Paramount to many of the symptoms of the menopause transition, insulin resistance is a significant health concern for women in perimenopause. In this stage of life, women face unique challenges that can impact their insulin sensitivity, with implications for their overall health. This article discusses the nature of insulin resistance, its specific relevance to perimenopausal women, what muscle has to do with it, and effective strategies to manage and mitigate its risks.
Understanding Insulin Resistance and Its Link to Menopause
Insulin resistance is a metabolic condition where cells in the body become less responsive to insulin, a hormone that regulates blood sugar levels. This results in elevated blood sugar and insulin levels, increasing the risk for conditions like type 2 diabetes and cardiovascular disease.
Perimenopause is characterized by hormonal fluctuations as the body transitions toward menopause. These hormonal changes, particularly the decline in estrogen, can adversely affect insulin sensitivity, increasing the risk of insulin resistance. This period is also associated with other metabolic abnormalities such as glucose intolerance, dyslipidemia, and central obesity – likely due to the same decline in estrogen – further elevating the risk of developing chronic diseases like diabetes and heart disease.
Increased Risk from Insufficient Sleep
Adding insult to injury, the chronic sleep disruptions that plague midlife women in perimenopause can exacerbate poor insulin regulation further. According to a newly published randomized trial conducted exclusively on women, chronic sleep deficiency can significantly increase insulin resistance, particularly in postmenopausal women. In its reporting on the study, SciTech Daily referred to the increased “alarming diabetes danger” connected to insufficient sleep. Researchers discovered that even a mild reduction in sleep – as little as 1.5 hours less per night – can increase insulin resistance by up to 14.8%, with more pronounced effects in postmenopausal women, where the increase can be as high as 20.1%.
This suggests that maintaining adequate sleep is essential in managing insulin sensitivity during this phase of life. However, any random midlife woman would likely tell you that maintaining 7-9 hours of sleep each night is easier said than done. (yawn)
Science has recognized the challenge presented to sleep in the menopause transition – thanks to estrogen flux and its many symptoms – for decades. Studies such as this one and this one, and even this review article were conducted and written more than a decade ago, stating that the hormone environment as well as physiological and psychological symptoms of perimenopause contribute to insufficient sleep, and that it must be treated for better quality of life and health outcomes.
It would seem that the 40-60% of midlife women experiencing chronic sleep disruption and insomnia would be fated to metabolic syndrome.
Fortunately, there are lifestyle adjustments that can contribute to better sleep as well as better insulin sensitivity – namely the pursuit of muscle.
Benefits of Muscle Building in Insulin Regulation
Building and maintaining muscle mass is a potent strategy for improving insulin sensitivity. Research indicates that an increase in skeletal muscle mass is associated with a substantial reduction in insulin resistance. Specifically, each additional 10% of skeletal muscle mass correlates with an 11% decrease in insulin resistance and a 12% lower risk of transitioning to prediabetes or diabetes. Those with higher muscle mass are significantly less prone to diabetes, highlighting the importance of strength training and muscle-building activities for metabolic health.
Again, easier said than done in perimenopause. Because estrogen is our muscle-building hormone, its decline makes it easier to lose muscle and harder to build it. Harder, but not impossible. Read on to discover four strategies to improve your muscle-building capacity and insulin sensitivity, and potentially improve your sleep.
Management and Prevention Strategies for Insulin Resistance
1. Regular Strength Training: Consistent strength training is anabolic (building) for muscle and bone. Incorporate resistance training exercise into your week to improve muscle mass and insulin sensitivity. Begin with two full-body workouts each week. Increase weight and decrease repetitions as you get stronger.
TIP: Focus on extension. While all resistance training improves body composition, studies show that the eccentric part of the lift – or the lowering/stretching phase of the movement – yields the most muscle-remodeling benefit. For example, when performing an overhead press, taking two or three times longer to lower the weight than to lift it can increase muscle building capacity of the exercise. Using this method provides more muscle-building benefit without increasing load.
2. Regular High-Intensity Interval Training: During the menopause transition, long, steady-state cardio such as distance running becomes a physiological stress burden, which can contribute to an outsized cortisol response. This makes us even more insulin resistant. Solve this by performing brief sessions – 30 minutes max – of short bursts of high intensity interrupted by a low-intensity recovery period. The best form of interval training for insulin regulation and body composition changes is sprint (or short) interval training (SIT), which limits the all-out intensity effort to very short bursts, such as 10-20 seconds, and calls for complete recovery between bursts.
SIT can be applied to any form of cardiovascular exercise – running, cycling, swimming, rowing, or using any cardio equipment. It can also be applied to drills using equipment, such as kettlebells, dumbbells, and medicine balls.
BONUS: An added benefit of regular exercise is its ability to promote sleep pressure, allowing us to increase sleep quantity and quality.
2. Healthy Diet: Focus on a balanced diet that prioritizes lean proteins, is rich in fiber and healthy fats, and limits processed foods and sugars.
Because we are less able to efficiently break down protein thanks to diminished HCl production, we don’t absorb as much. So quality and quantity matter at this stage of life, especially when your goal is to build lean muscle. Aim for 1.6-2 grams of high-quality protein per kilogram of bodyweight.
Fiber becomes increasingly important in midlife, too, due to the disrupting impacts of estrogen decline on gut health. Fiber serves as a prebiotic, feeding our microbiome. Additionally, fiber slows the absorption of glucose from food, which helps manage insulin.
TIP: Avoid consuming carbohydrate foods on their own. Combining carbohydrate with lean proteins slows absorption, providing another layer of insulin regulation and glucose management.
4. Stress Management: Engage in stress-reduction practices like yoga, meditation, and calming walks. As mentioned above, high cortisol levels that accompany unmanaged stress levels create a further impairment to insulin sensitivity. Therefore, stress management is crucial to insulin regulation.
5. Regular Health Monitoring: Keep track of blood glucose levels, body composition, and consult healthcare professionals for personalized advice about menopause hormone therapy and its influence on glucose control and sleep quality.
Conclusion
For perimenopausal women, managing insulin resistance is crucial for maintaining overall health, currently and long term. By understanding the unique challenges we face during this phase of life, including the impact of hormonal changes and sleep patterns, and by adopting strategies like strength training and stress management, women can effectively improve sleep and mitigate the risks associated with insulin resistance. Of course, consulting your healthcare professional for tailored advice is always recommended.