Menopause Increases the Risk of Prediabetes, But It’s Reversible — Here’s How

The hormonal changes from perimenopause and menopause that can cause insulin resistance, higher blood pressure and midsection weight gain — plus increased stress and lack of consistent, quality sleep — put midlife women at higher risk of developing diabetes. About one-in-three U.S. adults has prediabetes, meaning their blood sugar levels are higher than normal but don’t yet meet the threshold for being diagnosed with diabetes. But the good news is it can be managed or even reversed.

“The first thing I emphasize to my patients is that a diagnosis of prediabetes provides an important opportunity to intervene early,” Dr. Chhaya Makhija, a board-certified endocrinologist and lifestyle medicine specialist who is CEO and founder of Unified Endocrine & Diabetes Care, tells Flow Space. “The encouraging part is that prediabetes represents an earlier stage of metabolic dysfunction, where interventions can be particularly effective.” Here’s what to know.

More from Flow Space

How to Get Screened for Prediabetes

Screening means getting bloodwork to check Hemoglobin A1C levels and fasting glucose levels or taking an oral glucose tolerance test. According to Makhija, these are the cutoffs for receiving a prediabetes diagnosis:

• Fasting plasma glucose: 100-125 mg/dL

• 2-hour glucose tolerance test: 140-199 mg/dL

The American Diabetes Association (ADA) recommends all adults start screening for prediabetes at age 35. People who have additional risk factors, like carrying excess weight or having a family history of diabetes, should talk to their doctors about earlier screening.

Midlife women have unique risk factors, which makes staying on top of screening especially important. “Estrogen plays an important role in metabolic regulation, including insulin sensitivity and fat distribution,” says Makhija. Lower levels mean less protection. These changes aren’t always obvious, either — even if a woman’s weight doesn’t change significantly, she can still experience fat accumulation around her internal organs and loss of muscle mass which both raise prediabetes risk.

Dr. Amy Ahnert, a board-certified cardiologist and director of the Women’s Heart Program at Atlantic Health Morristown Medical Center, adds that pregnancy complications such as gestational diabetes put a woman at greater risk of future diabetes or heart disease.

What to Do If You’re Prediabetic

Treating prediabetes is an individualized process, but it typically involves lifestyle adjustments, medications or some combination of the two.

“Improving nutrition, increasing physical activity, preserving or building muscle mass, improving sleep and addressing excess visceral fat can significantly improve insulin sensitivity,” explains Makhija. “For some individuals, these changes may be sufficient to bring their glucose and A1c levels back into the normal range without medication.” She adds that reducing and managing stress helps, too.

Sometimes lifestyle interventions are enough. She says Metformin can be especially useful for people who are at greater risk of progressing to Type 2 diabetes, while GLP-1s are also an option.

Here are some specific tips:

• Aim to start meals with non-starchy vegetables, complex carbs and protein. “Structuring meals consistently throughout the day may help improve glucose regulation,” adds Makhija.

• Work with your doctor or a nutritionist to structure your meals because “quality, type, timing and composition of meals are equally important,” she adds.

• Get in the habit of walking after meals and moving throughout the day

• Seek treatment for chronic sleep issues like insomnia and sleep apnea and other chronic conditions like obesity or heart disease