Hormone Replacement Therapy & Type 1 Diabetes: What the Research (and I) Say
🔥 Key Takeaways: HRT, Type 1 Diabetes & Menopause
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.
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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…
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/)
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...
Has Anything Changed? The Latest Research (2023–2024 Update)
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:
âś… HRT reduced HbA1c levels by 0.56% and fasting glucose by 1.15 mmol/L
âś… 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:
âś… HRT (both oestrogen-only and combined oestrogen-progestogen) improved insulin sensitivity
âś… Positive effects seen in healthy postmenopausal women
đźš« 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.
Keep Exploring 👇
Discover more tips to feel stronger, more energised, and in control of your health:
What This Means for Women in My Coaching Programme
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.
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!).
4. Manage Stress with “Mini Mechanisms”
Stress raises cortisol, which impacts blood sugar and menopausal symptoms.
Incorporate simple stress-busting strategies like deep breathing, walking, or my quick Power 7 Blast workout to keep things in check.
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 mendical specialist 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 GuideThe 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.
Want to Learn More?
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âś… Simple nutrition tweaks to balance hormones and reduce cravings
âś… Short, effective workouts designed for menopausal women
âś… Powerful mindset shifts to boost motivation and confidence
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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.