What… the Menopause?
Each week we spotlight an unexpected and frustrating symptom of menopause that no one warned you about. Because menopause is more than just hot flashes and missed periods.
This week’s spotlight: Blood sugar crashes
Are you someone who eats breakfast and feels great, but only a couple of hours later, you’re starving?
Or maybe you get bbrain fog, get the shakes, or a sudden need for something sweet. Do you feel you’re exhausted, irritable, or reaching for another coffee just to make it through the afternoon?
This may be a blood sugar crash.
Not every energy crash means your blood glucose has actually dropped too low, but menopause can change the way your body handles glucose and insulin.
The Hack My Age podcast recently featured an episode with Danielle Hamilton, a blood sugar and hypoglycemia expert, discussing how fasting, carbohydrate restriction and pushing exercise harder can sometimes backfire for midlift women experiencing low blood sugar symptoms.
What’s going on with your blood sugar during menopause?
Menopause can make blood sugar regulation more challenging because declining estrogen is associated with changes in insulin sensitivity, body fat distribution, muscle mass, and glucose metabolism.
Glucose is the main sugar in your blood and one of your body’s primary sources of energy. When you eat carbohydrates, they are broken down into glucose, which enters your bloodstream.
Your pancreas responds by producing insulin, a hormone that helps move glucose out of your bloodstream and into cells where it can be used or stored for energy.
The problem is that during the menopause transition, several things can change at once.
Estrogen declines. Muscle mass can get harder to maintain. Fat distribution often shifts toward the abdomen. Sleep can get worse. Stress can increase. And insulin sensitivity can change.
Insulin resistance means your cells don’t respond to insulin as effectively as they once did, so your body needs more insulin to achieve the same effect. Over time, this can contribute to higher blood glucose and increase the risk of prediabetes and type 2 diabetes.
This doesn’t mean menopause automatically causes diabetes. It doesn’t.
But the menopause transition is a period when metabolic health deserves a little more attention. And here’s where things get confusing. A “blood sugar crash” doesn’t necessarily mean you have hypoglycemia. Hypoglycemia is medically defined as low blood glucose, generally below 70 mg/dL (3.9 mmol/L). Symptoms can include shakiness, sweating, hunger, dizziness, weakness, confusion, anxiety and a fast heartbeat.
You can also feel “low” when your glucose isn’t actually below that threshold. For example, your blood glucose may fall quickly after being elevated, or you may simply be experiencing an energy dip, hunger, stress response, poor sleep or another issue that feels very similar.
So if you’re constantly saying, “I think my blood sugar is crashing,” don’t automatically assume you have hypoglycemia.
How common are blood sugar crashes during menopause?
There isn’t a reliable percentage for how many menopausal women experience “blood sugar crashes,” because it isn’t a standardized medical diagnosis. But changes in insulin resistance and glucose metabolism are common enough during midlife that metabolic health deserves attention.
For example, recent U.S. population data found that insulin resistance and hyperinsulinemia affected more than 40% of women overall, with later menopausal stages associated with higher odds of insulin resistance and metabolic syndrome.
And studies around the world show that metabolic syndrome becomes increasingly common across the menopausal transition, although the exact numbers vary substantially depending on the population, age, diagnostic criteria and other risk factors.
That’s important because we’re often taught to think about menopause symptoms as separate little problems.
Hot flashes over here. Weight gain over there. Brain fog somewhere else. Afternoon fatigue? Probably just getting older. But your metabolism doesn’t work in neat little boxes.
Blood sugar regulation is connected to your nutrition, physical activity, muscle mass, sleep, stress, hormones and overall metabolic health.
And this is one reason I don’t love the idea of simply blaming every new midlife symptom on “hormones.”
What can you do to prevent blood sugar crashes in menopause?
The most useful place to start is not cutting out every carbohydrate. It’s creating meals, movement and daily habits that help your body handle glucose more steadily.
Build meals around protein, fiber and minimally processed carbohydrates. One of the easiest changes is to stop eating carbohydrates by themselves whenever you can. Think about the difference between eating a pastry on its own versus having a meal that combines protein, vegetables, fiber, healthy fats and a source of carbohydrate.
You’re not trying to make carbohydrates the enemy. You’re trying to make your meal more metabolically balanced.
Protein is particularly important during midlife because maintaining muscle becomes increasingly important for both strength and metabolic health. Skeletal muscle is a major site for glucose disposal, which makes maintaining and building muscle an important part of metabolic health.
Move after you eat. A short walk or some light movement after a meal can help your muscles take up glucose. And it doesn’t have to mean an hour at the gym. This is one of those wonderfully unsexy health strategies that can actually be useful because you can do it immediately.
Go for a walk. Take the stairs. Do some gentle movement around the house. If you have been sitting for hours, get up.
Don’t underestimate strength training. If menopause is changing your metabolic health, muscle is one of your best allies. Resistance training helps preserve and build muscle, and muscle plays an important role in glucose regulation.
This is one reason the goal shouldn’t simply be “lose weight.” Your goal is to build a body that is metabolically resilient. That means muscle, strength, and movement. And enough recovery to actually adapt.
Be careful with aggressive fasting and extreme restriction. Intermittent fasting works well for some people. But more isn’t automatically better.
If you’re already dealing with significant hunger, shakiness, poor sleep, stress or suspected hypoglycemia, aggressively extending fasting windows may not be the experiment to run on your own. Your body is giving you information. Pay attention to it.
Look at the rest of your metabolic picture. If these crashes are happening regularly, don’t just keep buying snacks and hoping for the best. Talk to your healthcare professional.
Depending on your symptoms and medical history, they may consider things such as fasting glucose, HbA1c, cholesterol and triglycerides, blood pressure, waist circumference or additional testing when appropriate.
And if you’re having symptoms that genuinely suggest hypoglycemia, measuring your glucose during an episode can be much more useful than guessing. A continuous glucose monitor (CGM) can provide a fascinating picture of glucose patterns, but it shouldn’t be treated as a substitute for medical diagnosis.
Don’t chase perfect blood sugar numbers. Build the foundations that support metabolic health: protein-rich meals, fiber, regular movement, strength training, good sleep and sensible eating patterns. If symptoms are frequent or intense, investigate rather than guessing.
What worked for me?
I became much more curious about my own blood sugar instead of simply assuming I knew what was happening. I actually spend two weeks a couple times a year wearing a continuous glucose monitor to see what happens to my glucose throughout the day.
I want to know what different foods, stress and everyday activities are actually doing to my blood sugar, rather than relying on generic advice.
I shared that experiment on an episode of the Hack My Age podcast, including what a CGM is, why blood sugar can matter more during menopause, how stress can affect glucose and what I learned from wearing one for two weeks. And honestly, that’s the approach I like most.
Get curious. Test. Pay attention. Adjust.
Not every woman is going to respond to the same meal in exactly the same way. Two people can eat the same breakfast and have completely different glucose responses. That’s why I don’t believe in blindly following a perfect menopause diet.
Instead, I want women to understand their own bodies well enough to make better decisions for themselves. And one of the most interesting things I’ve found when experimenting with blood sugar is how powerful movement can be.
In one conversation, I talked about how even short bursts of movement after eating could change the glucose response I was seeing. Something as simple as doing a few minutes of air squats after eating made me think differently about how much power we actually have over our metabolic health. You don’t need another complicated protocol, sometimes the “hack” is surprisingly basic.
Eat a better-balanced meal. Move your body. Build muscle. Sleep. Manage stress. Then see what happens. And if something isn’t working, investigate it rather than blaming yourself.
My two-week CGM experiment is covered in this Hack My Age episode: Menopause & Blood Sugar: How to Use a Continuous Glucose Monitor
FAQ’s: Blood Sugar and Menopause
Can skipping breakfast cause blood sugar crashes during menopause?
It can contribute to hunger, fatigue or feeling shaky in some people, particularly when combined with long fasting periods, intense exercise, alcohol or other factors. But symptoms alone don’t prove that your blood glucose is actually low. If this happens repeatedly, tracking the pattern and discussing it with a healthcare professional is more useful than assuming breakfast is the problem.
Can alcohol trigger blood sugar problems at night?
Yes. Alcohol can affect glucose regulation, particularly when consumed without enough food, and can make nighttime glucose fluctuations more complicated. If you regularly wake up sweaty, shaky, hungry or with a racing heart after drinking, it’s worth discussing the pattern with your healthcare professional rather than assuming it’s simply a menopause symptom.
Should you use a continuous glucose monitor if you don’t have diabetes?
A CGM can be an interesting short-term experiment for some people, but it isn’t necessary for everyone and shouldn’t be used to diagnose a medical condition on your own. CGMs measure glucose in interstitial fluid and can differ from blood glucose readings, particularly when glucose is changing quickly. If you’re investigating suspected hypoglycemia, your healthcare professional can help determine whether a CGM, finger-stick testing or another form of testing makes sense.
Are blood sugar crashes the same thing as insulin resistance?
No. Insulin resistance and hypoglycemia are different problems. Insulin resistance means the body’s tissues become less responsive to insulin. Hypoglycemia means blood glucose has fallen too low. A person can have insulin resistance without experiencing hypoglycemia, and feeling like your blood sugar has crashed does not automatically mean you have insulin resistance.
When should you take blood sugar crashes seriously?
If episodes are frequent, severe, happening overnight, causing fainting or confusion, interfering with daily life, or occurring alongside symptoms such as excessive thirst, frequent urination or unexplained weight changes, it’s worth getting medical advice. True hypoglycemia can become dangerous when glucose falls significantly, particularly in people taking insulin or certain diabetes medications.
Download the Menopause Symptom Tracker to help you figure it all out.
Zora Benhamou is a gerontologist who studies aging and is dedicated to challenging menopause stigma and ageist stereotypes. As the host of the Hack My Age podcast, she focuses on empowering women navigating the menopausal transition through evidence-based techniques that support your 80 year old self.