Insulin resistance explained: signs, causes and why it matters during perimenopause and menopause

What is insulin resistance?

Insulin resistance is something I see discussed increasingly in relation to menopause, weight and metabolic health, but what does it actually mean?

Insulin is a hormone produced by the pancreas and one of its major roles is to help move glucose out of the bloodstream into our muscle, liver and fat cells, where it can be used or stored for energy.

When these tissues become less responsive to insulin, the pancreas compensates by producing more of it. This is insulin resistance. For some time, blood glucose may remain within the normal range because higher insulin levels are keeping it there. Eventually, however, this compensatory mechanism may become insufficient, increasing the risk of prediabetes and type- 2 diabetes.

What causes insulin resistance?

Insulin resistance is influenced by many factors rather than just one single cause. Genetics, ageing, visceral abdominal fat, physical inactivity, sleep deprivation and even some medications can all contribute.

Importantly, you don't necessarily need to be overweight to have insulin resistance.

What are the signs of insulin resistance?

You can’t see, feel or touch insulin resistance as it develops silently. Some people experience increasing abdominal weight, difficulty losing weight, fatigue or increased hunger, but these symptoms are not just specific to insulin resistance.

This is why appropriate assessment and pathology are important rather than diagnosing insulin resistance from symptoms alone.

Why can insulin resistance increase during menopause?

The menopause transition can confound and add another piece to the metabolic puzzle.

Oestrogen influences where we store fat, skeletal muscle function and insulin sensitivity. As ovarian oestrogen production declines, women commonly experience a shift towards greater visceral or abdominal fat and changes in body composition. Ageing and loss of muscle mass can compound these effects.

This doesn't mean menopause automatically causes insulin resistance though. Rather, it may create a metabolic environment in which insulin resistance becomes more likely, particularly when other risk factors are already present.

How is insulin resistance investigated?

There isn't one perfect routine test for insulin resistance. Assessment could include fasting glucose, HbA1c and, in selected circumstances, fasting insulin. Cholesterol, blood pressure, waist circumference, liver markers and other aspects of cardiometabolic health can help build a more complete picture.

Importantly, a "normal" fasting glucose result doesn't always tell the whole story either as high levels of insulin are being produced to keep blood glucose levels normal.

Can insulin resistance be improved?

Yes, the good news is that insulin sensitivity is modifiable.

Regular resistance and aerobic exercise can improve the ability of skeletal muscle to use glucose for energy. Adequate sleep, reducing excess visceral fat where appropriate and eating a minimally processed, fibre-rich diet such as a Mediterranean style diet can also support metabolic health.

For some people, herbal medicines such as Goat’s rue, Cinnamon, Bitter melon, Gymnema and Nigella plus supplements magnesium and inositol or medication such as metformin may be appropriate alongside lifestyle strategies.

The bigger picture

Insulin resistance isn't simply about blood sugar or body weight. It is associated with prediabetes and type 2 diabetes, cardiovascular disease, metabolic dysfunction-associated steatotic liver disease (MASLD) and other long-term health risks.

Identifying metabolic changes early provides an opportunity to intervene before they progress to disease.

Wondering whether insulin resistance could be affecting you?

A comprehensive naturopathic consultation can bring together your symptoms, medical history, pathology, medications, nutrition, exercise, sleep and menopause stage to build a clearer picture of your metabolic health with a personalised strategy for improving it.

References:

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