Women With T1D: What the Research Says About Perimenopause & Menopause

Perimenopause and menopause involve major hormonal changes. For women living with type 1 diabetes (T1D), these shifts can affect blood glucose, insulin needs, and overall health. While research specifically in T1D is limited, current studies and clinical experience provide important insights.

Hormones & Insulin Sensitivity

• Estrogen tends to improve insulin sensitivity. A large meta-analysis of postmenopausal women found that hormone therapy (estrogen alone or estrogen plus progesterone) significantly reduced insulin resistance compared with placebo. (Menopause.org)

• Progesterone can increase insulin resistance. Research shows it affects insulin signaling and glucose uptake, which may mean higher insulin needs during periods of higher progesterone. (J Physiol)

• Evidence specific to women with T1D is limited, so insulin responses can vary widely.

Hormone Replacement Therapy (HRT)

Hormone therapy is often used to manage menopause symptoms:

• Estrogen: Helps regulate temperature, support bone density, maintain vaginal and urinary health, and support mood and sleep.

• Progesterone: Added for women with a uterus to protect the uterine lining from estrogen-stimulated thickening, which reduces the risk of endometrial cancer. (Cleveland Clinic)

• Women who’ve had a hysterectomy typically receive estrogen-only therapy.

• HRT may affect insulin sensitivity differently depending on the type and dose of hormones, so monitoring blood glucose is important.

How Hormonal Changes Affect Women With T1D

• Declining estrogen can decrease insulin sensitivity.

• Progesterone may increase insulin resistance and insulin needs.

• Many women notice more variability in blood glucose during perimenopause and menopause.

• Effects vary between individuals and over time.

Coordinated Medical Care Is Key

Because hormonal changes affect insulin and overall health, it’s common to work with multiple specialists:

• Endocrinologists: Manage diabetes and insulin dosing.

• OB/GYNs or menopause specialists: Focus on hormone therapy and menopausal health.

• Hormone or metabolism specialists: May provide tailored guidance on HRT and metabolic care.

Specialists may give different recommendations. Bringing glucose logs and questions to appointments helps coordinate care and make informed decisions.

Practical Takeaways

✅ Hormones influence insulin sensitivity: estrogen may reduce resistance; progesterone may increase it.
✅ HRT often includes both estrogen and progesterone (if the uterus is intact) for symptom relief and uterine protection.
✅ Blood glucose may fluctuate during perimenopause and menopause — monitoring and adjustments may be needed.
✅ Regular visits with endocrinologists, OB/GYNs, and hormone specialists help balance diabetes and menopause care.
✅ Questions to bring to appointments:

• How might hormonal changes affect my glucose and insulin needs?

• Should HRT be considered, and what formulation is safest for me?

• What monitoring should I do for bone health, cardiovascular risk, and metabolism?

​

This article is based on peer-reviewed research and clinical evidence. It is for educational purposes only and not a substitute for medical advice. Always consult your healthcare providers regarding insulin, medications, and hormone therapy.

​