Insulin resistance tends to rise across the menopause transition, typically on the order of ~10–30%, with most of the change explained by midsection fat gain (especially liver and visceral fat). The exact amount varies by study design, body composition, and whether women are matched for adiposity.

What the best data show

• In a SWAN ancillary cohort followed from pre- to postmenopause (same women measured twice), mean HOMA-IR rose from 4.14 to 5.21—about a 26% increase over the transition (p=0.02). This sample was relatively heavy and also gained central adiposity, which likely amplified the change. PMC

• SWAN and related longitudinal analyses repeatedly report that the transition is accompanied by worsening insulin resistance and higher fasting glucose, even after accounting for aging; vasomotor symptoms were also associated with higher HOMA over ~8 years. PMC+1

• Mechanistically, the transition drives visceral and hepatic fat accumulation, which mediates much of the insulin-resistance signal. Midlife women who become postmenopausal show accelerated VAT gain, and liver fat plus lower SHBG strongly track higher HOMA-IR. PMC+1Wiley Online Library

• When postmenopausal and premenopausal women are tightly matched for body fat, clamp studies sometimes find little or no difference in insulin sensitivity—supporting the idea that fat distribution (not menopause per se) drives much of the change. PubMed

• Menopausal hormone therapy (when appropriate) generally improves glucose homeostasis and insulin sensitivity. Maturitas

Practical takeaway
Expect a moderate rise in insulin resistance during the transition—closer to the low end (~10–15%) in lean, active women with little central fat gain, and toward the higher end (~20–30%) when visceral/liver fat increases. Interventions that limit VAT (resistance + aerobic training, protein-forward Mediterranean-style eating, sleep regularity, and—when indicated—MHT) can blunt or reverse much of this rise. JCI InsightMaturitas

References

1. Kim C, et al. Changes in Iron Measures over Menopause and Associations with Insulin Resistance. SWAN ancillary study. Reported HOMA-IR increase from 4.14 to 5.21 (≈26%). PMC

2. Thurston RC, et al. Vasomotor Symptoms and Insulin Resistance in the Study of Women’s Health Across the Nation (SWAN). HOMA elevated with frequent VMS over ~8 years. PMC

3. Kravitz HM, et al. The menopause transition and women’s health at midlife: a progress report. Review summarizing SWAN findings, including links between sleep timing and insulin resistance. PMC

4. Lovejoy JC, et al. Increased visceral fat and decreased energy expenditure during the menopausal transition. Longitudinal imaging shows VAT increases at/after menopause. PMCPubMed

5. El Khoudary SR, et al. Abdominal Visceral Adipose Tissue Over the Menopause Transition. Review of VAT trajectory around final menstrual period. PMC

6. Toth MJ, et al. Effect of menopausal status on insulin-stimulated glucose disposal. Clamp data showing no difference when matched for adiposity. PubMed

7. Janssen I, et al. Liver fat and SHBG affect insulin resistance in midlife women (SWAN-Heart). Links liver fat/SHBG with HOMA-IR. Wiley Online Library

8. EMAS clinical guide: Menopause and diabetes. MHT has favorable effects on glucose homeostasis. Maturitas

9. SWAN body composition trajectory papers: fat mass and proportion fat rise sharply during the transition, stabilizing postmenopause. JCI Insightswanstudy.org

Midlife Metabolism Tip 

🫒🥗During the menopause transition, studies like the SWAN cohort show insulin resistance can rise by 10–30%, often driven by increased visceral and liver fat. This makes it harder for your body to keep blood sugar stable after eating.
One simple shift to help counter this: smaller, Mediterranean-style meals spread across the day instead of two or three large ones.

• Colorful vegetables and leafy greens
• Lean proteins like fish, eggs, or legumes
• Healthy fats from olive oil, nuts, and seeds
• Whole grains in modest portions
  

This eating pattern supports steadier energy, blunts post-meal glucose spikes, and provides the heart- and brain-protective nutrients the Mediterranean diet is known for—helping you push back against midlife metabolic changes.

References: Kim C et al., SWAN; Lovejoy JC et al., Am J Clin Nutr; El Khoudary SR et al., Menopause; EMAS clinical guide: Menopause and Diabetes.