, high blood pressure, high triglyceride levels and hardening of your arteries.

If insulin resistance is undetected or unaddressed, it can develop into prediabetes and type 2 diabetes over time. Eventually, the insulin-producing cells in your pancreas wear out, meaning the glucose in your bloodstream is unmanaged, and your blood sugar levels become chronically elevated (known as hyperglycaemia). This causes symptoms like increased thirst and urination, hunger, blurry vision, headaches, infections and slow wound healing. However, if it’s recognised early on, insulin resistance is manageable – and many health professionals consider it entirely reversible with dietary and lifestyle changes.

So how does perimenopause increase your risk of developing insulin resistance?

Given perimenopause involves many different changes within your body, which are often accompanied by lifestyle changes too, these can contribute to your risk of developing insulin resistance during this stage of life. Here are some of the potential driving factors to consider.

1. Hormonal Changes

As you know, perimenopause has a whole cascade of effects on many different hormones produced in your body, including sex hormones, adrenal hormones and thyroid hormones.

The most prevalent change is to your production of oestrogen. During peri, your body produces far less oestrogen, which has a direct and indirect effect on your risk of insulin resistance. Oestrogen helps your body remain sensitive to oestrogen, so lower oestrogen levels mean your insulin sensitivity and ability to regulate your blood sugar levels decreases, putting you at greater risk of insulin resistance. You may notice you start to accumulate fat around your middle, or begin to experience big spikes and crashes in your energy levels after consuming high-carbohydrate meals or foods. 

Oestrogen also plays a big role in regulating your appetite and hunger levels, so when you start to produce less of it you become less in control of your food choices, and more likely to overeat or crave high-sugar, refined foods. And if you give in to these cravings often, this can further contribute to insulin resistance. During peri, your low oestrogen levels make it more important to spread your intake of high-carbohydrate foods across the entire day, to prevent any significant spikes and crashes in your blood sugar and help manage your risk of insulin resistance.

Your adrenal hormones also change during perimenopause – particularly your production of your stress hormone, cortisol. Cortisol is also regulated by oestrogen, so when your oestrogen levels decline there’s nothing to keep it in check anymore. As a result, you start to produce more cortisol, which drives an increase in appetite and cravings for high-sugar, refined foods once again. Cortisol can also make you feel less full after your meals, meaning you’re more likely to overeat or reach for something sweet to finish off a main meal. This increase in cortisol levels and in the amount of stress on your body due to the many changes it’s experiencing mean your ability to manage your blood sugar and insulin levels can drop significantly, contributing to a higher risk of insulin resistance.

On top of this, your production of your thyroid hormones, especially T4, T3 and TSH, also falls in peri. Your thyroid hormones are responsible for regulating your metabolism, and supporting your body’s ability to turn your food into energy that can be used effectively by your body’s cells. When this function is impaired, your metabolism begins to slow, and your body becomes less capable of using the energy from your food. This can result in problems with your ability to regulate your blood sugar levels and may impair your sensitivity to insulin, once again worsening your risk of insulin resistance.

All these hormonal changes combined leave your body less able to naturally manage your blood sugar levels, and the amount of insulin in your bloodstream. As you know, both glucose in your blood and your production of insulin begin to build up over time, making your cells less responsive to insulin and contributing to hyperglycaemia and hyperinsulinemia, which of course result in insulin resistance if left unmanaged.

2. You’re less metabolically active.

 During peri, we see two key changes to your metabolic activity which can drive insulin resistance: lower oestrogen levels result in gradual muscle loss and weakness, and most women begin to exercise less too.

When you’re not producing as much oestrogen, your body experiences inflammation and oxidative stress, which leave you less able to build and maintain lean muscle mass from resistance training. Plus, you naturally lose muscle mass slowly as you age, leaving your bones and muscles weaker and at greater risk of sprains or injury. As your muscle mass begins to decline, your metabolism falls with it. This is because lean muscle is metabolically active tissue – meaning the more muscle you have, the more energy you burn each day even when you’re not being physically active. So naturally, the reverse is also true: when you have less muscle, you burn less energy throughout the day. This can result in fat gain around your middle, as well as a reduced ability to regulate your blood sugar and insulin levels.

Exercise plays a significant role in helping you efficiently regulate your blood sugar and insulin levels too. So if you start to exercise less and less during peri (especially when it’s resistance training you’re neglecting!), your body is less able to “mop up” and use the glucose in your bloodstream, and less responsive to insulin production. The combination of less physical activity and a slowed metabolism contribute to a much greater risk of insulin resistance during peri.

3. You experience changes to your gut and digestive system.

Enter: more hormonal changes which can increase your risk of insulin resistance in perimenopause!

Once again, lower oestrogen levels have been shown to reduce the diversity of your gut microbiome, meaning the variety of different strains of gut bacteria found in your gut decreases. These bacteria are responsible for many important body functions, including maintaining gut and digestive system health, facilitating your ability to absorb nutrients from your food, regulating your appetite and dictating your food choices too. With less diversity in your gut comes an increased risk of insulin resistance, as certain bacteria strains have been proven to increase your chances of craving (and eating!) high-sugar, highly palatable foods instead of more nutrient-dense whole foods. As you become less in control of your own food choices (side note: you probably won’t notice you’re less in control either), you tend to eat higher carbohydrate and sugar loads, spiking your blood sugar and contributing to the development of insulin resistance over time.

The hormones that help regulate your hunger and food choices also change during this stage of life. Three key players are involved here:

  Ghrelin. Ghrelin is your “hunger hormone”, meaning the more you produce, the hungrier you feel. Ghrelin levels have been shown to increase as insulin resistance develops, with evidence showing ghrelin influences insulin sensitivity (and vice versa too). Insulin is able to reduce ghrelin levels. So when your body stops effectively responding to insulin or becomes unable to produce it (because those cells in your pancreas have become exhausted), there’s no longer any regulation on your feelings of hunger. Instead, your production of ghrelin increases, making you more likely to overeat and go wild on high-sugar, refined foods which contribute to insulin resistance over time.

  Leptin. Leptin is almost the reverse of ghrelin, acting as your satiety hormone so you feel full and satisfied after eating. Your body produces leptin to help maintain your normal weight in the long-term. Studies show leptin resistance is linked to insulin resistance, with prolonged high blood insulin levels potentially causing leptin resistance, leading to metabolic syndrome and obesity in some people. High levels of leptin have a pro-inflammatory effect on your body, and have been proven to contribute to insulin resistance. Basically, when your body is no longer sensitive to recognise leptin, it doesn’t realise you’re full. So you’ll keep eating and eating – often high-sugar or high-fat foods – which wreak havoc on your blood sugar and insulin levels, and can worsen your risk of insulin resistance. Couple this with the increase in your hunger hormone and your appetite is all out of whack thanks to peri’s hormonal changes.

  GLP. GLP, or Glucagon-like peptide 1 (GLP-1), has also been linked to insulin resistance. Lower production of GLP has been associated with an increase in insulin resistance, potentially causing high blood insulin levels (hyperinsulinemia). GLP impacts markers of both obesity and insulin resistance, with changes to your production of this hormone during peri once again contributing to your risk of insulin resistance.

How can you reverse insulin resistance?

You’ve been bombarded with the many ways in which perimenopause changes can increase your risk of developing insulin resistance. But before you panic, it’s important to note this risk can be minimised with some simple dietary and lifestyle tweaks. Let’s get into them.

1. Movement

There are two key considerations for your movement patterns during peri to manage your risk of insulin resistance. Firstly, try to move after your meals. And you don’t have to smash out a HIIT session or a long-distance run! Studies show even 2 minutes of low-intensity walking after eating can help manage the effect your meals have on your blood sugar levels, thereby preventing insulin resistance at the same time. And if you can’t commit to walking after a meal, even standing up will improve your body’s response to the glucose load from your food.

Timing does matter too. If you’re doing your light movement at the same time as your blood sugar peaks after eating, this is even more effective in reducing your blood glucose levels – compared to if you did your movement before the peak. Research suggests this peak occurs between 30-90 minutes after your meal, so instead of racing out the door after your last bite, take your time. Go for a leisurely stroll after you’ve taken a moment to sit, digest and appreciate your food. This will prevent your blood glucose levels from spiking, and stabilise your insulin levels too. Over time, exercise also helps your body to use insulin more efficiently, preventing insulin resistance. Simple, but effective!

The second consideration when it comes to movement is to add resistance training into your regular routine. Not only is resistance training an excellent way to improve your body’s efficiency and sensitivity to insulin as mentioned, but it also helps you build lean muscle and supports a higher metabolic rate. This means your body burns more energy day-to-day, reducing your chances of developing insulin sensitivity significantly. In fact, various studies have shown just how effective resistance training is in improving insulin sensitivity as you age

2. Make sure you’re eating protein in each of your meals

Another simple swap, high protein diets (where protein makes up around 25% of your daily energy intake) have been shown to be incredibly effective in reducing insulin resistance – even more so than the Mediterranean diet, which is commonly considered one of the healthiest ways to eat. High protein dietary patterns increase the amount of energy your body burns during the day, even at rest, and help to preserve your lean muscle mass – once again helping you to burn more energy daily. Plus, protein makes you feel more full and satisfied after a meal, helping you avoid overeating and even consume less energy across the course of the day. Interestingly, research suggests high-protein diets also impact your food preferences and choices, making you less vulnerable to cravings for high-fat or high-carbohydrate foods, which can be a huge help in reversing insulin resistance.

Including protein in all of your main meals reduces the impact your food has on your blood sugar levels. Given protein is not broken down into glucose, a meal containing adequate protein won’t have the same effect in spiking your blood sugar levels and contributing to insulin resistance – especially when you’re eating the protein component of your meal first!

Including enough protein at each meal has been shown to improve glucose regulation and insulin sensitivity, and even reduce inflammation in your body – which can further help reverse or prevent insulin resistance. Plus, protein’s ability to help reduce excess body fat is another benefit of including protein in all your meals, as lower body fat levels have been linked to improvements in insulin sensitivity too.

3. Consider the timing of your meals.

Make sure you’re eating three main meals, regularly spaced throughout the day, to help reverse insulin resistance. Instead of grazing continuously all day, focus on creating balanced, satisfying main meals first and foremost – then add snacks in as needed. 

  1. And don’t skip breakfast! Research suggests skipping breakfast could contribute to insulin resistance, while consuming more of your energy intake (and carbohydrate intake!) earlier in the day may help prevent it in some people. This is due to your circadian rhythm, or your body’s natural sleep-wake cycle, which leaves your body better equipped to deal with higher glucose and insulin loads earlier in the day.

    Skipping meals has also been shown to increase insulin resistance and your risk of metabolic syndrome, so be sure to eat frequent meals, at regular intervals throughout the day. And make sure you’re eating slowly and mindfully, as this has also been proven to support the reversal of insulin resistance and prevent overeating.

4. Consider the types of carbs you’re eating.

Low-GI, high-fibre carbohydrate sources such as whole grains, non-starchy vegetables and legumes, have been shown to have a beneficial impact on people developing insulin resistance.

Low GI foods refer to foods with a GI of less than 55. GI, or glycaemic index, lists carbohydrate foods according to the amount by which they increase your blood sugar levels after you eat them. High GI foods cause a greater spike (and then crash) in blood sugar levels, meaning they contribute to and worsen insulin resistance, whereas low GI foods help to preserve insulin sensitivity. Low GI foods break down slowly in your body during digestion, meaning they release their glucose load into your bloodstream more gradually. Ideally, you want to choose whole, minimally-processed foods, and limit your intake of highly processed and refined foods (or high GI foods) like white breads, soft drinks, packaged baked goods and lollies. This will help to reverse insulin resistance and improve your metabolic and general health too.

Low GI diets have been shown to improve insulin resistance and lower insulin levels and blood glucose, which in turn lowers inflammation and your risk of cardiovascular disease and other health problems! It’s definitely a worthwhile and simple switch to make.

And while you’re at it, be sure to pair your carbohydrates with protein, fat and fibre. Eating carbs alongside these other nutrients further helps to blunt the spike they cause in your blood sugar – bonus points if you eat your carbs last, following your veggies and protein.

5. Fasting

While it’s not necessary to fast for 16 hours, or days at a time, fasting for 12-13 hours overnight between dinner and breakfast can be beneficial in reversing insulin resistance – as long as fasting isn’t interfering with your life too much, or preventing you going out to eat with friends and family. It’s important you don’t start to skip meals – as we’ve discussed, this can worsen insulin resistance – or replace your breakfast with coffee. This actually has a detrimental impact on blood sugar and insulin levels, so avoid making the switch at all costs. 

However, your blood glucose levels do have a chance to fall when you’re fasting for a decent period of time (12-13 hours is enough to experience this effect), allowing your pancreas to also reduce its insulin production, and preventing those insulin-producing cells from becoming worn out or dysfunctional. This hugely helps to reverse insulin resistance and preserve insulin sensitivity. 

It’s important to note that most studies promoting 16-hour or longer fasts have been conducted on males, who have very different hormone profiles to perimenopausal women. There’s no need to dive into long intermittent fasts to reverse insulin resistance – keep it simple, and focus on eating regular, balanced meals spaced throughout the day (particularly earlier on in the day!), avoid eating too much after dinner, and aim to have a 12-13 hour window between your dinner and breakfast the following day. Focusing on your overall food intake, the types of foods you’re choosing, and the regularity with which you’re eating are the most important factors to consider! 

While perimenopause does unfortunately increase your risk of developing insulin resistance, these effective, straight-forward strategies can help to combat the effects of hormonal and physical changes to your insulin and glucose levels, so you can stay metabolically healthy and insulin sensitive.

Looking for more practical advice on preventing the unwanted consequences of peri, and optimising your health during this time of change and transition? Book a consultation with me today to get all the personalised advice and support you need.