How continuous glucose monitoring (CGM) can help during menopause
Post-menopausal women have an increased risk of cardiometabolic disease. Here’s how a CGM can help you focus on metabolic health.
The menopause transition often includes symptoms of weight gain, hot flashes, night sweats, difficulty sleeping, mood changes, sexual dysfunction, and more. These symptoms can be highly frustrating and diminish the quality of life for the 1.3 million people who reach menopause each year.
Despite an overall lack of robust menopause research, growing evidence shows the connections menopause symptoms have to metabolic health status. These connections offer new opportunities for research areas, treatment options, and management tools.
Wearing a continuous glucose monitor (CGM) is one way women, and their healthcare providers, can gain insight into their metabolic health status. This insight may empower people to improve their metabolic health, which may help ease various menopause symptoms and help prevent chronic diseases, such as prediabetes, Type 2 diabetes, heart disease, dementia, obesity, and more. Postmenopausal women become more at risk for these diseases as a result of estrogen decline.
For example, more than 15% of the 2,295 postmenopausal women in a population-based study had Type 2 diabetes. Factors that increased the risk included a higher BMI, waist circumference, total cholesterol, and triglycerides. For comparison, in the global population, about 6% of people have Type 2 diabetes. Postmenopausal women also have a higher risk of cardiovascular disease when compared to those who haven’t reached menopause (and women who have early menopause have an even greater risk). Women in menopause also have a 67% increased risk of developing Alzheimer’s disease, the most common form of dementia. Estimates show that postmenopausal women have a nearly five-fold higher risk of developing abdominal obesity.
About 60% of women in a population-based study talked to their healthcare providers about menopause, but some research indicates women often feel their physicians dismiss their symptoms. Physicians and other healthcare providers may not be getting enough training in medical school regarding the topic. Part of the issue may be the lack of menopause research and federal funding to do the research. The National Institutes of Health only added menopause as a research funding category to its Research, Condition, and Disease Categorization system in 2023, though the system has been in place since 2008.
Researchers worldwide have now called for a more empowering model for managing menopause. Their 2024 Lancet article reports that women feel empowered when presented with ways to self-manage their menopause symptoms and have greater knowledge about them.
CGM may be an empowerment and self-management tool.
What’s the link between menopause and metabolic health?
First, a few metabolic health basics. Insulin is a hormone produced in the pancreas in response to glucose entering the bloodstream. Among its many jobs, insulin signals cells to take in glucose. Frequent blood sugar spikes—also known as high glycemic variability—and chronically high blood sugar lead to high insulin levels; over time, this can numb cells to insulin’s signaling, a condition called insulin resistance. This leads the body to release more insulin to get glucose into cells until it eventually can’t keep up, and blood sugar levels begin to stay elevated. Prediabetes and Type 2 diabetes are what occur if this process continues—they are the state of having chronically high blood sugar due to insulin resistance. Insulin resistance can also contribute to weight gain and obesity, cardiovascular disease, dementia, and more.
Insulin resistance and impaired blood sugar control are more prominent in women in menopause. These factors are also linked to many of the top menopause symptoms. The association is stronger for changes in body composition—such as fat gain and muscle loss—and for vasomotor symptoms, such as hot flashes and related night sweats. However, insulin resistance also has connections to other symptoms of menopause, including mood changes, sexual dysfunction, and increases in stress.
What’s happening in the body during menopause?
Menopause is the moment when someone stops menstruating for an entire year. Natural menopause, on average, occurs between 45 and 55. However, the years leading up to menopause, often when people start having irregular menstruation, are called perimenopause, or the menopause transition, which usually begins in one’s 40s.
Changes to hormone levels during this transition alter the tightly controlled feedback loop that makes up the menstrual cycle. The phases of a menstrual cycle occur via the hypothalamic-pituitary-gonadal (HPG) axis (also called HPO for ovarian). As one hormone level rises, it begins a set of chain reactions on other hormone levels. This feedback loop also impacts insulin sensitivity, how we use energy from food, and how we store it for later needs. So, when menopausal hormone changes occur, they can also affect glucose (blood sugar) levels.
One of the most impactful hormonal changes during menopause is the decline in estrogen. By the final menstrual period, estrogen can decrease by about half compared to the reproductive years. In a recent study, researchers saw that estrogen offers protection against insulin resistance by enhancing insulin sensitivity.
Estrogen is not the only hormone that changes during the menopause transition. Inhibin B declines, and follicular stimulating hormone (FSH) increases, leading to more rapid ovulation and sometimes shorter cycles. These shifts further contribute to hormonal swings during the luteal phase, including lower progesterone.
A decline in progesterone may lead to a more “androgenic pattern” of fat distribution, with accumulation around the abdomen. This and other factors put women in their middle decades more at risk for metabolic syndrome, a cluster of five risk factors that together raise the risk of chronic diseases and death.
All of that is why people in the menopause transition may see tangible benefits from maintaining tighter control over blood sugar through diet and lifestyle changes and where real-time insights from CGM can help.
What is a Continuous Glucose Monitor (CGM)?
CGM allows people to monitor their glucose levels in real time to see how their diet and habits impact their blood sugar. Users place a small sensor, about the diameter of a quarter, on their body, usually on their upper arm. The sensor has a tiny filament that painlessly enters the interstitial fluid just under the skin, where it measures glucose. This sensor sends a signal to your smartphone or a handheld monitoring device, where you can read your glucose levels.
Bio-individuality means the same foods can affect people differently. Lifestyle factors, like sleep, stress, and physical activity, also affect glucose levels. Plus, hormonal changes during the menstrual cycle, over the menopause transition, and beyond impact glucose response. That’s why the real-time feedback of CGM is the best way to connect your lifestyle choices with your blood sugar patterns and identify the foods and habits that keep your blood sugar stable.
If you are in perimenopause or have reached menopause, CGM can help you track your glucose levels so you can develop strategies to keep your blood sugar level in your optimal range and mitigate glucose spikes, which drive insulin production and can lead to insulin resistance.
What does the research say about CGM and menopause?
Research is lacking on whether the use of CGM may help people manage menopause symptoms. However, a few studies have used CGM to monitor metabolic health changes during the menstrual cycle and menopause, showing potential for CGM as an insightful tool.
In a small 2023 study, 49 menstruating participants wore a CGM to measure glucose levels and underwent daily hormone testing for an average of 80–100 days. The researchers found that average daily glucose levels rose during ovulation, peaking during the luteal phase, and then fell during the late follicular phase. Cravings were highest when glucose levels were highest. And glucose levels were lowest when estrogen was higher. The study shows the potential for CGM to help researchers better understand the menstrual cycle. The research also demonstrates how tightly glucose status is connected to the menstrual cycle.
In the 2022 ZOE PREDICT study, researchers used CGM and blood tests to monitor 1,002 women: 366 were not yet in perimenopause, 55 were in perimenopause, and 206 were postmenopausal. Postmenopausal women had higher fasting glucose and hemoglobin A1C than those who hadn’t reached menopause. The postmenopausal women also had higher postprandial (after eating) glucose responses and insulin levels. The researchers note the importance of monitoring risk factors for Type 2 diabetes and cardiovascular disease in women who are middle-aged or older. The study shows how menopause status can impact glucose status.
What are practical tips for using CGM during menopause?
To get a CGM in the United States, you’ll need a prescription from a doctor. In Europe and Canada, you do not. CGMs are traditionally used by people with diabetes. However, you can still ask your physician for a prescription, even if you don’t have diabetes. You can also work with Levels or other companies.
With Levels, you’ll answer a questionnaire, which a licensed telehealth physician will review. If you’re eligible, the physician will write you a prescription for CGM. The prescription will be filled by a partnering pharmacy and shipped to your door. Your kit will have instructions for getting started, such as applying the sensor and accessing your readings. Levels members can also get CGMs without a prescription by participating in our IRB-approved study, which looks to uncover glucose patterns in people without diabetes.
Once you start using your CGM, taking baby steps can be helpful. For example, for the first week, you may just want to practice getting readings and logging your meals and activities without changing your diet. This will allow you to see how your diet and lifestyle affect your glucose levels. Then in the second or third week, try implementing different strategies to reduce blood sugar spikes and to keep your blood sugar in the target range as much as possible. The Levels app will provide helpful feedback and insights.
Here are a few simple strategies for optimizing blood sugar control during the menopause transition:
- Build muscle. Research shows that in the later years of perimenopause and the early years of postmenopause, the rate of fat gain can double while muscle loss decreases. Muscle tissue is more metabolically healthy than fat tissue. Resistance training helps with body recomposition, which is a reduction in fat mass and an increase in muscle mass. Research shows that, in postmenopausal obese women, resistance training helps increase insulin sensitivity, reduce the risk for metabolic syndrome, lower body mass index and waist circumference, and increase lean body mass. Increasing and preserving muscle mass can help prevent sarcopenia, the loss of strength and muscle as we age. Sarcopenia puts people at risk for injuries and can make doing daily activities more difficult.
- Try a low-carbohydrate diet. In a study published in 2017, researchers analyzed data from the Women’s Health Initiative Observational Study. The data included 88,000 postmenopausal women followed for eight years. For their analysis, the researchers considered four dietary patterns: a low-fat diet, a reduced-carbohydrate diet, the Mediterranean diet, and a diet consistent with the Dietary Guidelines for Americans (DGA). The reduced carbohydrate diet was associated with a reduced risk for weight gain. The low-fat and the DGA diets, however, were associated with an increased risk for weight gain. The researchers concluded, “Consuming a reduced-carbohydrate diet, with moderate fat and high protein intake, may decrease the risk of weight gain in postmenopausal women.”
- Dress your carbs. Pairing carbohydrates with healthy fats, protein, fiber, or a combination can help slow glucose absorption into your bloodstream. You may also want to experiment with eating the carbs on your plate last.
- Move after a meal. A 30-minute walk after eating can help blunt a blood sugar spike.
- Engage in regular cardiovascular exercise. Physical activity in middle-aged women is associated with improved body composition and healthier blood lipid levels.
- Avoid ultra-processed foods. Ultra-processed food intake is associated with worsened menopause symptoms, including hot flashes. However, a higher intake of vegetables is associated with greater protection against depression, hot flashes, and sleep issues. Stick to whole, nutrient-dense foods as much as possible. Ultra-processed foods contain chemical additives, added sugar, sodium, and more. Their consumption is linked to insulin resistance. Additionally, many ultra-processed foods come in packaging that has endocrine-disrupting chemicals, which have some association with premature menopause.
- Up your protein intake. Protein is crucial for building and preserving muscle. Some research also indicates that three to four servings of plant protein per day is associated with a lower incidence of early menopause. Recent research recommends consuming 1 to 1.2 grams of protein per kilogram of body weight.
- Talk to your doctor about hormone replacement therapy (HRT). Not everyone is a candidate for hormone replacement therapy. Some conditions are contraindications. Newer research shows that HRT can be beneficial in alleviating menopause symptoms in women of menopausal age who are under 60. Although HRT is not approved for the prevention of Type 2 diabetes, it may help with blood sugar control. Research shows HRT in menopause supports insulin secretion and sensitivity and glucose effectiveness. Some research also suggests that HRT may help preserve muscle and prevent sarcopenia in postmenopause.
Conclusion
CGM can help women in the menopause transition and beyond monitor their glucose levels and develop nutrition and activity strategies for keeping their blood sugar more stable. In turn, more stable blood sugar can help increase insulin sensitivity and potentially reduce symptoms of menopause, including weight gain, hot flashes, and more.
Plus, improved glucose control and insulin sensitivity help prevent the development of chronic conditions like Type 2 diabetes and cardiovascular disease. Menopause increases the risk for these conditions.
More research is needed with clinical trials to show how CGM may be of benefit for navigating menopause. Meanwhile, CGM is a non-medication, non-invasive tool that may hold promise in empowering people through the menopause transition and even setting them up for the best metabolic health possible when entering perimenopause.
Interested in trying CGM to manage your metabolic health?
Levels, the health tech company behind this blog, helps people improve their metabolic health by showing how food and lifestyle impact your blood sugar, using continuous glucose monitoring (CGM), along with an app that offers personalized guidance and helps you build healthy habits. Click here to learn more about Levels.
