HRT & Type 1 Diabetes: What the Latest Research Says

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🔥 Key Takeaways: HRT, Type 1 Diabetes & Menopause

HRT isn’t a silver bullet

Hormone therapy can help stabilise symptoms, but it’s not a standalone fix—your lifestyle still matters.

Nutrition needs shift in menopause (especially with Type 1)

Stable blood sugar, protein intake, and gut health become essential for energy, sleep, and weight control.

Lifestyle is still your strongest lever

Sleep, movement, and stress reduction all affect blood glucose control and hormone balance.

Joint pain and fatigue aren’t “just diabetes”

Perimenopause symptoms can overlap with diabetes signs—don’t ignore new or worsening patterns.

Exercise can help both HRT and insulin work better

Strength training and walking improve insulin sensitivity, stress resilience, and muscle maintenance.

Reset your routine in just 7 days

Download the 7-Day Menopause Reset to start balancing your hormones, energy, and blood sugar—without the overwhelm.

Introduction

When it comes to menopause, type 1 diabetes, and hormone replacement therapy (HRT), the scientific waters are still murky.

As someone who has spent a few years in the trenches of fitness, wellness, and education, I’ve seen first-hand how the right approach to exercise, nutrition, and mindset can transform lives.

But what about HRT? Does it help women with type 1 diabetes, or does it create more complications?

So, for today's post I wanted to take a quick trip back down memory lane, and go over a study that I was part of a team off.

So, let's dive straight in…

A realistic image of a middle-aged menopausal woman fanning herself with a hand fan, looking frustrated. She is seated at a table with a blood glucose monitor nearby, highlighting concerns about blood sugar management during menopause in a cozy home setting.
Content

Menopause, Type 1 Diabetes, and the Mystery of HRT

For women with type 1 diabetes, menopause is more than just a hormonal roller coaster, it’s a blood sugar balancing act that coule even put even the best tightrope walker to shame!

  • Hot flushes, mood swings, and sleep disturbances? Check.

  • Fluctuating insulin sensitivity and unpredictable glucose levels? Double check.

HRT is often prescribed to ease menopausal symptoms, but does it help (or hinder) women with type 1 diabetes?

That’s the question my colleagues and I tackled in our 2013 Cochrane Review on HRT for women with type 1 diabetes (Cochrane Database of Systematic Reviews, 2013).

Access the full paper here: https://pubmed.ncbi.nlm.nih.gov/23744560/

Infographic titled "Estrogen Roles" illustrating estrogen's functions in improving skin elasticity, decreasing plaque buildup, regulating the menstrual cycle, promoting reproductive health, and preserving bone density. Created by John Chisholm Fitness.

What Did the Research Find?

Brace yourself: not much!

After scouring every relevant study (which, sadly, wasn’t many), we found only one that even remotely fit the bill.

This study followed 56 postmenopausal women with type 1 and type 2 diabetes over 12 months, with half taking HRT and half taking a placebo.

The Results?

  • Blood sugar control: No significant differences.

  • Cardiovascular risk factors: A mixed bag—HDL (“good” cholesterol) levels were lower in the HRT group, which isn’t ideal.

  • Adverse effects: More breast pain and vaginal bleeding in the HRT group.

  • Long-term impacts: Unclear—things like mortality, diabetic complications, and quality of life weren’t even measured.

So, what does this mean?

HRT doesn’t seem to make blood sugar control worse—but it doesn’t necessarily improve it either.

Now, please remember, this was back in 2013, when I was pursuing my MRes in Clinical Physiology, so, you would imagine there has been a fair amount of research done since then. Lets have a look...

A scientific research scene showing the progression of hormone replacement therapy (HRT) and type 1 diabetes studies, with the text '2013 vs 2023-2024 Studies' prominently displayed.

HRT & Diabetes Research Update (2023–2024): What You Should Know

As I mentioned above, It’s been well over a decade since we published the 2013 Cochrane Review, so has the scientific community made any progress?

in 2023, a systematic review & meta-analysis was published by Speksnijder et al, (2023).

They reviewed 19 randomised controlled trials (RCTs) with 1,412 participants, but only 4% had type 1 diabetes.

Key Findings:

✅ HRT reduced HbA1c levels by 0.56% and fasting glucose by 1.15 mmol/L

✅ Indicated some positive effects on glucose regulation

🚫 However, due to the small number of type 1 diabetes participants, these findings aren’t conclusive for this group.

Then, in 2024, a report published in The Menopause Society, identified a meta-analysis on insulin resistance (The Menopause Society).

It identified a large-scale study of over 29,000 postmenopausal women, and showed that HRT significantly reduces insulin resistance. Thats good news!

Key Takeaways:

✅ HRT (both oestrogen-only and combined oestrogen-progestogen) improved insulin sensitivity

✅ Positive effects seen in healthy postmenopausal women

🚫 Again, not enough data specifically on women with type 1 diabetes.

What’s the Verdict?

HRT might have some positive effects on blood sugar regulation and insulin sensitivity, but there’s still no solid evidence specifically for women with type 1 diabetes.

More high-quality research is urgently needed.

A determined middle-aged woman checking her blood glucose monitor while exercising outdoors, representing menopause and diabetes management through active living

Keep Exploring 👇

Discover more tips to feel stronger, more energised, and in control of your health:

How I Help Women with Diabetes Navigate Menopause Confidently

As a coach specialising in menopause and fitness, first and foremost, I am not a physician, so I do not prescribe or medicalise anything.

Thats not my professional area.

I always tell my clients that they should always speak with their healthcare professional for medical advice.

However, I do know first-hand, just how critical stable energy, reduced brain fog, and improved sleep are for midlife women—especially those navigating hormonal changes and diabetes.

So, while the research on HRT is inconclusive, there are several practical steps you can take to support your body naturally:

1. Strength Training: Your Secret Weapon

Lifting weights isn’t just for bodybuilders—it’s essential for insulin sensitivity, bone health, and metabolism.

Even two to three short sessions a week can help balance blood sugar and keep your body strong.

A middle-aged woman lifting dumbbells in a bright, modern gym. She looks strong and confident, wearing comfortable workout clothes, promoting strength training for menopausal women.

2. Prioritise Sleep Like It’s Your Job

Poor sleep can wreak havoc on blood sugar control and hormone balance.

A consistent bedtime, reducing screen time, and relaxation techniques can help stabilise glucose levels overnight.

3. Smart Nutrition Over Restriction

Forget fad diets, a protein-rich, fibre-packed, and well-balanced approach works best.

Blood sugar-friendly choices include lean proteins, healthy fats, and slow-digesting carbs (yes, you can still eat carbs!).

A beautifully arranged plate of whole foods, including lean proteins, healthy fats, and fiber-rich carbs. The meal is vibrant and nutritious, supporting a balanced diet for menopausal health.

4. Ease Stress with Repeatable Tools

Stress increases cortisol, which worsens both blood sugar swings and menopausal symptoms.


That’s why one of the pillars in my EASE Method is learning to ease stress in a way that’s sustainable, without overhauling your entire day.


Start with something simple: 3 rounds of box breathing, a 10-minute walk, or my Power 7 Blast for a quick body reset.


It’s not about avoiding stress, it’s about building recovery into your rhythm.

A middle-aged woman meditating outdoors in a peaceful natural setting. She sits cross-legged on a yoga mat, eyes closed, surrounded by lush greenery, emphasizing relaxation and stress management.

5. Talk to Your Doctor About HRT - Armed with Knowledge

If you’re considering HRT, go in with questions:

  • Will it impact my insulin needs?

  • How will it affect my cholesterol and heart health?

  • What are the short- and long-term risks for me personally?

HRT might be an option, but it’s not a magic bullet, it needs to be part of a holistic plan.

Be sure to check out the excellent work by menopause expert Dr Louise Newson.

⚡ Struggling to balance hormones and blood sugar?

Whether you're navigating Type 1 diabetes, HRT, or just feeling wiped out—this guide is your starting point for real energy, better sleep, and a stronger, more supported you.

Download the FREE 7-Day Menopause Reset Guide

The Bottom Line: Take Charge of Your Menopause Journey

Menopause with type 1 diabetes comes with unique challenges, but you don’t have to navigate it alone.

Whether it’s through smart training, balanced nutrition, or mindset coaching, there are science-backed strategies that can help you feel energised, strong, and in control.

💪 Ready to Move with Confidence?

Whether you're easing back into exercise or ready to lift heavier, this quick form helps you get the right plan for your body, energy levels, and menopause stage.

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Want to Learn More?

❓ Want to Learn More About Managing Midlife Energy?

Feel like your body has changed overnight? If you're navigating:

  • Sudden weight gain or bloating
  • Brain fog and afternoon crashes
  • Low motivation to move or train

This free guide is your step-by-step reset—designed to help you regain control of your energy, hormones, and headspace in just one week.

Download the FREE 7-Day Menopause Energy Reset

💡 Managing Menopause with Type 1 Diabetes? These Posts Can Help.

When hormones, blood sugar, and fatigue collide, it’s easy to feel overwhelmed. These practical, evidence-informed reads can help you take back control—step by step.

“You don’t need perfect blood sugar to make progress—just the right tools and support.”

Use these articles to build a more confident, clear, and empowered menopause game plan—even with Type 1 in the mix.

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❓ Frequently Asked Questions

John Chisholm - Expert Menopause Fitness Coach at John Chisholm Fitness

About the Author

John Chisholm is a menopause fitness and wellness expert with over 20 years of experience helping women feel stronger, more energised, and in control of their health. Through John Chisholm Fitness, he provides practical, science-backed coaching in fitness, nutrition, and mindset.

Learn more about John or get in touch.