11 Best Ways to Balance Perimenopause Blood Sugar Levels

Looking for ways to balance blood sugar levels in perimenopause and into menopause? Blood sugar levels can become erratic during this hormone transition, and optimal control is one of the keys to regulating metabolism and reducing the risk of diabetes in the future, not to mention helping moods stay stable.  

Navigating perimenopause can feel like riding a hormonal roller coaster, with blood sugar levels often joining the wild ride. As estrogen declines and hormonal fluctuations become your new normal, your body’s ability to process glucose efficiently may change dramatically.

Many women are surprised to discover that the same hormonal shifts causing hot flashes and night sweats can also lead to blood sugar imbalances, potentially increasing the risk of insulin resistance, weight gain around the abdomen, and type 2 diabetes.

Key Takeaways

• Hormonal changes during perimenopause can significantly affect blood sugar levels and insulin sensitivity.
• A balanced diet rich in fiber, and balanced in protein, high fiber whole food carbohydrates, and healthy fats is essential for stabilizing blood sugar.
• Regular monitoring of blood sugar levels with continuous glucose monitors can provide valuable insights.
• Engaging in consistent and supportive physical activity enhances insulin sensitivity and overall metabolic health.
• Managing stress through mindfulness techniques can help maintain blood sugar balance during hormonal transitions.

1. Understand the Impact of Hormonal Changes on Blood Sugar Levels

The perimenopause transition typically begins in a woman’s 40s, though it can start earlier for some, and is often marked by irregular menstrual cycles, fluctuating hormone levels, and a variety of symptoms that may last for several months—or even several years. One of the key hormonal changes during this stage is the gradual decline and unpredictability of estrogen production.

Estrogen is more than just a reproductive hormone; it plays a critical role in how your body processes glucose and maintains insulin sensitivity. As levels drop, your cells may become less responsive to insulin, meaning glucose has a harder time moving out of the bloodstream and into your cells where it can be used for energy.

This reduced sensitivity can result in higher blood sugar levels, even if you haven’t made any changes to your diet, exercise, or lifestyle habits. What’s more, the relationship between hormones and blood sugar is a two-way street. Spikes and crashes in glucose don’t just affect your energy—they can intensify hallmark perimenopause symptoms like hot flashes, night sweats, weight gain, irritability, and disrupted sleep.

In other words, unstable blood sugar can exacerbate hormonal symptoms, while fluctuating hormones make it more challenging to maintain blood sugar control. This cycle can feel frustrating, but understanding the connection is the first step toward breaking it and regaining blood sugar balance.

2. Incorporate a Balanced Diet Rich in Fiber and Healthy Fats

A nutrient-dense diet forms the foundation of blood sugar control during perimenopause and menopause, but it’s not just about what you eat—it’s also about when and how you eat it because your body’s ability to handle carbohydrates shifts with hormonal changes, meal timing and macronutrient balance become especially important.

Strategic Carbohydrate Timing

Your body is generally more insulin-sensitive in the morning, which means it’s better able to process carbohydrates earlier in the day. Aim to include higher-quality carbohydrates with breakfast—think steel-cut oats topped with chia seeds, a veggie omelet with a slice of whole-grain toast, or a smoothie with berries and protein powder. At lunchtime, moderate your carbohydrate intake by pairing them with protein and healthy fats to keep energy steady. Later in the day, especially after 4 p.m., try to keep carbs lower (ideally less than 15 grams per meal or snack) to prevent evening glucose spikes that can interfere with sleep and intensify night sweats.

Meal Composition and Balance

Each meal should include a balance of protein, healthy fats, and complex carbohydrates to slow glucose absorption and provide lasting energy.

Here are some good examples:

Breakfasts

• Veggie Omelet with Avocado and Berries
  Eggs (protein), avocado slices (healthy fat), and a side of blueberries or raspberries (fiber-rich carbs).

• Greek Yogurt Bowl
  Plain Greek yogurt (protein), chia seeds and walnuts (fat + fiber), topped with sliced strawberries and a drizzle of almond butter.

• Savory Breakfast Quinoa
  Quinoa (complex carbs), sautéed spinach and mushrooms (fiber), and a poached egg with olive oil drizzle (protein + fat).

---

Lunches

• Salmon Salad Bowl
  Grilled salmon (protein + fat), mixed greens, roasted chickpeas (carbs + fiber), cucumber, and tahini-lemon dressing.

• Turkey Lettuce Wraps
  Ground turkey (protein), wrapped in romaine or butter lettuce, with avocado slices (fat) and a side of roasted sweet potato wedges (carbs).

• Mediterranean Power Bowl
  Hummus (protein + fat), farro or quinoa (carbs), roasted peppers, cucumbers, olives, and feta cheese.

---

Dinners

• Chicken Stir-Fry
  Chicken breast (protein), sesame oil and cashews (fat), stir-fried with broccoli, bell peppers, and cauliflower rice (carbs + fiber).

• Shrimp with Zoodles and Pesto
  Shrimp (protein), zucchini noodles tossed in olive oil pesto (fat), and a side of roasted cherry tomatoes (low-glycemic carb).

• Beef and Lentil Stew
  Lean beef (protein), lentils (carb + protein), carrots and celery (fiber), cooked with bone broth and herbs.

---

Snacks

• Apple slices (carbs) + almond butter (protein + fat)

• Hard-boiled egg (protein) + a handful of pistachios (fat) + cucumber slices (fiber carb)

• Cottage cheese (protein) + flaxseed (fat) + raspberries (carb)

• Beef jerky (protein) + baby carrots (carb) + guacamole (fat)

Overnight Fasting

In addition to balancing meals, giving your body a consistent overnight break from food supports both glucose metabolism and hormone regulation. Aim for a 12–14 hour fasting window overnight—for example, finishing dinner at 7 p.m. and breaking your fast between 7 and 9 a.m. This practice allows insulin levels to naturally decline and can help reset your body’s sensitivity.

High-Fiber Choices

Fiber is your best friend during perimenopause. Beyond vegetables like broccoli, cauliflower, and leafy greens, consider adding lentils, chickpeas, chia seeds, flaxseeds, and berries to your meals. These foods slow the release of glucose into your bloodstream and support gut health—another key player in hormone balance. When shopping, use the “10:1 carb-to-fiber ratio” as a quick label-checking rule: for every 10 grams of carbohydrates, aim for at least 1 gram of fiber. The closer the ratio is to 5:1, the better. This helps you avoid processed foods that may claim to be “whole grain” but actually cause blood sugar spikes.

Example Foods to Incorporate Regularly

• Fiber-rich vegetables and fruits: broccoli, cauliflower, leafy greens, Brussels sprouts; Berries, avocados, pears, apples, organges

• Healthy fats: avocados, extra-virgin olive oil, nuts, chia seeds, pumpkin seeds, sunflower seeds

• Quality proteins: fish, poultry, eggs, legumes, Greek yogurt (if tolerated), lean meats, non gmo tofu and edamame

• Complex carbohydrates: sweet potatoes, quinoa, lentils, steel-cut oats, berries

3. Monitor Blood Sugar Levels Regularly with Continuous Glucose Monitors

Knowledge is power when managing perimenopause blood sugar fluctuations. Continuous glucose monitors (CGMs) provide real-time feedback about how your body responds to different foods, activities, and even stress levels.

These small wearable devices track your glucose levels throughout the day and night, helping you identify patterns and make informed decisions. Many women report that using a CGM during perimenopause or post-menopause has been eye-opening, revealing how certain foods or eating patterns affect their unique metabolism.

In the past these were reserved for people with diabetes and only available via prescription.  However, now you can order them either via direct-to-consumer options like Lingo or Stelo, or through your healthcare provider, or paired with coaching programs like Nutrisense.

4. Engage in Regular Physical Activity to Enhance Insulin Sensitivity

Exercise is a powerful tool for improving insulin sensitivity and managing weight during perimenopause. As hormonal changes contribute to decreases in muscle mass and increases in visceral fat, regular physical activity becomes even more important.

Aim for a mix of these exercise types: – Strength training to preserve and build muscle mass (2-3 times weekly for at least 30 minutes, working all muscle groups) – Moderate cardio like walking, swimming, or cycling (5 times weekly for at least 30 minutes, and aiming for daily movement goals of seven thousand to ten thousand steps) – Flexibility and balance work like yoga or Pilates – Short bursts of high-intensity interval training for metabolic benefits

Even modest increases in physical activity can yield significant improvements in blood sugar regulation and overall health.

5. Manage Stress Through Mindfulness and Relaxation Techniques

Chronic stress elevates cortisol levels, which can directly raise blood glucose and worsen insulin resistance. Unfortunately, the hormonal shifts of perimenopause often amplify stress responses, creating a challenging cycle.

Effective stress management techniques include:

– Daily meditation or deep breathing practices.  If you need support I find the following apps very helpful for myself and my patients: Calm, Aura, InsightTimer, and HeadSpace.

– Regular time in nature.  Even if it’s just being outside for a short walk in your neighborhood the simple act of seeing the trees, grass, birds, and more can be super helpful not only for exercise but for your stress levels.

– Journaling or creative expression.  Writing down your feelings, thoughts, stressors, and what you are grateful for can provide a wonderful outlet for stress, hope, and change.

– Adequate rest and quality sleep.  Aim for 7-8 hours of regular sleep.  Try to go to sleep at the same time (roughly) every night and establish a good nighttime routine.

– Setting appropriate boundaries.  Try to limit toxic relationships and say no to things if you feel overwhelmed; this can greatly reduce your stress levels and, in turn, help regulate your blood sugar levels.

Finding what works for your unique stress patterns is key to maintaining blood sugar balance during this transitional time.  Check out this blog for more ideas on managing stress and even anxiety during hormonal shifts. Perimenopause and Anxiety

6. Stay Hydrated to Support Overall Metabolic Function

Proper hydration plays a surprisingly important role in glucose metabolism. When you’re dehydrated, your liver produces more glucose, potentially raising blood sugar levels.

Aim for at least 8-10 cups of water daily, adjusting for activity level and climate. Some women find that replacing sugary beverages with herbal teas or infused water helps satisfy taste preferences while supporting hydration goals.

Consider tracking your water intake alongside your blood sugar levels to identify any potential connections between dehydration and glucose fluctuations.

7. Limit Processed Foods and Sugary Snacks

The hormonal changes of perimenopause can intensify cravings for sugary, processed foods – exactly the items that worsen blood sugar control. Insulin resistance during this time makes these foods particularly problematic.

Instead of completely eliminating favorite treats, try these strategies:

– Pair small amounts of sweeter foods with protein and healthy fats, and eat the protein and fats first to help keep the blood sugar stable.

– Choose dark chocolate (70%+ cacao) instead of milk chocolate, even better if you choose 85% or higher.  When chocolate is 85% or higher it has more fiber and protein, and less sugar, but can also offer a mild sweetness that can curb sugar cravings.

– Swap refined carbs for whole grain alternatives, keeping in mind the 10 grams of carbs for every 1 gram of fiber noted above.

– Keep trigger foods out of the house.  Not having the temptation makes it much easier to avoid the temptation and once you make it past that 2 week mark of avoiding simple sugars it often breaks the habit.

– Plan satisfying meals to prevent hunger-driven choices.  See our ideas above for protein, fat, carb balanced meals.

Remember that perfection isn’t the goal – consistent, sustainable choices make the biggest difference for long-term health.

8. Consider Professional Guidance from a Dietitian or Healthcare Provider

Navigating perimenopause blood sugar issues often benefits from professional support. A healthcare provider can assess your individual risk factors, including family history, body mass index, and existing health conditions.

Working with a registered dietitian who specializes in women’s health can provide personalized nutrition strategies tailored to your unique needs and preferences. They can help you develop an eating plan that supports blood sugar balance while addressing other perimenopause concerns like bone health and heart disease risk.

A functional medicine provider can also be key in helping you identify your unique hormone patterns and how to optimize your symptoms during perimenopause and into post-menopause.

9. Recognize Symptoms of Low Blood Sugar and Their Overlap with Menopause

Interestingly, low blood sugar levels can mimic or intensify many common menopause symptoms, including: – Increased anxiety and irritability – Heart palpitations – Excessive sweating – Dizziness and brain fog – Fatigue and weakness

This overlap can make it challenging to determine whether you’re experiencing a hot flash or a blood sugar crash. Tracking both your glucose levels and symptoms can help identify patterns and appropriate interventions.  This is where continuous blood glucose monitoring (see the section above) can make a huge difference

Eating your carbs balanced with protein and fat and fiber can make a huge difference in balancing blood sugar and avoiding low blood sugar.  Low blood sugar can trigger spikes later in blood sugar and cortisol, and actually raise your average blood sugar (hemoglobin a1c) and insulin.

10. Maintain Consistent Meal Timing to Stabilize Blood Sugar Levels

Your body thrives on routine, especially during perimenopause when hormonal fluctuations create internal chaos. Establishing regular meal and snack times helps maintain steady blood sugar levels throughout the day.

Aim to eat something every 3-4 hours, and try not to go longer than 5 hours without food during waking hours. This approach prevents extreme hunger, which often leads to poor food choices and subsequent blood sugar spikes.

Alternatively, fasting overnight can actually be helpful in managing blood sugar balance and avoiding low blood sugar.  Fasting for 12–14 hours overnight allows insulin levels to drop naturally, which helps your body reset and maintain steadier blood sugar control. By preventing constant spikes and crashes from late-night eating, fasting actually reduces the risk of low blood sugar swings the next day.

11. Explore Supplements That May Support Blood Sugar Balance

While food should remain your primary source of nutrients, certain supplements may help support blood sugar regulation during perimenopause. Always consult your healthcare provider before starting any supplement regimen, to be sure they are safe for you.

Supplements that may support glucose metabolism include:

– Magnesium (supports insulin function)

– Chromium (helps improve insulin sensitivity)

– Vitamin D (often deficient in women with insulin resistance)

– Alpha-lipoic acid (may improve insulin sensitivity)

– Berberine (shows promise for blood sugar management)- I have found berberine very helpful for women with elevated a1c levels and fasting blood sugar levels.

Quality matters tremendously with supplements, so choose reputable brands and appropriate dosages based on professional guidance.

Conclusion

Managing blood sugar during perimenopause requires a multifaceted approach that addresses both the hormonal shifts and lifestyle factors that influence glucose metabolism. By implementing these strategies, you can navigate this transition with greater ease and protect your long-term health.

Remember that small, consistent changes often yield the most sustainable results. The good news is that many of the same approaches that support blood sugar balance also alleviate other perimenopause symptoms and reduce your risk of chronic diseases like cardiovascular disease and diabetes.

Your perimenopause journey is unique, so be patient with yourself as you discover what works best for your body during this significant life transition.

Sign up for our newsletter to receive more evidence-based information about navigating perimenopause and menopause with confidence, see the link on our website. Share this article on social media to help other women understand the connection between perimenopause and blood sugar balance.

You may also love:

Nutrition for Perimenopause: Top 13 Foods to Eat for Healthy Hormones!

Ultimate Guide: Stages of Perimenopause and What to Expect