Insulin Resistance & Menopause

Why this “master hormone” matters more than you think

January, when so many women are cleaning up their nutrition feels like the perfect time to talk about insulin resistance. This is one of the most important (and misunderstood) topics for women on the menopause journey, whether you’re just entering perimenopause or well past your final cycle.

It truly applies to all of us. So let’s talk about what insulin resistance actually is, why it matters so much in midlife, and how to recognize it.

So what is insulin resistance—and why is it relevant to menopause?

Insulin resistance is a state where your cells stop responding efficiently to insulin. When that happens, your body has to produce more and more insulin just to keep blood sugar stable.

This becomes especially relevant in menopause because shifting and declining estrogen makes women more prone to blood sugar dysregulation, visceral fat gain, inflammation, and metabolic slowdown. In other words, the hormonal changes of midlife make insulin resistance easier to develop—and harder to ignore.

This is why insulin is often described as a “master hormone.” It doesn’t just regulate blood sugar. It influences fat storage, inflammation, cardiovascular risk, hormone balance, and energy production. When insulin is chronically elevated, it quietly drives many of the symptoms women blame on “aging” or “bad genetics.”

What does insulin resistance actually do in the body—and why is it so important?

When cells stop responding to insulin, the pancreas compensates by making more of it. Blood sugar may stay normal for years, but insulin levels are working overtime behind the scenes.

In menopause, this pattern matters deeply. Declining estrogen increases insulin resistance in muscle and fat tissue, making women more susceptible to blood sugar swings, visceral fat accumulation, and long-term risks like type 2 diabetes and cardiovascular disease. This is also why weight gain—especially around the middle—can feel stubborn and unfair, even when “nothing has changed.”

How do you know if you have insulin resistance?

There is no single test that gives a clear yes-or-no answer. Clinically, insulin resistance is best assessed by looking at patterns—symptoms, physical signs, and labs together.

As described in clinical nutrition literature, “Symptoms of insulin resistance include metabolic inflexibility, fatigue (especially after eating), abnormally increased hunger, episodes of reactive hypoglycemia, and fat gain—especially visceral fat gain.”

Visceral fat is the deep, metabolically active fat stored around your abdominal organs like the liver and intestines. It strongly influences blood sugar regulation, insulin resistance, and inflammation. Visceral fat is not the soft, pinchable fat under the skin. It isn’t just cosmetic—it’s hormonally active and metabolically disruptive.

Physical signs that can offer clues

Some women notice physical signs that suggest insulin resistance may be present. These can include skin tags—especially around the neck, armpits, or groin, which are major lymphatic areas. Others notice darkening of the skin on the neck, armpits, elbows, knees, or knuckles, a condition called acanthosis nigricans.

Elevated blood pressure can also be a clue, whether it’s systolic (over 120) or diastolic (over 80). And yes, reversing insulin resistance can often help lower blood pressure.

Waist circumference is another simple, though unscientific, at-home screening tool. Measuring midway between the lower rib and the top of the hip bone (around belly-button level) can give insight into visceral fat. For many women, a waist measurement greater than about 33 inches suggests higher visceral fat and possible insulin resistance. A more precise method is waist-to-height ratio: a waist measurement greater than half your height raises concern.

It’s also important to say this clearly: you can have insulin resistance without any of these signs. That’s why context matters so much.

Blood tests: what helps and what doesn’t

One of the most important things to understand is this: you cannot rule out insulin resistance with a normal fasting glucose. It is very possible to have “normal” blood sugar and still be insulin resistant.

HbA1c (hemoglobin A1c) measures average blood glucose over the past three months. It measures glucose, not insulin. While useful, it does not rule out insulin resistance.

A more direct test is fasting insulin. This is a single blood draw taken after a 12-hour overnight fast, ideally in the morning when insulin should be low. A high fasting insulin suggests chronically elevated insulin and insulin resistance.

This test does have caveats. Insulin is an unstable molecule and must be processed correctly, or results may appear falsely normal or low. Extended fasting, very low-carbohydrate intake, or intense exercise before testing can also skew results. The key insight is this: if fasting insulin is high, insulin resistance is very likely. If it’s normal or low, you still don’t have the full picture.

Approximate interpretation:

• 8–12 mIU/L suggests mild insulin resistance
• 13–17 mIU/L suggests moderate insulin resistance
• Greater than 18 mIU/L suggests severe insulin resistance

Professor Warren Kidson notes that “fat breakdown is inhibited until fasting insulin falls below 8 mIU/L.” This is why changes in body composition can lag behind lifestyle changes. Even when you’re doing the right things, it takes time for insulin levels to come down—and meaningful fat loss follows after that shift.

Other labs that can suggest insulin resistance

Patterns in routine bloodwork often tell a story. Elevated triglycerides—especially above 150 mg/dL—strongly suggest insulin resistance, particularly when HDL is low. A high triglyceride-to-HDL ratio is one of the most useful markers to watch.

Elevated ALT, one of the liver enzymes, often points to fatty liver and insulin resistance when AST and GGT are normal. For some researchers, ALT is considered one of the single most important biomarkers for insulin resistance.

Elevated uric acid can also be a clue. According to Dr. Richard Johnson, this may reflect activation of the “survival switch,” though alcohol and other causes must be ruled out. Elevated hs-CRP (greater than 1 mg/L) can suggest underlying inflammation associated with insulin resistance.

Where does a continuous glucose monitor (CGM) fit in?

A continuous glucose monitor (CGM) doesn’t diagnose insulin resistance on its own—but it offers powerful real-time insight. A CGM shows how your blood sugar responds to meals, stress, sleep, and exercise throughout the day.

For many menopausal women, CGMs reveal exaggerated glucose spikes, delayed glucose clearance, or frequent dips—patterns that strongly suggest insulin resistance, even when fasting labs look “normal.” They are especially helpful for identifying reactive hypoglycemia and understanding how specific foods affect your body.

Think of a CGM as a pattern-recognition tool rather than a diagnostic test. It adds context and clarity, especially when combined with symptoms and lab data.

So… what now?

If you’re recognizing yourself in this, the good news is this: insulin resistance is highly responsive to targeted, individualized support—especially when addressed as early as possible.

The key isn’t doing more. It’s knowing what actually matters for your body, your hormones, and your stage of menopause.

If you want help understanding your labs, symptoms, or blood sugar patterns—and how insulin fits into your menopause journey—I’d love to support you.

👉 Book a complimentary health strategy call to explore what’s happening beneath the surface and map out your next steps with clarity and confidence.

💚 Pam / Earth Mama
🌿 Rooted in tradition. Backed by science. Focused on you.

Quick Reference: Markers That Can Suggest Insulin Resistance

• Fasting insulin
  • 8–12 mIU/L → mild insulin resistance
  • 13–17 mIU/L → moderate insulin resistance
  • 18 mIU/L → severe insulin resistance
  • Fat burning is inhibited until fasting insulin falls below ~8 mIU/L (Warren Kidson).
• Fasting glucose
  • May appear normal even in insulin resistance
  • Cannot be used alone to rule it out
• HbA1c (Hemoglobin A1c)
  • Reflects average blood glucose over ~3 months
  • Measures glucose, not insulin
  • Does not rule out insulin resistance
• Triglycerides
  • 150 mg/dL (1.7 mmol/L) strongly suggests insulin resistance
  • Especially concerning if HDL is low
• Triglyceride : HDL ratio
  • Higher ratios are one of the strongest indicators of insulin resistance
• ALT (Alanine aminotransferase)
  • Isolated elevation often suggests fatty liver and insulin resistance
  • Considered by some researchers to be one of the most important biomarkers
• hs-CRP (high-sensitivity C-reactive protein)
  • 1 mg/L suggests underlying inflammation associated with insulin resistance
• Uric acid (urate)
  • Elevated levels may indicate activation of the “survival switch” (Richard Johnson)
  • Other causes, such as alcohol intake, should be ruled out
• Waist circumference
  • 33 inches (approximate, unscientific screen) suggests higher visceral fat
  • Waist-to-height ratio >0.5 raises concern
• Continuous glucose monitor (CGM)
  • Reveals exaggerated glucose spikes, delayed glucose clearance, and reactive hypoglycemia
  • Helpful for identifying blood sugar patterns even when labs appear normal

Sources

• Briden, L. Metabolism Repair for Women.
• North American Menopause Society