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.
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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.
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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
You’ve probably seen it popping up in wellness podcasts, health stores, or even your friend's supplement cabinet: bovine colostrum. Marketed for gut health, immune support, and recovery, this early-life nutrient source for calves is now showing up in adult wellness routines. But is it worth your time and money? As a lifestyle medicine physician focused on women’s midlife health and longevity, here’s what I want you to know before you jump on the colostrum bandwagon. Let’s Start With the Basics: What Is Colostrum? Colostrum is the first form of milk produced by mammals (including humans) in the first few days after giving birth. It’s loaded with antibodies, growth factors, and immune-modulating compounds designed to jumpstart a newborn’s immune system and line the gut. Bovine colostrum—from cows—is the form used in most supplements. It's freeze-dried and packaged into powders or capsules, and often promoted for: Gut barrier support ("leaky gut") Immune system priming Exercise recovery Anti-aging benefits But let’s be honest: just because something has growth factors doesn’t mean it belongs in your Amazon cart. Does the Science Support It? Evidence in humans is limited— but not nonexistent. Some small clinical studies have shown potential benefits: Gut health: In people with NSAID-induced intestinal permeability ("leaky gut"), bovine colostrum has been shown to reduce damage and symptoms. Immune function: Some data in athletes suggests reduced upper respiratory infections. Exercise recovery: A few studies report improvements in performance, gut comfort, or muscle soreness—especially in endurance athletes. But these benefits aren’t guaranteed. And the quality and dosage of colostrum varies widely, with no standardized formulation across brands. So Should You Take It? Here’s where my clinical voice kicks in: Before you reach for colostrum, ask yourself: Have you addressed the basics? Are you sleeping? Managing stress? Eating fiber and whole foods? Getting enough protein? Building muscle? Moving your body? Supporting your gut with real food (not just powders)? If the answer is no—then colostrum is not your next step. You’re throwing powdered fuel on an engine that’s missing spark plugs. Do you have dairy sensitivity? Colostrum is a dairy product. Even if it's low in lactose, it may not be tolerated by everyone. Are you already taking quality foundational supplements? Vitamin D, omega-3s, magnesium, creatine, iron (when needed), and probiotics have stronger bodies of evidence for many women in midlife. When Might It Be Worth Trying? Colostrum might be a reasonable add-on if you: Have mild gut symptoms (especially post-infectious or stress-related) Are recovering from illness or antibiotics Train hard and experience frequent upper respiratory issues Want to support your immune system during travel or stress Even then, I recommend: A 2–3 month trial only after dialing in basics Choosing a third-party tested brand Tracking symptoms and benefits Cost, Hype, and the Bigger Picture Many women I work with are overwhelmed by supplement costs. Colostrum can run $50–100/month —and that adds up. So here’s what I tell my patients: Just because something is trending doesn’t mean it’s essential. And just because it works for someone on TikTok doesn’t mean it’s the right tool for your body right now. Your body is an incredible machine. When you give it rest, movement, nourishment, and support—it can do amazing things. Colostrum is not magic. It’s just one tool in a very big toolbox. Bottom Line Colostrum may hality sources. You’re not broken. You might just need a reset—not another powder.
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