Is Insulin Resistance to Blame for Menopause Weight Gain?

Here’s what you need to know about insulin resistance, weight, and wellbeing.

It’s difficult to escape social media posts about insulin resistance (IR) causing weight gain in perimenopause. Influencers zero in on women frustrated by midlife weight gain that seems to come from left field. Grifters peddle IR as the reason for your expanding waistline, then offer a fix (No fruit! No bread! Buy my exercise program!) that promises to melt away so-called stubborn menopause fat. Some influencers, including a certain popular menopause doctor, speak with such certainty about the relationship between IR and weight gain that I wonder if they’ve read the research.

Don’t get me wrong. Insulin resistance is serious, but midlife weight gain is rarely down to just one thing. Let’s separate fact from fiction about IR.

Insulin and Insulin Resistance

Insulin is a hormone made by the pancreas. Hormones are chemical messengers that tell cells what to do. During digestion, food is broken down to glucose, the energy for cells, and blood levels of glucose rise after eating. Elevated blood glucose (BG) triggers the pancreas to release insulin, which attaches to cells and instructs them to absorb glucose from the bloodstream to keep levels within a normal range.

Insulin resistance happens when cells stop responding efficiently to insulin. In IR, the pancreas produces more and more insulin to try to move glucose into cells, which is like throwing good money after bad because it doesn’t solve the problem. Eventually, the pancreas becomes overworked, insulin production slows, and blood glucose levels remain high.

Why Insulin Resistance Is Dangerous to Your Health

Insulin resistance is associated with the development of prediabetes, type 2 diabetes, and several other chronic conditions.

You can’t feel IR. When the pancreas is still producing enough insulin to overcome the resistance, you may have no symptoms of IR, but the damage is being done. For example, as a result of IR, your blood glucose levels can qualify for prediabetes for many years before a diagnosis of type 2 diabetes.

The term “prediabetes” actually diminishes the danger of this condition. In addition to type 2 diabetes, prediabetes increases the risk for heart disease and stroke. A 2019 review in Clinical Diabetes and Endocrinology found that during a three to five-year time frame, about 25% of people with prediabetes developed type 2 diabetes, and upwards of 70% of those with prediabetes ultimately went on to have type 2 diabetes during their lifetime.

In addition to type 2 diabetes, people with prediabetes and IR are prone to other conditions, including high blood pressure, nonalcoholic liver disease (also called metabolic dysfunction-associated steatotic liver disease, or MASLD), and unhealthy levels of cholesterol and triglycerides (fat) in the blood.

Several factors influence the risk for IR, including genetics, aging, a history of gestational diabetes or giving birth to a baby weighing nine pounds, certain medications such as steroids and antidepressants, physical inactivity, and having overweight or obesity. Click here for a more complete list of risk factors for IR.

Does Perimenopause Result in Insulin Resistance?

Declining estrogen levels affect insulin’s function. One 2007 Menopause study concluded menopause was an independent risk factor for elevated fasting blood glucose levels, a sign of IR. Researchers writing in 2022 in eBioMedicine found that lower estrogen levels in postmenopausal women were associated with higher blood glucose concentrations after eating independent of age, which may indicate IR. And a 2018 Diabetes study concluded that premenopausal women have greater insulin sensitivity (less IR) than postmenopausal women.

Though this research points to menopause’s involvement with IR, it doesn’t mean that every woman will develop IR and elevated blood glucose levels. Nor does it mean that your midlife weight gain is due to IR alone.

Insulin Resistance and Body Weight

The research suggests that IR doesn’t result in weight gain. A 2024 Nutrition & Diabetes study found that excess calorie intake is the reason for weight gain and that IR is a result of weight gain, not the other way around. It’s also worth noting that it’s possible to have IR even when your weight falls in the healthy range.

The menopause transition can create the perfect storm for IR, especially if you started perimenopause with overweight or obesity. Changes in body composition in perimenopause, which can last for years, contributes to a greater risk for IR.

A 2019 JCI Insight study that included more than 3,000 ethnically-diverse women from across the U.S. found that black and white women gained fat mass and lost lean mass, including skeletal muscle, during the transition to menopause. This is noteworthy because skeletal muscle tissue consumes and stores more glucose from the blood stream than any other tissue, making it a major player in regulating BG and helping to prevent IR.

Where you gain weight in midlife also matters for IR. As estrogen levels drop in perimenopause, women tend to add pounds in the belly area. That extra mass is predominantly visceral fat, found behind the abdominal wall and surrounding internal organs. Visceral fat is different from subcutaneous fat, the type of fat found on buttocks, thighs, and arms because it presents more of a health threat. Visceral fat produces compounds called cytokines that incite inflammation, enhance skeletal muscle breakdown, and aggravate IR.

A waist circumference (WC) of ≥ 35 inches (90 cm) is a sign of excess visceral fat. It’s easy enough to measure waist circumference at home to help determine if you’re at risk for IR. While standing, place a tape measure just above your hipbones after you breath out. Though this method can’t separate visceral fat from the subcutaneous kind, experts say it provides a good idea of your chances for IR. Plus, it’s free and convenient.

Body weight alone isn’t a reliable indicator IR risk. The combination of WC and body mass index (BMI) work better together. That’s because it’s possible to have a BMI in the healthy range and excess visceral fat at the same time. Waist circumference could be just as telling about IR, if not more, in people with a lower BMI. Calculate your BMI here.

Testing for IR is not routine because it’s complex and impractical and typically reserved for research studies. Chances are that your doctor or nurse practitioner will infer a diagnosis of IR from other signs. For example, a combination of elevated triglycerides, high fasting BG, and a big waist circumference increase the chances for IR.

How to Prevent and Manage Insulin Resistance in Midlife

It’s unlikely that menopause alone causes IR in all women and is the sole cause of menopause weight gain. However, IR contributes to making weight control more difficult, especially since women in perimenopause are also aging, which increases the likelihood of IR. And other IR risk factors, including a lack of exercise or poor diet, further complicate matters. The good news is that you don’t need to take drastic measures, such as giving up your favorite foods, intermittent fasting, or suffering through killer work outs to improve insulin sensitivity.

A balanced eating plan with adequate carbohydrate, protein, and healthy fat that promotes weight loss, if necessary, is essential for preventing and reducing IR. It’s not necessary to completely cut out carbohydrates, the nutrient the body most easily converts to glucose, but you may need to tweak your food choices.

Switching to foods with complex carbohydrates instead of those with simple sugars helps your body maintain more normal blood glucose levels. Soluble fiber, a complex carbohydrate found in foods such as oats, berries, apples, lentils, and legumes, forms a gel with water in your digestive tract to slow digestion, which may decrease the amount of insulin necessary to process glucose in the blood stream.

Learn more about carbohydrates here, and find out how much fiber you need every day and how to get it here.

As for that stubborn belly fat influencers go on about, it's no harder to lose than subcutaneous fat. In truth, visceral fat is actually easier to get rid of than subcutaneous fat because it’s more sensitive to being broken down by the body. A 2023 British Journal of Sports Medicine pooled the results of 36 randomized controlled trials and found that calorie reduction and regular exercise helped people lose visceral fat.

Physical inactivity is a risk factor for IR, but it doesn’t take much exercise to see an improvement in insulin levels. A 2018 PLOS One study found that exercise plus a modest weight loss reduced IR. Women (postmenopausal) and men with overweight or obesity, ages 40 to 65, did high or moderate intensity aerobic exercise (such as brisk walking) for eight months, but weren’t instructed to change their eating patterns.

At the end of the study, insulin sensitivity improved more in those who lost at least three percent of their starting weight than in those who lost less. (As an example, three percent of 175 pounds is about 5 pounds). Insulin sensitivity improved the most in the moderate-intensity exercise group who walked the equivalent of about 12 miles a week at a brisk pace, which is a little more than two miles a day, five days a week.

Exercise reduces the dependency on insulin to deliver energy to muscle cells, which helps prevent and manage IR. Skeletal muscle absorbs upwards of 70% of circulating BG, which helps offset IR. Even better, muscle cells can absorb glucose from the blood when you exercise without using insulin, another reason why exercise is central to reducing IR.

Which exercise is best for reducing IR? A 2017 BMJ Open Sport & Exercise Medicine review found that aerobic activities and resistance exercise (strength training) can improve blood glucose levels and IR, and that a combination of the two may be more effective than either type of exercise alone. That conclusion echoes the expert recommendation of at least 150 minutes of moderate intensity exercise and two strength training sessions weekly.Strength training helps to maintain and build muscle mass. Make sure to include adequate protein to support this process every day.

Don’t overlook the benefits of NEAT (non-exercise activity thermogenesis), the energy you burn doing everything but eating, sleeping, and exercising. In a 2014 British Journal of Sports Medicine study of women and men over the age of 60 that lasted more than 12 years, researchers found that higher levels of NEAT, such as taking the stairs, doing housework, and gardening, were associated with a healthier waist circumference and more favorable triglyceride levels. Climbing stairs was associated with a lower risk for type 2 diabetes over a span of 12 years in a 2023 Journal of Sport and Health Science study of more than 450,000 older adults.

The Bottom Line

Several factors contribute to weight gain during the menopause transition and afterwards, but the solutions are basic and timeless, and don’t involve drastic measures. Touting IR as the sole reason for weight gain is a major red flag.

What questions do you have about insulin resistance? Let me know!