Blood Sugar During Perimenopause: What Changes and How to Manage It
Blood sugar dysregulation is common in perimenopause. This guide explains the hormonal causes, symptoms to watch for, and dietary and lifestyle strategies to stay balanced.
How Hormones Affect Blood Sugar in Perimenopause
Estrogen plays an important role in how cells respond to insulin, the hormone that allows glucose to enter cells for energy. When estrogen levels are stable, cells are more sensitive to insulin and blood sugar is managed efficiently. As estrogen fluctuates and declines during perimenopause, insulin sensitivity tends to decrease. Cells become less responsive to insulin (a state known as insulin resistance), meaning the pancreas has to produce more insulin to achieve the same effect. This is further compounded by cortisol, which tends to rise with the stress and poor sleep common in perimenopause, and cortisol actively raises blood glucose. The result is a greater risk of blood sugar spikes and crashes.
Signs of Blood Sugar Dysregulation
Blood sugar imbalance does not always announce itself clearly, and many women attribute the symptoms to perimenopause in general without recognising the specific blood sugar component. Common signs include energy crashes after meals (particularly carbohydrate-heavy ones), strong cravings for sugar or refined carbohydrates, feeling shaky or irritable when meals are delayed, difficulty concentrating in the afternoon, waking between 2am and 4am, and difficulty losing weight despite dietary efforts. Over time, persistent insulin resistance can progress to prediabetes or type 2 diabetes, making perimenopause an important window for preventive action.
Eating for Blood Sugar Balance
Prioritising protein and fibre at every meal is the most effective dietary strategy for stabilising blood sugar. Protein slows gastric emptying and blunts the glucose response to carbohydrates. Fibre, particularly soluble fibre, has a similar effect. Eating carbohydrates as part of a complete meal rather than alone (for example, rice with vegetables and fish rather than rice alone) significantly reduces the glucose spike. Choosing lower glycaemic index carbohydrates such as wholegrains, legumes, sweet potato, and oats over white bread, white rice, and sugary drinks reduces the magnitude of glucose rises. Vinegar, including apple cider vinegar, taken before meals has modest evidence for lowering postprandial glucose.
Exercise and Its Blood Sugar Benefits
Exercise is one of the most powerful tools for improving insulin sensitivity. Muscle tissue is a major site of glucose uptake, and building and maintaining muscle mass through resistance training makes the body significantly more efficient at managing blood sugar. Even a 10 to 15 minute walk after meals has been shown in studies to reduce postprandial glucose levels more effectively than a single longer walk. High-intensity interval training (HIIT) is particularly effective for insulin resistance but should be introduced gradually. The goal is to move consistently throughout the day rather than being sedentary most of the time and then exercising intensively once.
Supplements That Support Blood Sugar
Several supplements have clinical evidence for modest blood sugar-lowering effects. Berberine has comparable glucose-lowering effects to metformin in some studies and works partly by activating AMPK, an enzyme involved in cellular energy regulation. Magnesium deficiency is associated with insulin resistance, and supplementing at 300 to 400mg daily is often warranted during perimenopause. Inositol, particularly myo-inositol, supports insulin signalling and has been studied in the context of PCOS and insulin resistance. Chromium picolinate at 200 to 400mcg may reduce carbohydrate cravings. Always discuss supplements with your GP if you are on medication for blood sugar, as interactions are possible.
When to Request Testing
Routine blood sugar testing is not yet standard for perimenopausal women in many countries, but it is worth requesting. Ask your GP for a fasting glucose test and HbA1c (which gives a picture of average blood sugar over the preceding three months). A fasting glucose of 5.6 to 6.9 mmol/L indicates prediabetes in the UK; HbA1c between 42 and 47 mmol/mol is the prediabetes range. If you are experiencing the symptoms described above, have a family history of type 2 diabetes, or are carrying weight centrally, these tests are especially important. Early identification of prediabetes allows dietary and lifestyle intervention before diabetes develops.
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