Question:Does menopause change insulin sensitivity, and what about hormone replacement therapy after menopause?
Answer:You know menopause occurs in all women, we hope, if they live long enough, and it's ultimately going to modify insulin sensitivity very little.
The change in insulin sensitivity that does occur probably doesn't relate as much to the female hormones that are now lower, but probably relates to some extent to the body fat redistribution; in other words, women tend to put more fat on after the menopause, and they tend to put it more centrally around the abdomen. And if insulin resistance does occur within menopause, that's probably a better explanation than not having estrogens and progestin on a cyclic basis.
Now the issue of hormone replacements is a little more complicated, because for a long time it was fairly automatic to put a woman on female hormones after the menopause even if symptoms were not present. But today, the more recent evidence would suggest that women probably shouldn't take female hormones after the menopause unless her symptoms are severe; and those symptoms could be hot flashes, or pain with intercourse, or perhaps women that have a low bone mass, it might be giving an indication for female hormones to prevent osteoporosis.
However, I think what we're seeing now with even more recent data, is that women who start female hormones closer to the menopause may not incur the same risk for heart attack and stroke or other clotting disorders, as women who start the female hormones say a decade or longer after the menopause.
So, this is an area that you need to work carefully with your physician about to determine whether you should be on female hormones, and ultimately what type of regimen is best for you.