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CGMs and Menopause: An Open Niche for SaMD

Blood sugar is greatly affected by hormone changes, especially those that occur during menopause. Here we examine this relationship and discuss the potential uses for continuous glucose monitors (CGM) in premenopausal and menopausal women.

The connection between hormones and blood glucose levels has been well established. Not only do hormones influence how high or low blood sugar gets, but blood sugar can in turn affect how hormones are released and utilized by the body. Nowhere is this interaction more apparent than in menopause.

The changing hormones women experience at the end of their reproductive years lead to noticeable shifts in average blood glucose levels. These changes can have a profound impact on a woman’s symptoms and her risk of developing type 2 diabetes. 

Despite this connection, CGM use in non-diabetic perimenopausal and menopausal women is almost non-existent. This presents a multitude of opportunities for SaMD development.

How Menopause Affects Blood Sugar

The effects of female sex hormones on blood sugar levels are well-documented. Throughout the menstrual cycle, insulin resistance and sensitivity ebb and flow with changing levels of progesterone and estrogen. These same effects can be seen in women entering menopause. 

But these hormone changes are far more exaggerated than what women experience during the typical monthly cycle. And the effects tend to be cumulative and long-lasting. 

Additional hormone-mediated changes in body composition and sleep quality further influence blood glucose levels. 

Changing Estrogen Levels

Estrogen makes the body more sensitive to insulin. During the first two weeks of the menstrual cycle, most women experience more level blood sugars as their cells readily bind with insulin to accept glucose. Too much estrogen in the body can even lead to hypoglycemia, or low blood sugar.

As the body enters perimenopause, the amount of estrogen produced by the ovaries in the form of estradiol begins to drop. But this drop is rarely steady. Instead, levels peak and fall in unpredictable ways, leading to periods of higher-than-normal and lower-than-normal blood sugars. As perimenopause gives way to full-blown menopause, estrogen levels bottom out and blood sugars trend higher than normal.

Changing Progesterone Levels

The role of progesterone in blood glucose maintenance is far more complicated. This hormone not only increases insulin resistance in cells but also stimulates glucose release in the liver and insulin production in the pancreas(1). 

Some of these factors work to elevate blood glucose levels while the increase in insulin production helps stabilize it. Overall, though, most women experience higher than normal blood sugar when progesterone levels are high.

During menopause, progesterone production slows. A lack of this hormone doesn’t appear to directly affect blood sugar trends. But, due to progesterone’s role in inducing healthy sleep, a lack of it can lead to sleep problems. And these sleep disturbances, in turn, can cause elevated blood sugar.

Reduced Sleep Quality

Without enough progesterone in the body to maintain normal sleep patterns, menopausal women often experience cortisol dumps during the night as the body tries to keep itself awake. Prolonged sleep deprivation leads to excess cortisol release throughout the day as well.

Cortisol stimulates gluconeogenesis in the liver, which leads to an excess of glucose being dumped into the bloodstream. Due to the insulin resistance caused by low estrogen levels, this excess blood glucose is not readily taken up by cells. This leads to consistently higher-than-normal blood sugar levels.

Increased Visceral Fat 

Shifts in hormones also cause changes in how women store body fat. While premenopausal women typically accumulate subcutaneous fat around the thighs and buttocks, postmenopausal women gain visceral fat around the abdomen. 

Visceral fat releases a substance called retinol-binding protein 4. This protein causes insulin resistance. Not only does the accumulation of fat around the midsection cause higher blood sugars, but it is associated with a higher risk of type 2 diabetes. 

Increased Diabetes Risk

Increased visceral body fat and higher overall insulin resistance increase menopausal women’s risk for developing type 2 diabetes. This risk is increased further in women who experience early menopause. 

There is some debate about how much of this risk is caused by menopause itself, rather than normal changes all experience with aging. But most research suggests that postmenopausal women are far more likely to develop diabetes than their premenopausal counterparts. 

How Blood Sugar Affects Menopause

Menopause doesn’t just cause higher-than-average blood sugar levels. It can also be influenced by high blood sugar. This feedback loop can lead to worsening menopausal symptoms and cause premature menopause.

Hot Flashes

Research has shown that menopausal women with higher blood sugar levels are more likely to experience severe menopausal symptoms including hot flashes. This correlation exists independent of overall body fat composition and total estrogen level. 

But this process may not be a matter of simple cause and effect. The autonomic nervous system that regulates skin temperature is the same system that helps regulate glucose and insulin production. It is possible that high blood sugar doesn’t cause severe hot flashes, but rather, an impaired autonomic nervous system causes hot flashes and high blood sugar levels.

Early Menopause

Women diagnosed with type 1 diabetes before the age of 30 or type 2 diabetes before the age of 39 are far more likely to experience early menopause than women without diabetes(2). Damage caused by elevated blood glucose is believed to impair ovary and reproductive system function. But more research is needed to fully understand this process.

Interestingly, women diagnosed with type 2 diabetes after the age of 50 but before the onset of menopause are more likely to experience later natural menopause.

Controlling Blood Sugar to Ease Symptoms & Risks

There are many things women can do to help counteract the processes of menopause that lead to higher-than-normal blood sugar levels. These include diet changes, increased exercise, stress management, and supplementing with natural herbs and synthetic hormones.

Diet Changes

Low-carb and low-GI diets are associated with more stable blood sugar levels. When dealing with insulin resistance caused by hormone shifts, avoiding foods that cause glucose spikes can be incredibly helpful. Low-carb diets focused on balanced fat and fiber intake have also shown a potential to reduce belly fat accumulation in postmenopausal women.


Exercise increases the amount of glucose used by the body without increasing insulin production. Even during times of high insulin resistance, exercise can effectively reduce blood sugar. And sustained daily activity can reduce visceral fat accumulation and cortisol production, two factors that further reduce blood sugar levels.

Stress Management

While it can be difficult to remedy the sleep problems caused by menopause, it is possible to lower cortisol levels not associated with sleep disturbances. By doing this, you can limit how much cortisol enters the system to increase blood sugar. Effective stress management techniques can greatly reduce excess cortisol production.

Supplements and Medications

There are many natural supplements and medications that can be used by menopausal women to reduce insulin resistance. However, the effect these will have on any individual is hard to predict. Even prescription hormone treatments, which are highly regulated, produce variable results. While some women see improvement in blood sugar and menopausal symptoms, just as many see no change at all(3).

Untapped Potential: CGM Use in Non-Diabetic Menopausal Women

The relationship between menopause and blood sugar is a complex one. It is also, largely, a phenomenon unknown to the average middle-aged woman. This is a shame given how much could be learned and solved if each individual had the means to track their blood sugars in relation to their symptoms and other vital statistics.

Continuous glucose monitors (CGM) could easily fill this knowledge gap and give menopausal women the means to better control their symptoms and overall health.

CGM Treatment Opportunities in Menopause

Above, we looked at four effective means for reducing blood sugar during menopause. But without the ability to see how these changes affect actual glucose numbers, women cannot make the necessary adjustments needed to reach their goals. 

But with a CGM, menopausal women could easily adjust their diet to the foods that best reduce blood sugar spikes for them personally. A CGM-connected app with nutrition information, low-GI food recommendations, and personalized reports could go a long way to helping menopausal women the same way these apps have helped people with type 2 diabetes.

Women could also use CGMs to gain a much clearer picture of how exercise intensity and frequency change blood sugar over time. Combining a CGM reader with other vitals monitors, such as pulse and blood pressure readers, would be especially helpful for older women looking to get more active without putting themselves at risk for cardiovascular issues.

The use of CGMs in mental health therapy is gaining steam. These same principles can be applied to help menopausal women find effective ways to reduce stress and lower cortisol levels. This same type of behavior modification feedback app could even be used to improve sleep quality and duration.

Lastly, CGM applications that incorporate medication and supplement tracking could provide vital feedback on what works and what doesn’t in the pursuit of more normal blood glucose levels.

The Importance of CGM Software Interconnectivity

Integrating these types of mobile medical apps with others that track hormone levels would be vital for painting a clearer picture of hormone and blood sugar interactions. In premenopausal women, these could serve as a warning for impending hormonal changes and detect early menopause, which could be a sign of a deeper problem. In menopausal women, the combination of these readings could signal when changes may be needed in routine or medications. Reacting to these changes early could help prevent chronic hyperglycemia and lower diabetes risk.

Given the strong relationship between blood sugar and hormones, it only makes sense to use CGMs and SaMD to help women improve their health and livelihoods during menopause.

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