28: Menopause, Hormones, & Diabetes Prevention
Ep. 28
In this episode of Reset Recharge, Dr. Komal Patil-Sisodia explores a groundbreaking study that reveals how menopause hormone therapy (MHT) may actually reduce the risk of type 2 diabetes in perimenopausal women with prediabetes.
Dr. Komal unpacks the data from a major Diabetes and Metabolism study of over 6,500 women aged 46–60, showing that those who used hormone therapy were 30% less likely to develop diabetes. She explains the science behind how estrogen supports metabolic health — improving insulin sensitivity, lowering inflammation, reducing central fat gain, and supporting pancreatic function — and why timing, age, BMI, and ethnicity make all the difference.
Listen to the full episode:
🩺 How Menopause Hormone Therapy May Lower Diabetes Risk in Midlife Women
Understanding the connection between hormones, metabolism, and diabetes prevention
Menopause marks a profound biological transition in a woman’s life. It’s a time when the body recalibrates its hormonal landscape — often bringing symptoms like hot flashes, night sweats, sleep changes, and mood fluctuations. But beneath these visible shifts lies another, quieter transformation: how menopause affects metabolic health.
In recent years, researchers have begun uncovering just how deeply hormones — especially estrogen — influence blood sugar control, fat distribution, and inflammation. As estrogen levels drop, many women notice not only changes in energy and mood, but also in their metabolism: weight gain around the middle, higher fasting glucose levels, and worsening insulin resistance. These changes can increase the risk of type 2 diabetes, particularly in women already navigating prediabetes in their 40s or 50s.
That’s why new research exploring menopause hormone therapy (MHT) — also known as hormone replacement therapy (HRT) — is so exciting. Beyond easing classic menopausal symptoms, MHT may also offer metabolic protection, reducing the likelihood of developing diabetes during this hormonal transition.
In this episode of Reset Recharge, Dr. Komal Patil-Sisodia unpacks a 2024 study published in Diabetes and Metabolism by Dr. Shih and colleagues — and explains what it means for women, clinicians, and the future of personalized menopause care.
📊 What the Research Found
The study analyzed health data from over 6,500 women aged 46–60 who already had prediabetes before menopause. These women were followed for up to 20 years to see whether menopause hormone therapy influenced their risk of developing type 2 diabetes.
Some of the participants received hormone therapy — either estrogen alone or estrogen combined with progesterone — while others did not.
The findings were remarkable:
“The women who used hormone therapy were about 30% less likely to develop type 2 diabetes than those who didn’t.”
That translates to a hazard ratio of 0.69. In simpler terms, if 100 women were expected to develop diabetes, only 69 did with MHT — meaning 31 women avoided diabetes altogether. That’s a meaningful, long-term metabolic benefit.
However, the study also revealed that this effect wasn’t universal. Several factors shaped who benefited most:
Age: The strongest protection occurred in women aged 46–50, suggesting that earlier initiation matters.
Ethnicity: The benefits were statistically significant in white women, but not in Black or Asian women — underscoring the need for more inclusive research.
BMI: Women with a BMI under 30 (normal to overweight range) saw clear benefits, whereas those with obesity (BMI ≥ 30) did not.
These findings reinforce that hormone therapy’s metabolic impact is highly individualized.
💡 Why Estrogen Influences Diabetes Risk
So why might estrogen therapy help prevent diabetes?
Here are the main biological mechanisms Dr. Patil-Sisodia outlines:
Improved Insulin Sensitivity
Estrogen enhances how muscles and fat cells respond to insulin, allowing glucose to enter cells more efficiently. This leads to lower fasting glucose and better A1C levels.Protection of Pancreatic Beta Cells
These are the insulin-producing cells in the pancreas. Estrogen helps them respond more effectively to blood sugar changes, reducing stress on the pancreas.Reduction in Central Adiposity
Menopause often causes fat to shift toward the abdomen — specifically visceral fat inside the abdominal cavity. This type of fat is highly inflammatory. Estrogen helps prevent that redistribution, leading to a healthier fat pattern.Lower Inflammation and Better Energy Balance
As estrogen declines, inflammation rises and metabolism slows. MHT counters this by keeping inflammation lower and helping women burn more energy efficiently.Improved Lipid and Liver Health
Estrogen therapy can improve cholesterol profiles and reduce the liver’s glucose output, helping stabilize blood sugar levels and support metabolic function.
Together, these effects explain how hormone therapy may act as a metabolic ally during the menopause transition.
🧠 The Timing Hypothesis: Why When You Start Matters
Timing is everything.
Dr. Patil-Sisodia explains the “timing hypothesis” — the idea that MHT provides the most benefit when started near menopause or even in perimenopause, rather than many years later.
When women begin therapy early, their blood vessels and insulin sensitivity are still relatively healthy. Estrogen can therefore exert protective effects more effectively. However, when therapy begins long after menopause, inflammation and vascular changes may blunt those benefits or even increase risks.
This is why current guidance from both the American Heart Association and the Endocrine Society supports what’s called the “window of opportunity” for initiating MHT — generally before age 60 or within 10 years of menopause.
⚖️ Not All Hormone Therapy Is the Same
The formulation and delivery method of MHT matter — a lot.
Estrogen Alone vs. Estrogen + Progestogen:
Women who have had a hysterectomy can safely take estrogen alone, while those with an intact uterus need both estrogen and progesterone to protect the uterine lining.
Dr. Patil-Sisodia emphasizes that micronized progesterone and dydrogesterone are metabolically neutral and preferred.Route of Administration:
Oral estrogen passes through the liver (the “first-pass effect”), influencing triglycerides and clotting factors.
In contrast, transdermal estrogen — delivered through patches, gels, or sprays — bypasses the liver, offering steadier hormone levels and lower clotting and inflammation risk.
For women with overweight, obesity, or cardiovascular concerns, this route is often the safer and more effective option.
In fact, some studies show transdermal estradiol improves glucose metabolism more favorably than oral formulations.
❤️ Balancing Benefits and Risks
Like any medical therapy, MHT isn’t without potential risks — such as clotting, breast cancer, or cardiovascular events. But evidence shows that when started early and appropriately individualized, the benefits outweigh the risks for many women.
“For women who have pre-diabetes or metabolic syndrome, menopause hormone therapy can serve as both symptom relief and metabolic protection — a double win.”
Dr. Patil-Sisodia underscores that personalization is key: MHT should be prescribed based on a woman’s age, health history, ethnic background, BMI, and personal goals.
🌸 The Takeaway: Individualized Menopause Care
To wrap up, this episode highlights several key insights:
Menopause hormone therapy can reduce diabetes risk by about 30% in the right population.
The benefits are strongest in younger perimenopausal women (ages 46–50) with BMI under 30.
Effects differ by ethnicity, so more diverse research is needed.
Transdermal routes and bioidentical progesterone may offer better metabolic profiles.
Most importantly, personalized medicine matters — MHT is not a one-size-fits-all solution.
If you’re approaching menopause and wondering whether hormone therapy is right for you, have a conversation with your clinician about your risks, metabolic health, and goals. Hormone therapy can be more than symptom management — it can be a tool for long-term health and prevention.