Written by Dr Saptarshi Bhattacharya September 17, 2025 01:54 PM IST 4 min read When estrogen levels fall with age or after menopause, insulin sensitivity deteriorates, leading to higher blood sugar and increased risk of type 2 diabetes.A 48-year-old woman came to see me bothered by her recent blood sugar readings as part of her routine annual check-up. Her fasting blood sugar was 128 mg/dL, her HbA1c (average blood sugar count of three months) was 6.4 and her post-meal sugar was 140 mg/dL (touching the upper limit). She was a regular walker but of late she was worried about fat gain, particularly around her abdomen. She kept to daily routines, was conscious about her diet, didn’t smoke or drink and had no family history of diabetes. Many would wonder why a textbook case like hers could have elevated blood sugar levels for no apparent reason.The woman had been one year into her menopause, a stage when periods stop and the hormone estrogen dips in women. This hormonal drop not only increases their diabetes risk but also complicates blood sugar control and heightens the risk of diabetes-related complications.How does estrogen control blood sugarEstrogen helps the body dispose of glucose efficiently, primarily by facilitating insulin delivery to muscle tissues. When estrogen levels fall with age or after menopause, insulin sensitivity deteriorates, leading to higher blood sugar and increased risk of type 2 diabetes. Estrogen drops can raise stress hormones like cortisol and other hormones that work together to boost fuel supplies in the body. These changes can lead to lower insulin secretion and insulin resistance.Women experiencing early menopause, whether naturally or surgically, tend to develop Type 2 diabetes sooner than those who maintain regular hormone cycles until later in life.What are other risk factors that develop alongside Type 2 diabetes?Post-menopause, higher blood sugar tends to get converted to abdominal fat. Cardiovascular risk rises sharply after menopause, especially in women with pre-existing diabetes. Blood lipid profiles often worsen with elevated cholesterol and triglycerides, raising risks of hypertension and atherosclerosis. Reduced estrogen can exacerbate diabetic kidney disease progression. Diabetes combined with low estrogen increases vaginal dryness, infections and sexual dysfunction.How self-management strategies help?Weight control is key. That’s why regular physical activity remains the most effective way to boost insulin sensitivity and support cardiovascular health. Exercise helps your body use the insulin your body makes more effectively. This helps stabilise your blood sugar levels whether you have diabetes or not. Exercise further boosts your bone strength, which is compromised by falling estrogen levels.Get into the habit of monitoring your blood sugar, blood pressure, cholesterol and kidney function tests regularly. Have a nutrient-rich, sugar-controlled diet with emphasis on high-fibre foods, lean proteins and unsaturated fats. Get tested for your calcium and vitamin D levels and take supplementation as advised to reduce risk of bone fractures. Give up smoking as risks from diabetes and menopause compound significantly with tobacco use.Story continues below this adRemember, casual walking may not elevate your heart rate enough to burn significant calories and engage more muscle groups, which is necessary for effective fat reduction. Add strength training, which helped my patient get rid of her belly fat.What about hormone therapy?Hormone replacement therapy (HRT) is known to help improve blood glucose and lipid levels as well as kidney health in postmenopausal women with Type 2 diabetes. However, HRT is not suitable for everybody as it may increase risks of some cancers and blood clots, which may travel through the bloodstream and lodge in a blood vessel, obstructing blood flow. HRT should be strongly considered when menopause is early (less than 45 years) or premature (less than 40 years). The benefits of HRT after timely menopause have to be balanced against the risks of adverse effects. It has very limited application. Please go with your doctor’s advice on this.Through proactive, individualized care, all of the risks can be reduced and good health sustained into the later decades.(Dr Bhattacharya is senior consultant, endocrinology, Apollo Hospitals, Delhi)© The Indian Express Pvt Ltd