Do MHT or HRT Affect Blood Sugar?

Clinically reviewed by Holistic Nutritionist Beth Bollinger

Many women going through menopause wonder whether menopause hormone therapy (MHT), also known as hormone replacement therapy (HRT), will impact their blood sugar levels. The relationship between MHT/HRT and glucose metabolism is complex, with research showing predominantly positive effects on blood sugar control. Understanding how MHT/HRT affects your body's ability to manage glucose can help you make informed decisions about your health during and after menopause.

What is MHT (HRT)?

Menopause hormone therapy/hormone replacement therapy is a treatment that helps restore hormone levels that decline during menopause. As women age, their ovaries produce less estrogen, progesterone, and testosterone, leading to various symptoms including hot flashes, night sweats, mood changes, and metabolic shifts.

MHT/HRT typically includes:

Estrogen - The primary female sex hormone that affects multiple body systems, including metabolism, bone health, cardiovascular function, and brain health.

Progesterone or progestins - Natural progesterone or synthetic forms that protect the uterine lining and support sleep quality, which can improve metabolic health.

Testosterone - Often overlooked but crucial for metabolic health. Testosterone replacement can improve insulin sensitivity, increase lean muscle mass, and support healthy body composition. Women produce testosterone in their ovaries and adrenal glands, and levels decline during menopause. Low testosterone is associated with increased abdominal fat, reduced muscle mass, sexual dysfunction, and metabolic dysfunction.

Treatment approaches include:

• Combination therapy - Multiple hormones together for comprehensive support

• Estrogen-only therapy - For women who have had a hysterectomy

• Vaginal estrogen - For localized urogenital symptoms

MHT/HRT comes in various forms, including oral, transdermal patches, gels, sprays, and vaginal preparations. The method of delivery can influence how the hormones affect your metabolism and blood sugar levels.

How does MHT/HRT impact blood sugar?

Research consistently shows that MHT/HRT generally has beneficial effects on blood sugar control, particularly for women with existing insulin resistance, prediabetes, or diabetes. Multiple large-scale studies have demonstrated that hormone replacement therapy can improve glucose metabolism through several mechanisms.

Improved insulin sensitivity

Improved insulin sensitivity is one of the primary benefits. Estrogen acts directly on estrogen receptors in muscle tissue, the liver, and fat cells to reduce insulin resistance. This means your cells become more responsive to insulin, allowing glucose to move more efficiently from your bloodstream into your cells where it's needed for energy.

Enhanced insulin transport

Enhanced insulin transport represents another crucial mechanism. Recent research from UT Southwestern Medical Center shows that estrogen stimulates cells lining blood vessels to deliver insulin more effectively to muscles, which consume approximately 80% of the body's glucose. This improved insulin transport helps maintain better blood sugar control.

Reduced abdominal fat

Reduced abdominal fat occurs because estrogen increases fat oxidation - the breakdown of fat to produce energy. Since abdominal fat is strongly linked to insulin resistance, this redistribution of body fat contributes to better glucose control.

Studies involving women with type 2 diabetes have shown that those taking MHT/HRT experienced:

• Significant decreases in fasting plasma glucose levels

• Lower insulin levels, indicating improved insulin sensitivity

• Reduced HOMA-IR scores (a measure of insulin resistance)

• Better overall glucose homeostasis

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Does MHT/HRT impact A1C?

Yes, MHT/HRT can positively impact A1C levels, which measure your average blood sugar over the previous 2-3 months. Multiple studies have documented this relationship:

A large study of over 15,000 women with type 2 diabetes found that those using MHT/HRT had significantly lower HbA1c levels compared to non-users. Even after adjusting for factors like age, ethnicity, obesity, diabetes duration, and medication use, MHT/HRT remained independently associated with decreased A1C levels.

Research specifically examining A1C outcomes showed:

• Women aged 40-49 taking MHT/HRT experienced decreased A1C levels

• Women over 50 showed no adverse effects on A1C, with many experiencing improvements

• Both estrogen-only and combination therapies showed positive results

It's important to note that individual responses can vary, and women with diabetes who start MHT/HRT may need more frequent monitoring and potentially adjusted diabetes medications as their glucose control improves.

How does MHT/HRT work?

MHT/HRT works by replacing the hormones that naturally decline during menopause, primarily estrogen, progesterone, and testosterone. Understanding these mechanisms helps explain why MHT/HRT can be beneficial for blood sugar control.

Estrogen's metabolic effects

Estrogen's metabolic effects are wide-ranging. This hormone:

• Binds to estrogen receptors throughout the body, including in muscle, liver, and fat tissue

• Enhances insulin signaling pathways, making cells more responsive to insulin

• Stimulates insulin secretion from pancreatic beta cells when needed

• Promotes the transport of insulin from blood vessels into muscle tissue

• Influences the expression of genes involved in glucose metabolism

• Reduces inflammation that can contribute to insulin resistance

Progesterone and progestins

Progesterone and progestins have more complex effects. While natural progesterone generally has neutral or slightly beneficial effects on glucose metabolism and has beneficial effects on sleep which can improve metabolic health, synthetic progestins can sometimes counteract some of estrogen's benefits. However, the overall effect of combination MHT/HRT still tends to be positive for blood sugar control.

Testosterone's metabolic effects

Testosterone's metabolic effects include:

• Promoting lean muscle mass, which increases glucose uptake capacity

• Improving insulin sensitivity in muscle tissue

• Supporting healthy body composition by reducing abdominal fat

• Enhancing energy and motivation for physical activity

• Supporting bone density and overall metabolic function

• Maintaining metabolically active muscle tissue that serves as a glucose sink

Many practitioners now consider testosterone an important component of comprehensive hormone therapy for women, particularly those with metabolic concerns, significant muscle loss, or low energy levels that affect their ability to maintain healthy lifestyle habits.

Timing considerations

The timing of MHT/HRT initiation also plays a role. Starting MHT/HRT during the "window of opportunity" - soon after menopause begins or even during perimenopause - appears to provide the greatest metabolic benefits while minimizing risks. Current medical thinking emphasizes individualized treatment duration based on ongoing benefits versus risks, with many women safely continuing therapy beyond 10 years when appropriate for their specific situation.

How menopause impacts blood sugar

The transition through menopause creates metabolic changes that can significantly affect blood sugar control. Understanding these changes helps explain why some women develop glucose intolerance or diabetes during this life stage.

Hormonal changes

Hormonal changes during perimenopause and menopause include:

• Declining estrogen levels, which reduces insulin sensitivity

• Fluctuating hormone levels that can cause unpredictable blood sugar swings

• Changes in growth hormone and cortisol patterns that affect glucose metabolism

• Alterations in appetite-regulating hormones like leptin and ghrelin

• Loss of testosterone and muscle mass, reducing metabolic capacity

Body composition shifts

Body composition shifts commonly occur during menopause:

• Increased abdominal fat storage, which is strongly linked to insulin resistance

• Loss of muscle mass, reducing the body's capacity for glucose uptake

• Changes in fat distribution from hips and thighs to the midsection

• Overall weight gain that can worsen insulin sensitivity

Metabolic consequences

Metabolic consequences of these changes include:

• Increased risk of developing type 2 diabetes

• Worsening glucose control in women who already have diabetes

• Higher fasting glucose levels

• Elevated insulin levels as the body tries to compensate for increased resistance

• Greater likelihood of developing metabolic syndrome

Research shows that women face a 23% increased risk of developing type 2 diabetes in the five years following menopause. This risk is particularly pronounced in women who experience surgical menopause (removal of ovaries) or early menopause.

The good news is that these metabolic changes aren't inevitable. Lifestyle modifications including regular exercise, healthy eating, weight management, and potentially MHT/HRT can help counteract many of these effects and maintain better blood sugar control during and after menopause.

Bottom line

MHT/HRT generally has beneficial effects on blood sugar control, with research consistently showing improvements in insulin sensitivity, glucose metabolism, and A1C levels. For women with existing diabetes or prediabetes, MHT may offer significant metabolic advantages alongside relief from menopausal symptoms.

Current medical thinking emphasizes that hormone therapy should be highly individualized based on symptoms, metabolic profile, risk factors, and personal preferences rather than following a one-size-fits-all approach. The decision to use MHT/HRT should involve a thorough discussion with a healthcare provider who understands both the benefits and risks for your specific situation.

When considering MHT/HRT for metabolic benefits, comprehensive hormone replacement including estrogen, progesterone, and testosterone may provide the most complete support for maintaining healthy blood sugar control and overall metabolic function during and after menopause.

The Next Step: Support for Your Metabolic Health

Understanding how MHT/HRT affects your blood sugar is empowering, but knowledge alone isn't enough. You need practical strategies, support, and tools to make lasting changes.

The Blood Sugar Method is an online program and membership designed specifically for women navigating hormonal changes and metabolic health. You'll get:

• A structured, self-paced course with video modules and actionable guides

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• A supportive community of women achieving real results

• Ongoing guidance from a certified holistic nutritionist

Women in our program report improved energy, better sleep, clearer thinking, and lasting weight management without restriction or complicated rules, whether with or without MHT/HRT.

Ready to start? Here's how:

1. Take our survey so we can learn more about you and see if The Blood Sugar Method is the right fit

2. Schedule a 10-minute consultation with one of our experts to discuss your specific goals

3. Join today and start your journey toward metabolic balance

Your metabolism isn't broken. It's just changing. Let us show you how to work with your body naturally.