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Managing Blood Glucose During the Menopause Transition to Postmenopause

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The transition from menopause to postmenopause can be a time of great hormonal fluctuation and change. This transition is difficult for women who do not live with diabetes. In the case of a woman with diabetes, these fluctuations in hormones provide unique challenges in maintaining and regulating stable blood glucose.

How Hormonal Fluctuations Impact Blood Glucose

In order to know how estrogen and progesterone affect blood glucose during this transitional phase, it is important to delineate the role of each of the hormones that are essential to the functioning of the female reproductive system. Estrogen, produced by the ovaries, generally enhances insulin sensitivity, meaning it helps the body use insulin more effectively to lower blood glucose levels. This effect can help regulate blood glucose in people with diabetes. Estrogen also helps to enhance glucose uptake. It promotes glucose uptake in muscle and fat tissue. This helps to reduce blood glucose levels. Estrogen also has anti-inflammatory properties, which may help reduce the inflammatory state associated with insulin resistance in type 2 diabetes. Estrogen improves lipid profiles, which indirectly benefits insulin sensitivity and glucose metabolism. Knowing how estrogen helps when the levels are within the normal range, we can see that, during menopause, a decrease in estrogen allows for the opposite. Insulin sensitivity is decreased, and blood glucose becomes more difficult to manage.

The hormone progesterone tends to have the opposite effect of estrogen. Progesterone reduces insulin sensitivity. This means higher levels of progesterone can make it harder for the body to use insulin effectively, leading to higher blood glucose levels. During the transitional time from perimenopause to postmenopause, the levels of progesterone become erratic and unstable. Knowing the effect of progesterone on insulin levels, it is understandable how rises and falls in the progesterone levels can cause erratic fluctuations in insulin and subsequent erratic levels of glucose. For this reason, it is important to watch, not only for blood glucose spikes, but for increased insulin resistance – making blood glucose more difficult to manage with quantities of insulin which may have been effective prior to the transition time.

Given the hormonal fluctuations in estrogen and progesterone and the subsequent difficulties in managing blood glucose, it is imperative that women with diabetes have reliable methods of managing their blood glucose. This transitional time is an excellent opportunity for the use of continuous glucose monitors. Continuous glucose monitors (CGMs) are devices designed to measure and monitor glucose levels in the fluid surrounding the cells just beneath the skin. CGMs are particularly useful for individuals with diabetes to track glucose trends and make real-time adjustments to their treatment. At a time of life when glucose levels can fluctuate in a less-than-ideal manner, a continuous glucose monitor can be an essential tool in the armamentarium of adequate glucose management.

Adjusting Your Diabetes Management Plan

Treating diabetes with insulin or other medications is an essential part of managing blood glucose. The transitional time of perimenopause to menopause can be particularly challenging. During this transitional time, it is important that those with diabetes work with their healthcare professional to help find the best solution to keeping blood glucose stable and maintaining health.

Nutrition Strategies

Getting beyond the hormonal fluctuations, it is important to use as many strategies medically and holistically to maintain adequate glucose management. One very important strategy is to use nutrition to facilitate adequate blood glucose management. A balanced meal plan for blood glucose management includes foods that are rich in fiber, healthy fats, and protein. It is important to minimize the ingestion of processed carbohydrates and sugars. Some key foods to focus on:

1. Non-Starchy Vegetables such as leafy greens (spinach, kale), broccoli, cauliflower, zucchini, bell peppers, cucumbers, and asparagus. These vegetables are low in carbohydrates and calories but rich in fiber, vitamins, and minerals. Fiber slows the absorption of glucose into the bloodstream, preventing spikes in glucose levels.

2. Whole Grains, including quinoa, oats, brown rice, barley, farro and bulgur. These whole grains contain more fiber and nutrients than refined grains. Fiber helps slow carbohydrate digestion and the release of glucose into the bloodstream, which stabilizes blood glucose levels.

3. Lean Proteins such as chicken breast, turkey, fish (like salmon, mackerel, and sardines), eggs, tofu, and legumes (beans, lentils, chickpeas). Protein helps stabilize blood glucose by slowing down digestion and the absorption of glucose. It also prevents insulin spikes after meals.

4. Healthy Fats including avocados, nuts (almonds, walnuts, pistachios), seeds (chia seeds, flaxseeds, pumpkin seeds), olive oil, fatty fish (salmon, mackerel). These types of healthy fats do not raise blood glucose and help you feel full longer. They also improve insulin sensitivity and help regulate blood glucose levels.

5. High-Fiber Fruits, including berries (blueberries, raspberries, strawberries), apples (with skin), pears, cherries, oranges. These fruits have a lower glycemic index and are rich in fiber, which slows the release of glucose into the bloodstream. Berries, in particular, have a lower impact on blood glucose than other fruits.

6. Legumes and Beans such as lentils, black beans, kidney beans, and chickpeas. Legumes are rich in fiber, protein, and slow-digesting carbohydrates, which help to stabilize blood glucose levels. Their low glycemic index makes them an excellent choice for blood glucose management.

Exercise and Physical Activity: The role of regular exercise for blood glucose management. 

  1. Improves Insulin Sensitivity
  • How it works: During exercise, your muscles use glucose for energy, which reduces the amount of glucose in your bloodstream. After exercise, your body becomes more sensitive to insulin, meaning it requires less insulin to move glucose into cells.
  • Benefits: Improved insulin sensitivity helps lower blood glucose levels and reduces the need for insulin or medications in individuals with diabetes, especially type 2 diabetes.

2. Lowers Blood Glucose Levels

  • How it works: Physical activity, particularly aerobic exercise, directly helps muscles absorb glucose from the blood, reducing blood glucose levels even without insulin.
  • Benefits: This immediate lowering effect can be particularly useful for managing post-meal blood glucose spikes. Regular exercise helps maintain stable glucose levels over time.

3. Enhances Weight Management

  • How it works: Exercise helps burn calories, build muscle, and reduce body fat, which contributes to overall weight loss or maintenance.
  • Benefits: Weight loss, especially the reduction of visceral fat (fat around internal organs), improves insulin sensitivity and blood glucose regulation. This is especially important for individuals with type 2 diabetes, as obesity is a key risk factor.

What types of exercise are helpful to manage blood glucose levels in menopause?

1. Aerobic Exercise such as walking, cycling, swimming, and jogging can have benefits such as increasing your heart rate, improving cardiovascular health, and helping your muscles use glucose more efficiently. These activities also aid in weight management, which is important for blood glucose management during menopause.

2. Strength Training (Resistance Exercise) such as weightlifting, resistance band exercises, bodyweight exercises (squats, lunges, push-ups), or using machines. These exercises help build muscle mass, which declines during menopause. Muscle mass improves insulin sensitivity, helping to regulate blood glucose levels. It also boosts metabolism and bone density, both of which can be impacted during menopause.

3. High-Intensity Interval Training (HIIT)which are short bursts of high-intensity activities like sprinting or fast cycling, followed by periods of low-intensity recovery. This type of exercise can be more effective at improving insulin sensitivity in a shorter amount of time compared to moderate-intensity exercise. It also aids in fat loss and improves cardiovascular health.

Other types of exercise, such as low impact cardiovascular exercise, yoga, and strength and flexibility, can also be generally helpful. Anytime our muscles are working, this is helping to manage blood glucose.

Recommendations for Frequency

  • Aerobic exercise: Aim for at least 150 minutes of moderate-intensity or 75 minutes of vigorous-intensity aerobic activity per week.
  • Strength training: Perform at least two sessions of strength training each week, targeting major muscle groups.
  • HIIT: Try including one or two sessions of HIIT per week if you’re able to do higher intensity exercises safely.

Additional Tips

  • Stay consistent: Regular physical activity is crucial for long-term blood glucose management.
  • Monitor blood glucose: Check your blood glucose before and after exercise, as menopause can cause fluctuations.
  • Hydration and Nutrition: Staying hydrated and eating balanced meals can help maintain stable blood glucose levels during and after workouts.
  • Talk to your Healthcare Team: If your blood glucose remains higher than normal for you, a medication adjustment may be required. 

Incorporating a mix of these exercises can help you manage blood glucose, reduce menopause-related symptoms, and enhance overall health. Ensuring an adequate intake of protein, and simple and complex carbohydrates in your eating plan is essential to managing the inevitable fluctuations in blood glucose that can come during the perimenopause transition. Appropriate nutrition and regular exercise are also a great way to mitigate some of the weight gain in menopause and to enhance body confidence – one of the keys to well-being as we age.


About the Author

Dr. Mala Freeman-Kwaku, lead physician at Arboretum Gynecology, has over 22 years of experience specializing in gynecologic care, including treating uterine fibroids, heavy menstrual bleeding, and menopausal symptoms. A graduate of the University of Virginia and Georgetown University Medical Center, she transitioned from a group practice to create a more intimate healthcare environment, successfully rebranding her practice while maintaining patient loyalty. Skilled in hysteroscopy and advanced procedures like the Sonata fibroid ablation, she shares her expertise as a speaker for Gynesonics and through her private consulting firm, MFK Advising Group, LLC. Dr. Freeman-Kwaku is married with four children, enjoys traveling, and remains active in her church and community.

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Dr. Mala Freeman-Kwaku
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