Menopause has (at least) 32 symptoms that span the body. Besides vasomotor symptoms, like hot flashes and night sweats, or genitourinary ones, like vaginal dryness and bladder issues, metabolic symptoms due to menopause, like weight gain and increased insulin resistance, can also happen.

In a comment recently published on December 1 in the journal Nature Reviews Endocrinology, a group of researchers from countries, including the United States, United Kingdom and Australia, argued that midlife is a key prevention window for women at risk for type 2 diabetes, and, as a result, prevention programs can be enhanced by considering sex-specific risk factors like menopause.

This idea supports research that shows that the hormonal shifts associated with menopause put midlife women at higher risk of developing a host of metabolic issues, which include diabetes.

Flow Space spoke with experts about why midlife women have this increased risk of developing type 2 diabetes and why midlife is such a key time to focus on prevention.

Why Midlife Is Such a Key Window for Diabetes Prevention

Midlife women are more prone to developing metabolic issues like diabetes largely because of the impacts of hormonal shifts due to menopause, experts said.

“A lot of the thinking is that there’s body composition changes that happen and changes in insulin sensitivity that are directed by lack of estrogen and shifts in a way that are unfavorable,” Dr. Ava Port, a board-certified endocrinologist at MedStar Georgetown University Hospital, told Flow Space.

Estrogen is thought to help insulin work better, she said, while dropping levels can increase insulin resistance, which can lead to higher levels of blood sugar and an increased type 2 diabetes risk. Menopause can also increase inflammation, which is also associated with a higher risk of developing diabetes.

Additionally, women tend to lose leaner mass and can gain more visceral fat, particularly around the midsection, which increases cardiometabolic risk.

“Before menopause, women have a lower risk of cardiometabolic disease than men, but after menopause it really shifts and equalizes,” said Port.

Another reason midlife is such a crucial window for diabetes prevention is the fact that these shifts can start even before menopause, said Port. Some women may have already been dealing with metabolic issues earlier in their lives; those are compounded when they hit menopause.

Early awareness can help mitigate some of the effects.

“There’s a rapid change that happens in the menopausal transition… Before you get to menopause, it’s up and down as your metabolism is changing. So rather than waiting for that abrupt drop-off, when there’s a big jump in your cardiometabolic health risk, it makes more sense to try to prime your system in a way that’s favorable,” she explained.

Dr. Ajaykumar D. Rao, a board-certified endocrinologist and chief of the section of endocrinology, diabetes and metabolism at the Lewis Katz School of Medicine at Temple University, said the comment is “really a call to action” to raise awareness of the link between menopause and increased diabetes risk.

“It really puts a nice spotlight on the menopause transition and to really look at some of these other factors [and say] ‘Is there something different we have to do based on what’s going on, their gender or biological sex,” he said.

Spotlighting this link can also help women understand why this shift is happening so they can feel empowered to seek help and don’t turn their frustrations inward.

“Women need to understand that these are changes that are part of normal physiology, and as you start to see them happening, you really want to be aware that you’re not just being lazy and your body is really starting to shift,” said Port, who added that she treats many midlife women in her weight management clinic.

How to Reduce Diabetes Risk

A number of interventions can help reduce midlife women’s risk of developing diabetes.

Using hormone replacement therapy (HRT) can minimize some of the hormonal shifts that increase risk, Rao said. Speak with your doctor about whether this is a good option for you.

Rao also said it’s important to keep up with your regular appointments and health screenings, which can surface any issues that can impact your metabolic health and diabetes risk. If an issue or an increased risk for one is discovered, your healthcare provider will discuss the many treatments plans and preventative steps you can take to get your health back on track

One such way is through lifestyle changes.

“We know that staying active as much as you can and having a healthy lifestyle can have far reaching benefits besides just the glucose lowering aspect of things, so it’s all very good and very important,” said Rao, who added that even small habit shifts help.

Make sure you get regular exercise and eat a diet rich in nutritious foods, which can help you maintain a healthy weight and keep blood pressure down.

Poor sleep also increases diabetes risk, so try your best to consistently get enough quality sleep. Smoking can also cause type 2 diabetes, so don’t start; but if you already do smoke, quitting can help lower your risk. Speak with your doctor to make a plan for lowering metabolic risk.

Additionally, medications like metformin and GLP-1s can also be very helpful.

“Sometimes, you get to a point where it’s really challenging to lose weight, and those women might benefit from medical therapy or even surgical interventions in more extreme cases,” said Port.