Last updated October 15, 2026
When a woman comes to see me for support with weight management, one of the things I want to understand is how well her body is managing blood sugar, cholesterol, and other aspects of metabolic health.
Why? Because metabolic dysfunction can develop gradually, often without obvious symptoms, and it may be particularly relevant during midlife.
You don't have to have diabetes or significant weight gain to have changes in your metabolic health.
What Is Metabolic Dysfunction?
Metabolic dysfunction is a broad term used to describe changes in how the body regulates important processes such as blood sugar, insulin, and fats (including cholesterol and triglycerides).
For example, insulin resistance develops when the body's cells become less responsive to insulin, making it harder for sugar to move from the bloodstream into cells. Over time, the body may compensate by producing more insulin, and blood sugar levels may eventually rise.
Metabolic health is also influenced by factors such as blood pressure, abdominal fat distribution, liver health, and physical activity.
These changes don't necessarily cause noticeable symptoms, which is why understanding your health history and relevant laboratory results can be so valuable.
Why Does Metabolic Health Matter During Perimenopause and Menopause?
During the menopause transition, declining estrogen levels are associated with changes in where the body stores fat, including an increase in abdominal and visceral fat (the fat stored around our organs).
At the same time, age-related changes in muscle mass, sleep disruption, stress, and changes in physical activity may influence insulin sensitivity and overall metabolic health.
This doesn't mean every woman will develop metabolic dysfunction during menopause. However, it's a stage of life when paying attention to metabolic health becomes particularly important.
If you've noticed changes in your weight or waistline, you may also find my article on why weight gain happens during perimenopause and menopause helpful.
What Are the Early Signs and Risk Factors of Metabolic Dysfunction?
One of the challenges with metabolic dysfunction is that you may feel perfectly well while changes are developing beneath the surface.
Rather than relying on symptoms alone, I look at a combination of health history, physical measurements, and laboratory markers.
Some factors that may warrant a closer look include:
1. Increasing waist circumference or abdominal fat
Changes in waist circumference, particularly increasing belly fat, can be associated with greater cardiometabolic risk, even when overall body weight hasn't changed significantly.
2. Changes in blood sugar
Elevated fasting blood sugar or HbA1c may indicate prediabetes or diabetes. Insulin resistance can also be present before blood sugar levels become abnormal.
3. Changes in cholesterol or triglycerides
Elevated triglycerides, low HDL cholesterol, and other lipid abnormalities can provide clues about cardiometabolic risk.
4. Elevated blood pressure
High blood pressure often develops without noticeable symptoms and is an important component of metabolic health.
5. A history of PCOS or gestational diabetes
Women with a history of polycystic ovary syndrome (PCOS) or gestational diabetes have an increased risk of developing insulin resistance and type 2 diabetes later in life.
6. Family history and other health conditions
A family history of type 2 diabetes or cardiovascular disease, as well as certain medical conditions, medications, and lifestyle factors, can also influence metabolic risk.
None of these factors alone necessarily means you have metabolic dysfunction. The goal is to understand your overall risk profile rather than draw conclusions from a single symptom or measurement.
What Can You Do to Improve Metabolic Health?
The encouraging news is that many aspects of metabolic health can improve with appropriate support.
Depending on your individual needs, strategies may include:
Nutrition: Eating patterns that support adequate protein and fibre intake, blood sugar regulation, and overall dietary quality.
Strength training and movement: Building and maintaining muscle, increasing daily movement, and incorporating regular aerobic activity to support insulin sensitivity and cardiovascular health.
Sleep: Addressing insufficient or disrupted sleep, which can affect glucose regulation and appetite.
Weight and body composition: Reducing excess visceral fat while preserving muscle may improve metabolic risk factors.
The right starting point depends on your health history, current habits, laboratory findings, and goals.
If you're feeling frustrated despite your efforts, I've also written about why weight management can feel harder after 40 and why an individualized approach matters.
Understanding Your Metabolic Health Is the First Step
This is one of the principles behind The Metabolic Method™, my individualized approach to weight management and metabolic health for women navigating midlife.
Rather than assuming that everyone needs the same diet, exercise routine, or treatment plan, we begin by assessing your health and identifying what deserves attention.
For some women, that may mean focusing on blood sugar regulation or cardiometabolic risk. For others, improving sleep, building muscle, or addressing nutritional gaps may be a more appropriate starting point.
Assess thoroughly. Prioritize what matters. Build a strategy around you.
Interested in Understanding Your Metabolic Health?
If you're in your 40s or 50s and have concerns about your weight, body composition, or metabolic health, I'd be happy to help you explore your options.
I provide individualized naturopathic care for women navigating perimenopause, menopause, and metabolic health concerns.
Book a complimentary 15-minute discovery call to learn more about my approach and whether working together may be a good fit.
Dr. Andrea Gri, ND, MSCP
Naturopathic Doctor | Menopause Society Certified Practitioner
References
1. Lambrinoudaki I, Paschou SA, Armeni E, Goulis DG. [The interplay between diabetes mellitus and menopause: Clinical implications.](https://doi.org/10.1038/s41574-022-00708-0) Nature Reviews Endocrinology. 2022.
2. Lobato VA, Minari TP, Pisani LP. [Perimenopause and metabolic vulnerability: Hormones, body composition and lifestyle changes.](https://pubmed.ncbi.nlm.nih.gov/42634879/) Climacteric. 2026.
3. Nichols AR, Chavarro JE, Oken E. [Reproductive risk factors across the female lifecourse and later metabolic health.](https://pmc.ncbi.nlm.nih.gov/articles/PMC10871592/) Cell Metabolism. 2024.
4. Ward E, Gold EB, Johnson WO, et al. [Patterns of cardiometabolic health as midlife women transition to menopause: A prospective multiethnic study.](https://pubmed.ncbi.nlm.nih.gov/30365014/) The Journal of Clinical Endocrinology & Metabolism. 2019.
5. El Khoudary SR, Aggarwal B, Beckie TM, et al. [Menopause transition and cardiovascular disease risk: Implications for timing of early prevention: A scientific statement from the American Heart Association.](https://doi.org/10.1161/CIR.0000000000000912) Circulation. 2020.
Disclaimer: The information provided on this blog is for educational and informational purposes only and is not intended as medical advice. Always consult with a qualified healthcare professional before making any changes to your health regimen. The content shared here is based on the author’s research and personal experiences, and individual results may vary. The author and blog are not responsible for any adverse effects or consequences resulting from the use of any suggestions, preparations, or procedures discussed on this site.