Why Women Struggle with Insulin Sensitivity and Weight During Menopause: The Liver–Bile–Hormone Connection

For many women, the transition through perimenopause and menopause brings an unexpected shift in weight, blood sugar control, and metabolic resilience. While hormones like oestrogen certainly play a central role, what’s often overlooked is how menopause impacts the liver–bile–insulin axis.

What the science shows:

Oestrogen supports healthy bile flow by upregulating bile acid synthesis and transport (Gonzalez et al., 2016). As oestrogen declines, bile flow often becomes sluggish. This matters, because bile isn’t just for digesting fats - it’s essential for cholesterol clearance, detoxification, blood sugar regulation, and maintaining gut microbial balance.

Bile acids activate receptors like FXR and TGR5, which influence glucose homeostasis, mitochondrial activity, and inflammatory signalling (de Aguiar Vallim et al., 2013). Impaired bile signalling has been linked to worsened insulin resistance, fatty liver, and low-grade inflammation - all of which are commonly seen in postmenopausal women.

Additionally, slow bile flow increases the risk of dysbiosis, endotoxin (LPS) absorption, and metabolic disruption - contributing to the weight gain and energy fluctuations many women face, regardless of calorie intake or exercise levels.

Functional testing can reveal this hidden burden - including bile acid profiles, hormonal metabolites, liver function, and inflammatory markers.

Oestrogen plays a key role in bile production and signalling, and when levels drop, the downstream effects on metabolism, detoxification, fat digestion, and glucose control can be significant. Yet this crucial piece is often overlooked in conventional care.

If you or your patients are navigating weight gain, fatigue, or blood sugar issues during menopause, addressing bile flow and liver function can be a game-changer.

As a BSc Nutritional Biochemist, MSc Medical Molecular Biologist, Clinical Nutritionist (DipCLN), and certified IFM Health Coach, I work 1:1 with women to assess these deeper drivers through functional labs, personalised protocols, and nutrition strategies tailored to your biochemistry, hormones, and metabolic status.

Through functional lab testing, I help women uncover the root causes behind their symptoms - from bile acid dynamics and hormone detoxification to gut-liver interactions and metabolic flexibility.

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References:

 • González, B., et al. (2016). “Estrogen regulation of hepatic bile acid transport and synthesis in female rats.” Biol Sex Differ.

 • de Aguiar Vallim, T.Q., Tarling, E.J., & Edwards, P.A. (2013). “Pleiotropic roles of bile acids in metabolism.” Cell Metabolism.