Hormone therapy and insulin resistance in non-diabetic postmenopausal women: a systematic review and meta-analysis
Tanya Li, Nathan S. Jiang, Julia Kaskey, Peter F. Schnatz, Matthew Nudy
Abstract
Objective Menopause increases the risk of insulin resistance and cardiometabolic diseases. This study summarizes the effects of hormone therapy (HT) on insulin resistance in non-diabetic postmenopausal women.Method The study analyzed randomized controlled trials (1998–2024) that assessed the impact of HT on insulin resistance using homeostasis model assessment of insulin resistance (HOMA-IR) in non-diabetic postmenopausal women. Raw mean differences (RMDs) with 95% confidence intervals (CIs) were calculated using a random-effects model. Subgroup analysis compared estrogen alone (E alone) and estrogen plus progestogen (E + P) to placebo.Results Seventeen randomized controlled trials with 5772 women (3644 on HT: E alone [n = 1259] or E + P [n = 2385]; 2128 on placebo) were included. The weighted mean (standard deviation) age was 56.91 (5.95) years, with treatment lasting 8 weeks to 3 years. HT significantly reduced HOMA-IR (RMD = −0.24 [−0.32 to −0.16], p < 0.001, I2 = 60.3%). Subgroup analysis showed reductions in both E alone (RMD = −0.42 [−0.55 to −0.29], p < 0.001, I2 = 35%) and E + P (RMD= −0.14 [−0.23 to −0.04], p = 0.005, I2 = 13.7%) compared to placebo.Conclusion HT significantly lowers insulin resistance in healthy, non-diabetic postmenopausal women, with E alone yielding greater reductions than combination therapy.