Hormone therapy associated with reduced insulin resistance

The risk of insulin resistance is significantly reduced by hormone therapy among menopausal women, according to a recent study presented at the 2024 Annual Meeting of The Menopause Society.¹

Declining estrogen levels lead to a significantly increased risk of insulin resistance among menopausal women, as the declining hormone levels make the body less responsive to insulin. Severe adverse outcomes in patients with insulin resistance include prediabetes, type 2 diabetes, and metabolic disorders.¹

Multiple factors may influence the risk of insulin resistance in postmenopausal women, such as sleep deprivation.² A clinical trial evaluated the impact of a 1.5-hour reduction in sleep per night on blood and glucose levels in women, reporting a direct association.

Participants were aged 20 to 75 years with healthy sleep patterns, defined as 7 to 9 hours of sleep per night. Sleep was monitored using a wrist sensor and nightly sleep logs, first during a 2-week typical sleep period then during 2 6-week periods of either healthy sleep patterns or restricted sleep.²

The typical sleep period involved an average 7.5 hours of sleep per night, vs an average 6.2 hours per night during the typical sleep period. During this period, both premenopausal women and postmenopausal women experienced a 14.8% increase in insulin resistance.

Postmenopausal women had more severe effects, with insulin resistance up to 20.1% reported in this population. Marie-Pierre St-Onge, PhD, noted that even additional insulin may not be enough to counteract rising blood glucose levels in these women.²

While prior trials attempted to evaluate the potential benefits of hormone therapy on the risk of insulin resistance, these studies led to inconsistent results.¹ To evaluate the impact of hormone therapy on insulin resistance, investigators conducted a meta-analysis of 17 randomized, controlled trials.

There were 29,000 participants between 1998 and 2024 included in the trials, with 15,350 participants randomized to hormone therapy and 13,937 randomized to placebo. Participants were aged a mean 47 to 75 years, and the treatment duration was between 8 weeks and 2 years.¹

The hormone therapy group consisted of patients receiving either estrogen alone or estrogen plus progestogen. Healthy postmenopausal women without metabolic diseases in this group had significantly reduced insulin resistance compared to those in the placebo group.

According to Xuezhi (Daniel) Jiang, MD, lead researcher from Reading Hospital Tower Health, results indicated significantly reduced insulin resistance in healthy postmenopausal women receiving hormone therapy through both oral and transdermal methods. However, the reduction was greater from estrogen alone vs combination hormone therapy.¹

Additional study details were discussed at the 2024 Annual Meeting of The Menopause Society during the abstract presentation, “Effect of hormone therapy on insulin resistance in healthy postmenopausal women: A systematic review and meta-analysis of randomized placebo-controlled trials.”

“Hormone therapy is an effective treatment for many bothersome menopause symptoms, including hot flashes,” said Stephanie Faubion, MD, MBA medical director for The Menopause Society. “This new meta-analysis is important as declining estrogen levels in menopausal women put them at greater risk for insulin resistance and hormone therapy could be beneficial in reducing insulin resistance in these women.”¹

References

1. Breast arterial calcification could be warning sign of heart disease. The Menopause Society. September 10, 2024. Accessed September 12, 2024. https://menopause.org/press-releases/breast-arterial-calcification-could-be-warning-sign-of-heart-disease
2. Krewson C. Sleep deprivation and insulin resistance: A crucial link for women's health. Contemporary OB/GYN. November 20, 2023. Accessed September 12, 2024. https://www.contemporaryobgyn.net/view/sleep-deprivation-and-insulin-resistance-a-crucial-link-for-women-s-health