Detailed definition
Insulin resistance is a state in which target tissues (muscle, liver, fat) respond less effectively to insulin's signal to take up glucose. Compensatory hyperinsulinemia maintains normal glucose initially, but eventually pancreatic beta-cell capacity is exceeded and glucose rises — progressing through prediabetes to type 2 diabetes. Insulin resistance worsens with age, abdominal adiposity, sedentary lifestyle, and after menopause as estrogen withdrawal contributes to fat redistribution and metabolic shifts. Management includes resistance and aerobic exercise, dietary patterns minimizing rapid carbohydrate spikes, weight management focused on visceral fat, and pharmacotherapy (metformin, GLP-1 receptor agonists) when indicated. HRT in observational studies has neutral-to-modestly-favorable effects on insulin sensitivity.
Why it matters in menopause
For midlife women with prediabetes or type 2 diabetes, the combination of resistance training, dietary pattern improvements, and weight management is the foundation. Transdermal estradiol HRT does not worsen and may modestly improve insulin sensitivity.