Hormones and Your Blood Sugar: The Hidden Link

Are you a woman in your late 30’s or beyond, and noticing your body inexplicably changing shape?

Or perhaps your energy levels are all over the place; sugar cravings are taking over; your HbA1c levels are creeping up; or you’re feeling irritable and tired, with no obvious reasons why…

When most people think of menopause, they picture hot flushes, night sweats, irregular periods, and mood swings — but there’s another major change happening quietly beneath the surface. As hormone levels shift during perimenopause and menopause, your body’s ability to regulate blood sugar and insulin also changes — often dramatically (1).

These shifts don’t just affect how you feel day to day either; they also impact your risk of long-term health issues such as type 2 diabetes, heart disease, metabolic syndrome and even dementia (2,3,4).

Up to 30% of women in perimenopause and menopause have prediabetes, while around 20% of menopausal women go on to develop type 2 diabetes.

But the good news?

Understanding what’s going on below the surface — and taking evidence-based action to reverse this process — can help you protect your health, energy, and vitality for years to come.

Let’s explore how and why hormonal changes influence your metabolism; what symptoms to look out for; and most importantly, what you can do to stay healthy through menopause and beyond!

The Hormonal Connection: How Estrogen and Progesterone Shape Blood Sugar Balance

Your hormones are powerful chemical messengers that influence nearly every system and cell in your body — including how your body processes and stores energy.

Estrogen and progesterone are the two primary female reproductive hormones, and they both play vital but often poorly recognized roles in blood sugar regulation:

• Estrogen helps your cells respond effectively to insulin — the hormone that allows glucose to move from your bloodstream into your cells for energy. In other words, it makes your body more insulin sensitive, and more able to use glucose for energy – which in turn keeps blood sugar levels stable.
• Progesterone can have the opposite effect, slightly increasing insulin resistance (cue carb cravings before your period!), but in balance with estrogen, it helps keep blood sugar stable before menopause.

Throughout the reproductive years, these hormones normally fluctuate smoothly each month in a coordinated rhythm, keeping things in balance. But during perimenopause (the transition leading up to menopause), this rhythm begins to drastically alter…

How Hormones Change Everything

Perimenopause is a time of huge hormonal transition, where both estrogen and progesterone can start to fluctuate wildly from month to month.

Many women notice common symptoms such as hot flushes, mood changes, changing menstrual cycles, or sleep disturbance – but as this transition occurs, it can have major impacts on your blood sugar levels too – even if you have no history of diabetes.

During perimenopause, estrogen and progesterone levels may be very high some months or during certain times of your cycle, before plummeting back down again around your period. This roller-coaster often occurs for years, until hormone levels eventually stabilise and stay low, and menopause occurs (defined as no periods occuring for >12 months).

And it’s not just a lack of progesterone and estrogen that messes with blood sugar and metabolism – any sharp decline in levels can disrupt the delicate balance your body once relied on. This means whenever there is less estrogen available, your cells become less sensitive to insulin, and blood sugar levels can potentially rise — even if your diet and lifestyle haven’t changed…

Where Hormones and Insulin Meet

What makes this particularly complex, is that estrogen and progesterone receptors exist in many tissues directly involved in metabolism — including the liver, muscle, fat tissue, gut, and pancreas.

This means when estrogen levels fall:

• The liver may produce more glucose than needed, causing blood sugar levels and insulin to rise

• Muscles become less efficient at using glucose, meaning less sugar is taken out of your blood to be used, and muscles also tire more easily (muscle is one of the biggest consumer and storer of glucose in the body).

• Fat distribution shifts from hips and thighs to around your tummy — increasing visceral fat (fat around your abdominal organs), which in turn releases inflammatory molecules that further drive insulin resistance.

• Your pancreas may begin producing more insulin to compensate, leading to chronically high insulin levels (hyperinsulinemia), and a condition called insulin resistance – where your cells stop responding to insulin, making it harder for your cells to process and use glucose from your blood.

These changes collectively form the foundation of menopausal insulin resistance, a key contributor to weight gain, fatigue, and long-term metabolic risk (5).

What To Watch For: Common Symptoms and Signs of Blood Sugar Problems

Not every woman experiences blood sugar issues the same way, but the following symptoms can be related to changing blood sugar levels and insulin resistasnce during perimenopause and menopause — even before any blood tests flag that there is a problem:

• Energy crashes after meals, especially meals high in carbs (reactive hypoglycemia, or low blood sugar)
• Difficulty losing weight, or unexplained weight gain (especially new abdominal fat, often called “meno belly”)
• Sugar or carbohydrate cravings
• Brain fog and irritability, as your brain struggles to get enough energy to function
• Poor sleep and increased night sweats (which can worsen glucose swings)
• More frequent urinary tract infections, due to higher blood sugar levels
• An increase in triglyceride cholesterol, or a decrease in HDL (good) cholesterol levels
• New onset of high blood pressure

You may be at higher risk of insulin resistance and type 2 diabetes if you are obese; have a family history of type 2 diabetes; have a history of polycystic ovary syndrome or gestational diabetes – if these apply to you, then proactive screening is especially important.

Because these symptoms can overlap with other classic hormonal symptoms or health issues, early metabolic changes are also often missed. Yet, catching them early is absolutely critical for preventing longer term health issues.

The Bigger Picture: Long-Term Health Implications

Changing hormones and blood sugar levels don’t just cause symptoms and short term issues either – they play a huge role in raising the risk of long term health conditions too, including Type 2 diabetes, cardiovascular (heart) disease, metabolic syndrome, and dementia.

1.Type 2 Diabetes:

Estrogen has a protective effect on glucose metabolism — so when levels drop, insulin resistance increases, and the risk of developing type 2 diabetes rises.

Some studies suggest that as many of 30-40% of women in menopause are prediabetic, with a large number of these women being undiagnosed (3). This increased diabetes risk is even higher in women who have gone into menopause suddenly due to surgery or medical treatment, and persists after menopause, even in women who maintain a healthy lifestyle, underscoring the strong hormonal influence (6). And these issues are becoming rapidly more common – with a US study showing rates of insulin resistance increasing from 22.5% to 30.2% over the past 20 years. The researchers in this study were so concerned, they called for urgent targeted public health strategies to address and screen for metabolic health in midlife women (9).

2. Cardiovascular Disease

Estrogen also supports healthy blood vessels and favorable cholesterol levels. When estrogen falls:

• LDL (“bad” cholesterol) and triglycerides rise.
• HDL (“good” cholesterol) tends to fall.
• Blood pressure can increase.
• Fat accumulates around the midsection.

While most people know about the importance of healthy cholesterol and blood pressure to prevent heart disease, many women may not be aware of how big a role blood sugar plays in their heart health.

Studies show that women are more likely than men to have undiagnosed diabetes or prediabetes; increasing their risk of undiagnosed heart disease (7)

Diabetic women are also more prone to developing, being hospitalised with, and dying from heart disease than men with diabetes (7).

In fact, a 2025 study of 9,371 postmenopausal women, found that insulin resistance was in fact one of the biggest risk factors for higher all-cause and cardiovascular mortality — particularly in women under 60 (8).

And since heart disease is the LEADING cause of death in women after menopause, addressing insulin resistance isn’t just about weight or diabetes – it’s about survival.

3. Metabolic Syndrome

Metabolic syndrome — a cluster of insulin resistance, high blood pressure, elevated triglycerides, low HDL, and central obesity — becomes significantly more common after menopause. It in turn dramatically increases risk for both type 2 diabetes and cardiovascular disease, for the reasons just mentioned.

During perimenopause, it’s estimated that around 20–25% of women have metabolic syndrome, with this number increasing sharply after menopause- with as many as 55% of menopausal women meeting criteria for metabolic syndrome.

Diving Deeper – How Estrogen, Gut Health and HRT Impacts Your Metabolism

While research in women has historically been sorely lacking, exciting new research is giving us vital insights into how hormonal changes impact directly on our health.

One 2024 study (10) showed that estrogen directly enhances insulin sensitivity by:

• Supporting GLUT4 transporters, the ‘key’ that allows glucose to move from our bloodstream into our cells
• Improving the efficiency of mitochondria in muscle tissue (these are the powerhouses in our cells that are responsible for producing energy)
• Helping to regulate inflammation levels, and production of glucose from our liver.

This means when estrogen levels drop, these processes weaken — contributing to higher fasting glucose and reduced metabolic flexibility.

The Gut Connection

Emerging evidence also highlights the gut microbiota as a key player in menopausal metabolism. A 2024 Diabetes, Obesity and Metabolism paper found that menopausal changes in gut bacterial composition, were associated with increased visceral fat, insulin resistance, and inflammation (11).

This highlights the importance of ‘feeding our gut bugs’ with fiber and probiotic-rich foods during and after the menopausal transition (for more info on looking after your gut health, see our article here)

How Menopausal Hormone Therapy (MHT/HRT) affects Insulin Resistance

You may well now be thinking ‘if estrogen is so important for metabolic health, can HRT help’?

In 2024, a major meta-analysis looked at just this, and reviewed 17 randomized controlled trials (over 29,000 women) to examine whether HRT could help stabilise blood sugar levels, and improve insulin sensitivity after menopause. And the findings were exciting – confirming that hormone replacement therapy (HRT) can significantly reduce insulin resistance in postmenopausal women — with estrogen-only therapy showing the strongest effect (12).

This means MHT/HRT may be a valuable addition to lifestyle strategies to help support metabolic health during menopause and beyond when used appropriately, and when safe to do so.

Summing It Up: The Mechanisms in Motion

While this all may sound fairly complicated, think of hormones as conductors of a metabolic orchestra, talking to almost every cell in your body.

This means when estrogen and progesterone decline, several things happen simultaneously:

• Insulin signalling weakens — cells don’t respond as well, so blood sugar stays elevated.
• Visceral (tummy) fat increases, and releases inflammatory compounds that further worsen insulin resistance.
• The liver produces more glucose (gluconeogenesis).
• Muscle mass declines, reducing glucose uptake capacity.
• Cortisol levels may rise (especially with poor sleep or stress), further impairing blood sugar control.
• Gut microbiota changes, affecting nutrient absorption and inflammation.

Each factor adds up — and together, they create the perfect storm for midlife metabolic change.

Tests To Ask Your Doctor About

As a result, many experts are now recommending that women start metabolic screening early — ideally during perimenopause when symptoms first start to appear (10)

This screening should include:

• HbA1c (average blood sugar over three months).
• Lipid profile (cholesterol levels)
• Waist circumference, and waist to hip ratio (to look for increased visceral fat)
• Blood pressure (to screen for heart risk factors)
• Fasting glucose and insulin (to calculate HOMA-IR – this test is generally not funded in NZ, but can be a useful early marker of insulin resistance)

Optimal (ideal) levels for these are as follows:

HbA1c – 35mmol/L or less

• 35-40mmol/L can indicate insulin resistance, is developing
• 40-49mmol indicates prediabetes
• >50mmol is diagnostic for diabetes)
• Also look at trends – is your HbA1c creeping up gradually, even if its still in the ‘normal’ range?

Cholesterol

• Total cholesterol: Less than 4 mmol/L
• LDL cholesterol (bad cholesterol): Less than 2 mmol/L, although up to 3.5mmol/L may be acceptable if no other cardiovascular risk factors are present
• Triglycerides: Less than 1.7 mmol/L
• HDL cholesterol (good cholesterol): Greater than 1 mmol/L
• Total cholesterol:HDL ratio: Less than 4
• Triglyceride to HDL ratio: Ideal is less than 0.87; above 1.74 is too high (A lower TG:HDL ratio is better and indicates improved insulin sensitivity and lower cardiovascular risk)

Waist/hip Ratio (WHR):

• Waist circumference <81cm
• Waist to hip ratio <0.81

Blood pressure:

• Normal: <130/80mmHg
• Optimal <120/70mmHg

Proactively monitoring these every 6–12 months through the menopausal transition means you can keep a close eye on your metabolic health, and take action early if changes occur – hopefully long before any other health issues develop!

Evidence-Based Strategies to Support Blood Sugar and Insulin Health

While hormonal changes are inevitable, there’s so much you can do to stay metabolically healthy — and most of it starts with lifestyle.

In fact the evidence to support a healthy lifestyle to optimise wellbeing in menopause is so strong, that the theme for World Menopause Day 2025 was Lifestyle Medicine in Menopausal Health!  This was based around a brand new study showing just how powerful lifestyle strategies can be to optimise wellbeing during perimenopause and beyond (13).

You don’t need to eat a perfect diet or join the gym to get the benefits either – it’s those small daily habits that make the difference:

1. Prioritise Balanced Nutrition

A stable blood sugar day (and healthy lifestyle) begins on your plate. Eating regular balanced meals is crucial for healthy blood sugar levels; and to help your cholesterol, heart health, and metabolic health too (14).

Here’s a few tips to get started:

• Choose fiber-rich carbohydrates: vegetables, oats, beans, lentils, and whole grains help slow glucose absorption. Aim for around 25% of your plate to be fibre rich carbs.
• Include lean proteins: chicken, fish, tofu, eggs, or legumes support muscle mass and steady energy. Ideally women in peri/menopause should aim for 1-1.2g of protein per kg of lean body weight per day (for a 60kg woman this would be 60-75g/protein spread across the day)
• Add a finger sized serving of healthy fats: olive oil, avocado, nuts, and seeds improve insulin sensitivity.
• Limit highly processed foods and added sugars, these can spike insulin and blood sugar levels and worsen resistance. Keep them for occasional treats instead!
• Eat mindfully: slower meals and balanced portions reduce post-meal glucose spikes.

Patterns like the Mediterranean diets also show specific benefits for postmenopausal women, with studies showing that menopausal women who follow a plant focused Mediterranean diet have healthier cholesterol and weight; lower blood pressure; better bone and muscle health; lower levels of inflammation; and a reduced risk of insulin resistance and type 2 diabetes (15).

We cover Mediterranean and Blue Zones diets in depth (with over 60 original plant based recipes) in our Nutrition course if you’d like to learn more.

2. Move for Metabolic Strength

Exercise is one of the most powerful tools we have for improving insulin sensitivity, and staying healthy through the menopausal transition (16)

Ideally, aim for:

• 150 minutes of moderate aerobic activity weekly (brisk walking, cycling, swimming).
• 2–3 strength training sessions to preserve muscle mass — essential for glucose uptake and long-term metabolic health.
• 1-2 bursts of high intensity intervals per week to help heart health (such as 6-8 30 second sprints, with 1-2 minutes of rest in between) (17, 18)

However every bit of movement matters if you’re just getting starting, as even short bouts of activity (such as a 10-minute walk after meals), can make a big difference to blood sugar levels and overall health!

3. Sleep and Stress Matter More Than You Think

Perimenopause often brings disrupted sleep and heightened stress — both of which can impair insulin sensitivity (19, 20, 21)

Try:

• A consistent sleep routine and cool bedroom environment.
• Relaxation techniques such as yoga, or breathwork.
• Setting boundaries, asking for help, and saying ‘no’ more often if you’re feeling overloaded
• Limiting caffeine, alcohol, and blue light/screens, especially near bedtime.
• Getting natural light and movement each day, ideally before midday to help set your body clock
• Magnesium, melatonin, or herbal sleep supplements may help
• Acupuncture, aromatherapy and massage have all been shown to improve sleep quality in menopausal women (22)
• If you’re struggling with sleep, consider CBT (cognitive behavioural therapy), which, along with mindfulness, is one of the most effective non pharmaceutical therapies for insomnia in menopause (22)
• HRT can also improve sleep and mood significantly in many women

Better sleep and stress that is kept manageable equals better metabolism, so make it a priority, not an afterthought!

For more in depth info on lifestyle strategies for peri/menopause, please check out our comprehensive ebook here.

4. Consider Helpful Supplements

While lifestyle should always come first, there are a a few supplements that have shown potential benefits:

• Vitamin D: supports insulin sensitivity and bone health (always follow recommended dosing) (23)
• Magnesium: involved in glucose metabolism; low levels are common in midlife women, and may be associated with an increased risk of insulin resistance (24)
• Omega-3 fatty acids: 1-2g/day may reduce inflammation and support heart health.
• Berberine: Can improve insulin sensitivity and blood sugar control; reduces HbA1c and triglycerides; activates AMPK (25).

Always discuss supplementation with your healthcare provider before starting anything new, as supplements can interact with prescription medication, and need to be tailored to your specific health needs.

5. Hormone Therapy (HRT)

When used appropriately, HRT can help alleviate menopausal symptoms and improve metabolic markers (12).

Benefits may include:

• Improved insulin sensitivity.
• Reduction in abdominal fat (although this is highly variable, and HRT may cause weight gain in some women)
• Better lipid profiles.

However, HRT isn’t always suitable for everyone — especially women with a history of breast cancer, blood clots, or certain cardiovascular conditions. A personalised discussion of the risks and benefits with a doctor experienced in menopause case is essential!

6. The Role of Continuous Glucose Monitoring

While standard screening tests such as HbA1c, lipids, blood pressure, and waist circumference remain key to monitoring metabolic health, continuous glucose monitors (CGMs) may be a helpful addition for some women.

Designed originally for diabetics, they are being used increasingly to support wellbeing (26) in people without diabetes (especially in those with prediabetes/insulin resistance), as they provide real-time feedback on how meals, stress, and exercise impact blood sugar.

While research into CGM use in non diabetics is limited, one recent study showed that brief periods of CGM monitoring during perimenopause and menopause can play a role in helping to detect insulin resistance and altered blood sugar levels early, to identify and empower women during this time (27)

These factors may make CGM’s a valuable tool for self-awareness and motivation.

You can buy CGM’s online in New Zealand (Freestyle Libre, Dexcom, and Linx are the most commonly used brands).

We also run a live CGM challenge twice a year – check out our course page for the latest info, or get in touch at hello@yourlifestylemedics.com to find out more.

Putting It All Together: A Practical Roadmap

Perimenopause is not just about surviving symptoms — it’s about understanding what your body needs in this next chapter.

Hormonal changes in perimenopause and menopause profoundly influence blood sugar, insulin, and overall metabolic health. As estrogen and progesterone levels decline, insulin resistance often increases — raising risks for diabetes, heart disease, and metabolic syndrome.

But with early screening, smart lifestyle choices, and evidence-based medical support, these risks can be managed — even reversed.

Here’s a simple action framework you can use:

• Screen early – ask your doctor for fasting glucose, HbA1c, blood pressure, lipids, and waist/hip ratio when you suspect perimenopause is starting; redo these every 6-12 months as needed
• Eat for balance – include protein and high fiber foods at every meal.
• Move regularly – ideally with a mix of both aerobic and resistance training.
• Sleep and stress – prioritise rest and emotional regulation.
• Reassess often – your needs evolve through perimenopause and beyond, and changing strategies along the way isn’t just smart thinking, it’s key to a healthy life!

Remember: menopause is a natural biological transition, not a disease. With awareness and proactive care, it can be a time of renewed strength and vitality.

You also have far more control over your health and destiny than you might think!

By supporting your body with gentle nourishment, movement, rest, and compassion, you can move through menopause with strength, clarity, and hope, and optimise your long-term wellbeing and metabolic resilience.

Want to learn more?

Why not check out our in depth Peri/Menopause ebook; our Nutrition, Movement, Sleep, Stress or flagship Reboot courses; join one of our live challenges (which are run regularly throughout the year); or book a 1:1 personalised consultation (NZ only). We’d love to help you!

Perimenopause and menopause don’t need to be feared; with the right knowledge and strategies, you can discover how to thrive, not just survive through this time, and info the future❤️

References:

1. Otsuki M, Kasayama S, Morita S, Asanuma N, Saito H, Mukai M, Koga M. Menopause, but not age, is an independent risk factor for fasting plasma glucose levels in nondiabetic women. Menopause. 2007 May-Jun;14(3 Pt 1):404-7. doi: 10.1097/01.gme.0000247014.56254.12. PMID: 17213751.
2. Menopause: a global health and wellbeing issue that needs urgent attention Delanerolle, Gayathri Pathiraja, Vindya et al. The Lancet Global Health, Volume 13, Issue 2, e196 – e198
3. Heianza Y, Arase Y, Kodama S, Hsieh SD, Tsuji H, Saito K, Shimano H, Hara S, Sone H. Effect of postmenopausal status and age at menopause on type 2 diabetes and prediabetes in Japanese individuals: Toranomon Hospital Health Management Center Study 17 (TOPICS 17). Diabetes Care. 2013 Dec;36(12):4007-14. doi: 10.2337/dc13-1048. Epub 2013 Oct 29. PMID: 24170752; PMCID: PMC3836104.
4. Mervosh N, Devi G. Estrogen, menopause, and Alzheimer’s disease: understanding the link to cognitive decline in women. Front Mol Biosci. 2025 Jun 30;12:1634302. doi: 10.3389/fmolb.2025.1634302. PMID: 40661313; PMCID: PMC12256231.
5. Bermingham KM, Linenberg I, Hall WL, Kadé K, Franks PW, Davies R, Wolf J, Hadjigeorgiou G, Asnicar F, Segata N, Manson JE, Newson LR, Delahanty LM, Ordovas JM, Chan AT, Spector TD, Valdes AM, Berry SE. Menopause is associated with postprandial metabolism, metabolic health and lifestyle: The ZOE PREDICT study. EBioMedicine. 2022 Nov;85:104303. doi: 10.1016/j.ebiom.2022.104303. Epub 2022 Oct 18. PMID: 36270905; PMCID: PMC9669773.
6. Ehn-Young Kim, Yae-Ji Lee, Yu-Jin Kwon, Ji-Won Lee. Age at menopause and risk of metabolic dysfunction-associated fatty liver disease: A 14-year cohort study. Digestive and Liver Disease, Volume 56, Issue 11, 2024 Pages 1880-1886. https://doi.org/10.1016/j.dld.2024.05.003.
7. Yoshida Y, Wang J, Zu Y, Fonseca VA, Mauvais-Jarvis F. Rising Prediabetes, Undiagnosed Diabetes, and Risk Factors in Young Women. Am J Prev Med. 2023 Mar;64(3):423-427. doi: 10.1016/j.amepre.2022.10.001. Epub 2022 Nov 25. PMID: 36437142; PMCID: PMC9974837.
8. Qian Han , Chai Dayang , Zhao Shouming. Insulin resistance assessed by estimated glucose disposal rate is associated with all-cause and cardiovascular mortality among postmenopausal women. Frontiers in Endocrinology, Volume 16, 2025. DOI=10.3389/fendo.2025.1583991
9. Xi X, Pei C, Song N. Prevalence of and trends in obesity and insulin resistance among US perimenopausal women, 2003-2023. Menopause. 2025 Jul 22. doi: 10.1097/GME.0000000000002612. Epub ahead of print. PMID: 40694784.
10. Patel P, Patil S, Kaur N. Estrogen and Metabolism: Navigating Hormonal Transitions from Perimenopause to Postmenopause. J Midlife Health. 2025 Jul-Sep;16(3):247-256. doi: 10.4103/jmh.jmh_75_25. Epub 2025 Sep 5. PMID: 40951853; PMCID: PMC12431702.
11. Maffei VJ, Bertoni AG, Wood AC, Rotter JI, Crago O, Chen YI, Petrosino JF, Hoffman KL, Goodarzi MO, Jensen ET. Menopause factors and alterations in gut microbiota and insulin homeostasis: A cross-sectional analysis of the microbiome and insulin longitudinal evaluation study (MILES). Diabetes Obes Metab. 2025 Oct;27(10):5444-5454. doi: 10.1111/dom.16578. Epub 2025 Jul 30. PMID: 40735808.
12. Li T, Jiang NS, Kaskey J, Schnatz PF, Nudy M. Hormone therapy and insulin resistance in non-diabetic postmenopausal women: a systematic review and meta-analysis. Climacteric. 2025 Jun 18:1-9. doi: 10.1080/13697137.2025.2509844. Epub ahead of print. PMID: 40531213; PMCID: PMC12354064.
13. Anekwe, C. V., Cano, A., Mulligan, J., Ang, S. B., Johnson, C. N., Panay, N., … Nappi, R. E. (2025). The role of lifestyle medicine in menopausal health: a review of non-pharmacologic interventions. Climacteric, 28(5), 478–496. https://doi.org/10.1080/13697137.2025.2548806
14. Erdélyi A, Pálfi E, Tűű L, Nas K, Szűcs Z, Török M, Jakab A, Várbíró S. The Importance of Nutrition in Menopause and Perimenopause-A Review. Nutrients. 2023 Dec 21;16(1):27. doi: 10.3390/nu16010027. PMID: 38201856; PMCID: PMC10780928.
15. Gonçalves C, Moreira H, Santos R. Systematic review of mediterranean diet interventions in menopausal women. AIMS Public Health. 2024 Jan 10;11(1):110-129. doi: 10.3934/publichealth.2024005. PMID: 38617417; PMCID: PMC11007410.
16. Hyvärinen, M., Juppi, HK., Taskinen, S. et al. Metabolic health, menopause, and physical activity—a 4-year follow-up study. Int J Obes 46, 544–554 (2022). https://doi.org/10.1038/s41366-021-01022-x
17. Sun S, Zhang H, Kong Z, Shi Q, Tong TK, Nie J. Twelve weeks of low volume sprint interval training improves cardio-metabolic health outcomes in overweight females. J Sports Sci. 2019 Jun;37(11):1257-1264. doi: 10.1080/02640414.2018.1554615. Epub 2018 Dec 18. PMID: 30563431.
18. Hesketh Katie L. , Shepherd Sam O. , Wagenmakers Anton J. M. , Cocks Matthew , Strauss Juliette A. Effect of self-paced sprint interval training and low-volume HIIT on cardiorespiratory fitness: the role of heart rate and power output. Frontiers in Physiology, Volume 16 – 2025. DOI=10.3389/fphys.2025.1484722
19. Faris M. Zuraikat, Blandine Laferrère, Bin Cheng, Samantha E. Scaccia, Zuoqiao Cui, Brooke Aggarwal, Sanja Jelic, Marie-Pierre St-Onge; Chronic Insufficient Sleep in Women Impairs Insulin Sensitivity Independent of Adiposity Changes: Results of a Randomized Trial. Diabetes Care 2 January 2024; 47 (1): 117–125. https://doi.org/10.2337/dc23-1156
20. de Zambotti M, Sugarbaker D, Trinder J, Colrain IM, Baker FC. Acute stress alters autonomic modulation during sleep in women approaching menopause. Psychoneuroendocrinology. 2016 Apr;66:1-10. doi: 10.1016/j.psyneuen.2015.12.017. Epub 2015 Dec 21. PMID: 26766119; PMCID: PMC4788552.
21. Woods NF, Mitchell ES, Smith-Dijulio K. Cortisol levels during the menopausal transition and early postmenopause: observations from the Seattle Midlife Women’s Health Study. Menopause. 2009 Jul-Aug;16(4):708-18. doi: 10.1097/gme.0b013e318198d6b2. PMID: 19322116; PMCID: PMC2749064.
22. Wang Z, Yang H, Li S, Cheng L, Yuan Y, Bai Y, Su J, Li Y, Wang T, Xu Z. Effectiveness of nonpharmacological interventions for menopause-related insomnia: A systematic review and Bayesian network meta-analysis. Maturitas. 2025 Aug 30;202:108713. doi: 10.1016/j.maturitas.2025.108713. Epub ahead of print. PMID: 40907338.
23. Pérez-López FR, Chedraui P, Pilz S. Vitamin D supplementation after the menopause. Ther Adv Endocrinol Metab. 2020 Jun 5;11:2042018820931291. doi: 10.1177/2042018820931291. PMID: 32551035; PMCID: PMC7278294.
24. Laires MJ, Moreira H, Monteiro CP, Sardinha L, Limão F, Veiga L, Gonçalves A, Ferreira A, Bicho M. Magnesium, insulin resistance and body composition in healthy postmenopausal women. J Am Coll Nutr. 2004 Oct;23(5):510S-513S. doi: 10.1080/07315724.2004.10719391. PMID: 15466953.
25. Caliceti C, Rizzo P, Cicero AF. Potential benefits of berberine in the management of perimenopausal syndrome. Oxid Med Cell Longev. 2015;2015:723093. doi: 10.1155/2015/723093. Epub 2015 Feb 17. PMID: 25785174; PMCID: PMC4346702.
26. Klonoff DC, Nguyen KT, Xu NY, Gutierrez A, Espinoza JC, Vidmar AP. Use of Continuous Glucose Monitors by People Without Diabetes: An Idea Whose Time Has Come? J Diabetes Sci Technol. 2023 Nov;17(6):1686-1697. doi: 10.1177/19322968221110830. Epub 2022 Jul 20. PMID: 35856435; PMCID: PMC10658694.
27. Bermingham KM, Linenberg I, Hall WL, Kadé K, Franks PW, Davies R, Wolf J, Hadjigeorgiou G, Asnicar F, Segata N, Manson JE, Newson LR, Delahanty LM, Ordovas JM, Chan AT, Spector TD, Valdes AM, Berry SE. Menopause is associated with postprandial metabolism, metabolic health and lifestyle: The ZOE PREDICT study. EBioMedicine. 2022 Nov;85:104303. doi: 10.1016/j.ebiom.2022.104303. Epub 2022 Oct 18. PMID: 36270905; PMCID: PMC9669773.