What are the signs of insulin resistance in women over 40?
The clearest signs of insulin resistance in women over 40 are a growing waist, skin tags or dark velvety skin, and blood work creeping up within the normal range. It rises fastest in the four years around the last period.¹
Insulin resistance means your muscles, liver and fat respond less to insulin, the hormone that moves sugar out of your blood. Your pancreas makes extra insulin to make up for it. You usually feel nothing,² so the signs worth knowing are the ones you can measure.
|
Sign |
How to check |
What it means |
|
Belly fat, or a bigger waist |
A tape measure, halfway between your lowest rib and the top of your hip, after a normal breath out. The flag is 35 inches or more, or more than half your height.³ ⁴ |
Fat around your middle is one of five markers of metabolic syndrome, a cluster of risks that comes with insulin resistance. Three or more make the diagnosis.³ |
|
Skin tags, or dark velvety patches on the neck, armpits or groin |
A mirror |
Both are linked to high insulin.⁵ Show any new dark patch to a doctor. |
|
Triglycerides of 150 mg/dL or more, or HDL cholesterol under 50 mg/dL |
Your last cholesterol test |
Two more of the five markers.³ |
|
Blood pressure of 130/85 or higher |
Your last checkup, or a home monitor |
Another marker.³ |
|
Fasting blood sugar of 100 to 125 mg/dL |
Your last blood test |
The fifth marker, and the prediabetes range.³ ⁶ By now, insulin resistance has usually been building for years.⁷ |
Tiredness, brain fog, hunger, sugar cravings and crashes after meals appear on most lists, but they have many other causes. For instance, an underfunctioning thyroid, brings the same tiredness and weight gain.⁸
Constant thirst and needing to pee more often mean blood sugar is already high, so see a doctor soon.⁹
Why does insulin resistance rise around menopause?
A study published in JCI Insight in October 2026 followed 1,315 US women who were 42 to 52 years old when they joined. Researchers measured their insulin resistance up to 12 times over the years.¹
|
Stage |
Yearly increase in insulin resistance |
|
Before the menopause transition |
1.2% |
|
From about 18 months before the last period to 2.5 years after |
4.3% |
|
After that |
0.9% |
The increase was fastest during the years around the final menstrual period. Researchers accounted for changes in body weight, indicating that weight gain alone did not explain the spike.
The study followed women over time without testing a treatment or changing their routine. So, it shows when insulin resistance increased, but not what caused it.
These yearly rates are estimates based on a specific reference profile used in the study. They are not predictions of what will happen to every woman. Your own experience may differ.
What is the role of estrogen in insulin resistance?
Estrogen helps your muscle, liver and fat respond to insulin.¹⁰ As estrogen falls, that help weakens. Muscle matters most, because it takes up most of the sugar from a meal.¹¹
In the same group of US women, fat gain doubled in speed at the start of the transition, and lean mass, which is mostly muscle, began to shrink. Both changes lasted until about two years after the last period, while weight kept rising at its old pace.¹² A separate study of 156 women found that only those who reached menopause gained fat deep inside the belly.¹³ So with menopause weight gain, a tape measure can show a change the scale misses.
Can insulin resistance cause hot flashes?
Higher insulin is linked to hot flashes, but no study has shown that it causes them. In a 2026 study in The Journal of Clinical Endocrinology and Metabolism, 704 US women had their insulin measured at about age 47.¹⁴ Those with higher insulin started having hot flashes and night sweats earlier, and their hot flashes lasted longer. The link held after allowing for weight and blood sugar.
An earlier analysis of 3,075 women from the same study found that women with hot flashes had higher insulin resistance over eight years, even allowing for weight.¹⁵
Nobody has tested whether lowering insulin shortens hot flashes. Hot flashes that start early or won’t let up are still a reason to ask about your insulin. If night sweats are wrecking your sleep and mood, our piece on perimenopause anxiety, rage and brain fog covers that side.
Which tests show insulin resistance?
There is no single routine test that directly diagnoses insulin resistance. The usual screening tests, A1c and fasting blood sugar, measure blood sugar rather than insulin.
A 2009 study published in The Lancet followed British civil servants who later developed type 2 diabetes. Among the 505 people who developed diabetes, the body's response to insulin began to worsen about five years before diagnosis. Fasting blood sugar, however, rose sharply only in the last three years.⁷
The American Diabetes Association recommends that adults begin screening for prediabetes and diabetes at age 35. If your results are normal, you should generally be screened at least every three years. Some people may need testing sooner, depending on their risk factors.⁶
|
Test |
What it tells you |
Worth knowing |
|
A1c |
Your average blood sugar over about three months. 5.7 to 6.4% indicates prediabetes.⁶ |
Your A1c can be normal even when your body is getting insulin resistant.⁷ |
|
Fasting blood sugar |
Blood sugar after a night without food. 100 to 125 mg/dL is prediabetes.⁶ |
Also rises late, after insulin resistance has already begun to worsen.⁷ |
|
Fasting insulin test |
How much insulin your pancreas makes to keep your sugar normal |
Results can vary between labs. In one comparison of 10 lab methods, 7 gave results more than 15% away from the reference method.¹⁶ |
|
HOMA-IR |
A score calculated from your fasting insulin and fasting blood sugar levels. Both are measured at the same time. |
No agreed cutoff. One study of 2,459 adults found cutoffs from 2.05 to 3.46, depending on how they were set.¹⁷ |
|
Triglycerides and HDL cholesterol |
Fats in your blood, from a standard cholesterol test |
Triglycerides of 150 or more and HDL under 50 count toward metabolic syndrome.³ |
|
Waist-to-height ratio |
Your waist measurement is divided by your height. You can calculate it at home using the same units for both measurements. |
A ratio below 0.5 is a general target. A ratio of 0.5 to 0.59 signals increased health risk.⁴ |
A review covering more than 300,000 adults found that waist-to-height ratio flagged heart and diabetes risk better than waist size or BMI.¹⁸
If your A1c is normal but your waist or triglycerides are climbing, ask for both fasting tests (insulin and A1c) drawn the same morning and repeated at the same lab.
What helps insulin resistance in your 40s and 50s?
Exercise (aerobic plus strength): In a review of seven trials covering 580 postmenopausal women, three to four months of regular exercise lowered insulin and insulin resistance, and six to twelve months reduced waist size.¹⁹ In a six-month trial of 136 inactive older adults, aerobic exercise and a mix of aerobic and strength training both improved insulin resistance. Strength training alone didn’t.²⁰ The mix did best overall, so pair strength work with walking, cycling or swimming.
Sleep: In a trial published in Diabetes Care in 2024, 38 women cut their sleep by about an hour and a half, to around 6.2 hours a night, for six weeks.²¹ Their fasting insulin and insulin resistance rose, more so in the 11 postmenopausal women. Our piece on the stress-diabetes loop covers how stress affects blood sugar.
Hormone therapy (HRT): A 2025 review of 17 trials in 5,772 postmenopausal women without diabetes found that hormone therapy lowered insulin resistance. Estrogen alone lowered it more than estrogen taken with a progesterone-type hormone.²² It’s prescribed for hot flashes and night sweats. For healthy women under 60, or within 10 years of menopause, its benefits for those symptoms usually outweigh the risks.²³
If your blood sugar is already in the prediabetes range, ask your doctor whether a medicine makes sense for you too.
Fenugreek: In a three-year study of 140 adults with prediabetes, 5 grams of a fenugreek powder twice a day before meals reported fewer cases of diabetes: 23 percent, against 55 percent without it.²⁴ Both groups also received guidance on diet and physical activity. The powder was debittered and defatted, so these findings may not apply to fenugreek seeds soaked at home.²⁴
Fenugreek is one of three herbs in Glucose and Metabolic Support, our formulation with gymnema and Indian kino tree. In 90-day research observations, participants who used it alongside targeted breathwork, dietary changes, and other lifestyle modifications showed up to a 14% reduction in A1c. The observations also recorded a 50% reduction in fatigue and frequent urination. The formula is intended to support healthy blood sugar levels, and normal glucose metabolism and pancreatic function.
Please note: Large amounts of fenugreek can lower blood sugar too much, particularly when combined with diabetes medications. Fenugreek supplements are best taken under medical supervision. Avoid taking fenugreek in amounts greater than those found in food during pregnancy.²⁵
Ayurvedic Science groups a growing abdomen, slow digestion and a craving for sweets under Kapha, the bioenergy that governs stability and lubrication in the body. It recommends daily movement and bitter foods such as fenugreek to regulate excess Kapha.
How LYBL supports insulin resistance around menopause
A normal A1c can make it look as though nothing needs doing, even while your waist and triglycerides climb. The LYBL Women’s Health program works on that stretch, alongside your own doctor and any hormone therapy or medicine you take.
Your intake covers your cycle, sleep, stress, thyroid and everything you already take. A Holistic Health Physician builds a cohesive care plan to address the root cause of your concerns. It includes formulations matched to your health, along with tailored yoga, nutrition, and lifestyle recommendations. Your holistic health physician goes through the plan with you every month and adjusts it as you go.
