Midlife Insulin Levels: Implications for Menopausal Symptoms and Cardiometabolic Risk

University of Victoria researchers report that higher midlife insulin at age 47 predicts an earlier onset and longer duration of menopausal hot flashes and night sweats — a finding that highlights overlapping cardiometabolic risk pathways and supports heightened diabetes vigilance in midlife.

The team analyzed a longitudinal cohort that began in perimenopause, with baseline metabolic measures at a median age of 47 and multi-year follow-up to capture vasomotor symptom onset and duration. Higher fasting insulin predicted both earlier onset and prolonged duration of menopausal vasomotor symptoms in cohort analyses. These results indicate a robust predictive association without establishing causation.

Insulin resistance correlated with increased frequency and greater severity of hot flashes and night sweats. Autonomic and thermoregulatory pathways plausibly link metabolic dysregulation to vasomotor burden, and the association persisted after adjustment for body mass index. As a result, metabolic syndrome features, including insulin resistance, can help inform risk stratification for perimenopausal patients.

Insulin and broader metabolic status can be incorporated into counseling to set expectations about vasomotor symptom risk and likely duration. Evidence-consistent midlife measures—weight management, regular physical activity, and dietary patterns that improve insulin sensitivity—are reasonable strategies to discuss for concurrent symptom reduction and cardiometabolic risk mitigation. Integrating metabolic assessment into midlife symptom counseling provides a practical framework to align symptom expectations with cardiometabolic risk management.