Insulin Resistance in Midlife Women: Why Your Labs May Look "Normal" But You Don't Feel Normal

Some of the changes that menopause brings, such as hot flashes, insomnia, and an increase in belly fat are hard to ignore. Others though, are much more subtle, happening almost silently.

Even if exercise and eating habits remain the same, because of the fluctuating hormone levels associated with the menopause transition, women’s bodies experience metabolic changes. If these changes continue unchecked, they could lead to insulin resistance, which may be developing even while routine lab tests appear to be in the normal range.

These noticeable changes, like increasing weight around your midsection, are important warning signs that menopause experts say women should never ignore. While visceral fat (often called belly fat) can understandably be a frustrating body image concern, it’s even more significant because it’s directly linked to a higher risk of serious conditions, including cardiovascular disease.

Fortunately, when women catch insulin resistance early, there are plenty of strategies including lifestyle changes and some medications that may help reverse it and protect their heart health.

What is insulin resistance and why does it matter?

Insulin is a hormone the pancreas produces to process sugars in the foods that we eat. When the pancreas senses sugar in the bloodstream, it releases insulin to help escort that sugar into our cells where it can be used for fuel. When we’re considered ‘insulin sensitive’ this process works well: our blood sugar stays balanced and the pancreas only makes insulin as needed.

Consuming excess sugar or ultra-processed foods, chronic stress and hormone fluctuations can affect how our cells accept glucose. The pancreas starts working overtime to make more and more insulin to compensate, causing blood insulin levels to rise, along with blood glucose levels, which causes inflammation. Excess insulin tells the body to store calories, so glucose is converted to fat and stored in our bodies, often in the midsection.

In this scenario, when insulin doesn’t work as it should, we’re considered insulin resistant. Insulin resistance can be the first step in a cascade of negative health changes that can lead to prediabetes, type 2 diabetes, non alcoholic fatty liver disease or heart disease, which the Centers for Disease Control and research cardiologist Dr. Jayne Morgan emphasize is the No. 1 killer of women.

Why does insulin resistance happen?

Anyone can become insulin resistant if they’re regularly eating more carbohydrate or sugar calories than they burn in a day. We live in a society where we have easy access to tempting sweet drinks, fast food and snacks, so it's little surprise that a University of North Carolina at Chapel Hill study found that just 12 percent of Americans were metabolically healthy. Many Americans are sedentary, with just 1 in 4 people getting the recommended weekly exercise: two days of weight training and 150 minutes of cardio, according to the Centers for Disease Control. Chronic stress can also lead to higher levels of the hormone cortisol, which can contribute to insulin resistance. And, people with a family history of diabetes or polycystic ovary syndrome are at higher risk.

A 2025 study of nearly 1000 women confirmed that compared to non-menopausal women, early menopausal women had a higher rate of insulin resistance. And, the researchers found the most reliable predictor of insulin resistance was their waist to hip ratio. For women, the normal waist-to-hip ratio is below 0.85; higher values are linked to reduced physical function and longevity.

What are insulin resistance symptoms?

For many women, the symptoms of insulin resistance may be subtle. Others start to feel fatigued or they may get a surprise diagnosis of prediabetes. Here are some of the common symptoms of insulin resistance:

• Visceral belly fat/Waist-to-hip ratio over the guidelines
• Low energy and fatigue
• High blood pressure
• Brain fog
• Dark patches (acanthosis nigricans) on the neck and skin folds
• Depression and anxiety
• Feeling hungry after a meal
• Urinating more often

So why do my labs look normal if I have insulin resistance?

There are several reasons insulin resistance can be hard to detect. One of the important issues is that most routine annual blood screening panels don’t check insulin levels or fasting blood glucose, and it can start in the teen years even in people who are slender.

At first, the body manages excess glucose by raising our blood sugar or storing excess sugars as fat while the pancreas makes extra insulin. Over time, this throws routine metabolic markers out of balance.

Some standard test values that can point to insulin resistance include:

• Elevated blood triglycerides
• High blood pressure
• Low HDL cholesterol

When someone has two of these, it means they’re likely to have other markers for metabolic syndrome, an array of which can be a harbinger of diabetes or heart disease. A savvy clinician will test fasting blood glucose as well as HbA1C, which looks at blood sugar levels over three months. Testing for fasting insulin and glucose levels allows a clinician to calculate a HOMA-IR score to measure the extent of insulin resistance.

This Lab Test Checklist outlines the key labs to discuss with your healthcare clinician, so you can better understand what’s happening in your body and advocate for your health.

What are strategies to restore insulin sensitivity?

Learning you’re insulin resistant isn’t necessarily good news, but it presents an opportunity to work with your clinician on mapping out some effective lifestyle changes and discussing medications that can help you improve your metabolic health. Even small changes can have a big impact. Here are some other science-backed strategies that may support insulin and glucose balance.

Manage stress

Elevated levels of the stress hormone cortisol put the body in constant fight or flight mode, so it holds onto weight. Meditation can be a wonderful and effective way to manage stress. One 2024 analysis found that relaxation and meditation were most effective at lowering cortisol levels. Women in a Canadian study said after 8 weeks of mediation and yoga they were less stressed and slept better. If you’re new to meditation, apps like BetterBrain and The Waking Up app can help you get started.

Try intermittent fasting

Intermittent fasting, which usually limits eating to an 8 or 12 hour window, can be an effective way to support the metabolic system and lose belly fat. In a 2022 metanalysis of 10 intermittent fasting studies, researchers concluded that “intermittent fasting diets… significantly improve insulin resistance.” Though subjects with metabolic syndrome followed different styles of intermittent fasting, they all experienced lower blood glucose, insulin levels, LDL cholesterol and triglycerides. They also lost overall body weight including around their waists. A small study of 31 women found that time-restricted eating was equally effective at helping both perimenopausal and post -menopausal women lose fat and improve insulin sensitivity.

Eat a non-inflammatory whole food diet with protein and fiber

Focus on eating a colorful, anti-inflammatory diet full of dark leafy greens, berries, nuts and lean proteins such as cold water fish with omega 3 fatty acids. Eating enough protein (about 30 grams per meal for most women) and fiber coming from vegetables, beans, nuts and fruit will slow absorption of sugars, which naturally keeps blood sugar more stable. If you’re not getting the recommended amount of fiber daily, a supplement like Fiber GDX can help. Eating a diverse array of 30 plants every week will keep your gut microbes happy, and reduce cravings for unhealthy sugary and high fat foods. Add green tea and spices like turmeric, cinnamon and ginger for flavor and their antioxidant power. Limit added sugars to 25 grams a day and reduce your consumption of ultraprocessed foods and empty carbs like sweet coffee drinks and chips.

Build strong bones and muscles

Did you know your muscles and your bones are metabolically active, helping manage blood glucose? Bone mass peaks by our early 30s and by the time we reach 50 it's in decline. Muscle mass peaks between 30 and 35. Ensure the health of both bones and muscles by doing resistance exercises like lifting weights two to three times a week. To learn more listen to Dr. Haver’s conversation with Dr. Vonda Wright on unPAUSED.

Get enough sleep

If you aren’t sleeping, it will be even harder to manage your insulin and glucose levels. In fact, getting less than 7 hours of sleep a night is a risk factor for insulin resistance all by itself. Sleep requires a routine that starts with early morning sun, exercise, eating dinner at least three hours before bed and avoiding blue light exposure. And if you’re still not getting the rest you need, the melatonin, L-theanine and magnesium in ‘Pause Sleep™️ have been shown to help support circadian rhythm to encourage adequate sleep.*

Consider hormone therapy

For perimenopausal and postmenopausal women who are candidates, hormone therapy can be one of the best ways to restore insulin sensitivity. Studies have shown estrogen helps protect metabolic function and combat insulin resistance. At the 2024 Menopause Society conference, researchers from Drexel University College of Medicine presented a large study confirming that estrogen therapy offers robust protection from insulin resistance. The researchers drew this conclusion after reviewing 17 randomized controlled trials with more than 29,000 healthy post-menopausal women. Analysis showed that both types of hormone therapy, including oral and transdermal routes, significantly reduced insulin resistance in healthy postmenopausal women.

Combine hormone therapy with GLP-1s or other metabolic medication

For women who have made exercise and dietary changes and still struggle with their metabolic health, GLP-1 agonists like semaglutide and tirzepatide may be considered. The body naturally releases GLP-1 hormones that regulate blood sugar and make us feel full when we eat foods rich in fiber, fat and protein and these drugs stimulate the release of the same satiety hormones. GLP-1 agonists are helping women lose the visceral belly fat that poses a significant health risk. Metformin and supplements like berberine may also be helpful to women struggling with metabolic syndrome. Listen to Dr. Rocio Salas-Whalen break down the science behind and potential benefits of GLP-1 medications on Dr. Haver’s podcast.

With lifestyle changes and patience, it’s possible to conquer insulin resistance and get your health back on the right track.

*FDA Disclaimer