Clearly Hormonal
Have you ever wondered why your body feels like it's falling apart just as you're hitting your stride in other areas of your life? Join Dr. Komal Patil-Sisodia as she explores women’s metabolic health changes that start in perimenopause. The episodes center around educating and empowering women to have open dialogue with their doctors so that they can achieve their best metabolic health. Dr. Patil-Sisodia is board certified in Endocrinology, Obesity Medicine and Internal Medicine. She is also a Menopause Society Certified Practitioner. Any medical discussion on this podcast is purely for educational purposes and is not individualized medical advice. Please consult with your doctor to discuss any health concerns you may have.
Clearly Hormonal
Ep 28: Menopause, Hormones, & Diabetes Prevention
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In this episode of Reset Recharge, Dr. Komal Patil-Sisodia explores a groundbreaking study that reveals how menopause hormone therapy (MHT) may actually reduce the risk of type 2 diabetes in perimenopausal women with prediabetes.
Dr. Komal unpacks the data from a major Diabetes and Metabolism study of over 6,500 women aged 46–60, showing that those who used hormone therapy were 30% less likely to develop diabetes. She explains the science behind how estrogen supports metabolic health — improving insulin sensitivity, lowering inflammation, reducing central fat gain, and supporting pancreatic function — and why timing, age, BMI, and ethnicity make all the difference.
You’ll learn:
- How estrogen affects blood sugar and fat distribution
- Why MHT works best when started near menopause
- Which hormone formulations and delivery routes are safest and most effective
- Why personalized, evidence-based care is key to menopause medicine
Whether you’re navigating perimenopause, supporting patients, or simply curious about hormone health, this episode breaks down complex science into practical takeaways you can use.
💡 Key takeaway: Menopause hormone therapy isn’t just about symptom relief — it can be metabolic protection for the right woman, at the right time.
Connect with me:
Eastside Menopause & Metabolism
Time Stamps:
00:00 – 00:54 | Welcome & Episode Overview
00:55 – 02:30 | The Study That Sparked the Conversation
02:31 – 04:00 | Who Benefits Most from Hormone Therapy
04:01 – 06:00 | How Estrogen Supports Metabolic Health
06:01 – 07:45 | The Timing Hypothesis Explained
07:46 – 09:15 | Type & Route of Hormone Therapy Matter
09:16 – 10:45 | Balancing Benefits and Risks
10:46 – 12:15 | The Takeaway: Personalized Menopause Care
12:16 – 13:06 | Closing & Next Steps
References:
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Welcome to Reset Recharge, the podcast where women's health takes center stage. I'm your host, Dr. Komal Patil-Sisodia, a triple board certified endocrinologist and women's health expert. This show is all about empowering you with the knowledge to understand your metabolic health, navigate hormonal changes, and feel confident in the conversations you're having with your healthcare provider. Whether you're managing symptoms, exploring treatment options, or just want to feel more in tune with your body, you're in the right place. As a physician, my goal is to educate on this podcast. The content shared here is for informational purposes only and should not replace personalized medical advice. If something we discuss resonates with you, please talk to your healthcare provider at your next visit. Now let's dive in and help you reset, recharge, and take control of your health.
Dr. Komal Patil-SisodiaHi everyone. Welcome back to Reset Recharge. Today we are going to talk about one of the most fascinating and hopeful areas in women's metabolic health. How menopause hormone therapy or MHT may actually reduce the risk of developing diabetes in perimenopausal women with pre-diabetes. There was a study published last year in Diabetes and Metabolism by Dr. Shih and colleagues, which has added important evidence to this discussion, and I wanted to unpack what it means. I have a lot of patients who are coming into my office who are asking what this study means for them and for family members. So let's unpack it. Figure out how this interaction between hormones and prediabetes and diabetes works, and what women and other clinicians can take away from this. Let's talk first a little bit about the study. What did the research find? The investigators from this particular study analyzed health data from over 6,500 women between the ages of 46 and 60 years old who had pre-diabetes before menopause already. I'm loving that. They're studying the right age group, which is 46 to 60. One of my big great. So if you've listened to some of my other podcast episodes has been that the Women's Health Initiative studied an older population of women for prevention of cardiac disease. And I think that's partly why we didn't see the results we were hoping to see. So this study is already off to a good start, 6,500 women, which is a significant number of women. In the right age range. Some of these women received menopause hormone therapy, either estrogen alone or in combination with progesterone, while others did not, and over a 20 year follow up, they found something pretty remarkable. The women who used hormone therapy were about 30% less likely to develop type two diabetes than those who didn't. The study reports a hazard ratio of 0.69. You might be listening to this and being like, my goodness, what is she talking about? Think about it this way. If a hundred people were going to get diabetes and only 69 of them did. That means that almost the risk was reduced by almost one third, right? So there's 31 people out there who didn't get it. So that's that 30% reduction that they're seeing, and that's a pretty meaningful long-term benefit. But here's where it gets interesting. The effect was not uniform across everyone in the study age. There were certain predictors that were interesting to look at. Age was one of the strongest predictors, and the strongest protection was in women age, 46 to 50. Second was ethnicity. There was clear benefit in women who are white but not, it was not statistically significant in women who are black or Asian. So you can't apply this to everybody across all ethnic groups. And then the last one, which I find the most interesting is that women who had a normal or moderately elevated, BMI up to 29.9, so in the normal or overweight category actually had benefit. However, women who struggled with obesity and had a BMI greater than or equal to 30 did not have benefit. So the big takeaway is that menopause hormone therapy can help lower diabetes risk, but the individual characteristics matter. So you need to talk to your doctor about whether this is actually something that is helpful for you based on age range, based on ethnicity, based on your BMI. All of these things matter into how MHT will work for you. Let's talk a little bit about why estrogen or hormone therapy in general would reduce diabetes risk. Let's talk about a few key things that are happening in our bodies that lead to reduced diabetes risk when using hormones. The first thing that happens is we see improved insulin sensitivity. Estrogen enhances how our muscles and fat cells respond to insulin and allow glucose to enter cells more efficiently. This means a lower fasting glucose, lower insulin levels, and an improved hemoglobin A1C. The second thing that estrogen does is it supports pancreatic beta cells, which are the cells that make insulin and improve their ability to respond to rising blood sugar. The third thing that we see is reduced what we call central adiposity or that weight gain around the middle. I have a lot of patients complain about this particular symptom, the weight gain around the middle. What happens in menopause is that the fat shifts towards the abdomen and primarily inside the abdomen, which increases that metabolic risk because any fat tissue that's inside your abdominal cavity is that visceral fat that's very inflammatory. Estrogen will help curb this redistribution, meaning it won't be visceral fat per se, that is accumulating. You could still have what we call subcutaneous fat, which is the fat that sits under the skin, but that is not as inflammatory. Number four, we see an effect on inflammation and energy balance. When estrogen levels fall, inflammation will rise and the metabolism slows down. Menopause hormone therapy will counteract these effects by keeping inflammation lower and helping. Women expend more energy. And lastly number five, there are effects on your lipid profile, which is the cholesterol and on the liver hormone therapy can improve cholesterol levels and reduce the liver's glucose production, which helps lower blood sugars and help support metabolic health. There are many metabolic benefits of menopause hormone therapy, and together they will contribute in lowering this diabetes risk in the individuals that we talked about before. The next logical question is, why do these effects vary by age, ethnicity, and BMI? With age, there's something called the timing hypothesis, and this suggests that hormone therapy works best when it started near menopause, or maybe even in perimenopause. Younger perimenopausal women have better insulin sensitivity and they've had less damage to their blood vessels throughout their body because they haven't been. Hormone deficient for as long, and that allows hormones to continue exerting protective effects. What happens later is that as we age and the longer we've been off hormones, more inflammatory things can develop. We saw in the Women's Health Initiative, when you give hormones to women who are further out from menopause, we actually see bad things happen. Number two, ethnicity. These differences can stem from genetics, diet, cultural patterns, other metabolic adaptations. And so we really need to study different populations of women to understand this better. So I want everybody to understand that. The study that was done showed that this effect was there in women who are white, not who are black or Asian. So we can't apply this data uniformly or promise the same effects when we're talking to our patients. And then the third one is BMI in women who Struggle. Overweight or obesity. And in this case, obesity, specifically, insulin resistance is already somewhat high, and the benefit of the estrogen is blunted by the inflammation. The benefit of the estrogen is likely blunted or decreased because of all the chronic inflammation that's happening, The key message here is that personalized medicine is crucial. Menopause hormone therapy is not a one size fits all intervention, and it's not going to have the same metabolic effect in everybody. The other differences that can play into this are the types of menopause hormone therapy that are utilized because they're not all created equal. In women who have typically had a hysterectomy, they can take estrogen alone because they don't have a uterus. They don't need a progestin to thin out the lining for endometrial cancer prevention because that risk is gone with a hysterectomy. The other category of hormone therapy is estrogen plus a progestogen, and this is required for women who have their uterus. In order to protect against endometrial cancer. You need both, and the type of progestogen matters. Micronized progesterone, or there's another one that's not available in the us. I think it's called dydrogesterone. Both Are metabolically neutral and preferred. The other one that I will tend to use is drosperinone, but I don't know that it's been studied in this particular case. The route of administration, meaning how you take the medication, also matters. Oral estrogen goes through what we call first pass effect in the liver, where when it gets metabolized through the liver, it will have influence on the triglycerides and on clotting factors. And so for women who are struggling with overweight or obesity. Transdermal estrogen, which comes in patches, gel sprays, avoids that first pass effect, and it gives steadier hormone levels and less risks for clotting and inflammation. So that tends to be my preference when I'm prescribing for my patients. In studies, both routes, oral and transdermal, improved glucose metabolism, but transdermal estradiol was often more favorable for women who are struggling with obesity or were at high cardiovascular risk, because of that decreased risk of inflammation and clotting. There was a 2025 study that found estrogen alone lowered insulin resistance more strongly than estrogen plus progestin therapy. So formulation and route will both matter. So I think that's important to note. And as always, when we talk about hormone therapy, we have to weigh the benefits against the potential risks such as cardiovascular events, breast cancer, and venous thrombosis. The good news is that when we start hormone therapy closer to the time of menopause, especially in women who are under 60, the cardiovascular risk profile is beneficial. Transdermal estrogen carries the lowest clotting risk, and then the dosing you can individualize just to optimize people's safety. The American Heart Association and Endocrine Society both support this concept of quote, window of opportunity. Or the timing hypothesis, which we talked about earlier, which is starting therapy early at the right dose and for the right reason. For Women who have pre-diabetes or metabolic syndrome, menopause hormone therapy, can serve as both symptom relief and potentially metabolic production protection, which is a double win, right? So two birds, one stone. To wrap up this topic, let's talk about. To wrap up, there's a few key things I want you to take away from this episode. Menopause hormone therapy when individualized can reduce the likelihood of developing diabetes, especially in perimenopausal women with pre-diabetes. This applies to women who are white and who have a BMI of less. Than 30. It was not seen in women who are black or Asian or in women who struggle with obesity and already have some degree of insulin resistance. The science is still evolving, and we need to look at other ethnic groups to understand what the benefit is across all women If you are approaching menopause and wondering whether hormone therapy is right for you, you need to have a personalized discussion with your clinician about your risks, what the goals are, and what your preferences are for treatment. Let me know if there's another article you want me to break down, or if you have a clinical question that you want broken down on a podcast episode. Thank you for tuning in for today's episode. I'll see you on the next one.