Dr. Herman Weiss
Sep 22, 2026
Three papers earned your time this cycle: the largest analysis ever of hormone therapy and blood sugar, the first large prospective study of PMOS in pregnancy since the renaming, and a randomized trial that turns "exercise is good for your brain" into an actual prescription. Then we'll look at what your feeds are serving - the Senate finally held a menopause hearing, and creatine is having a moment. I read the science so you don't have to.
Hormone therapy and type 2 diabetes: a small effect, honestly reported. Liang and colleagues pulled together every randomized trial and cohort study they could find on menopause hormone therapy (MHT) and glucose metabolism - 49 studies, nearly 1.5 million women, published September 18 in Diabetologia. Among women without diabetes, MHT users had lower fasting insulin and a 17% lower relative risk of developing type 2 diabetes (risk ratio 0.83). Among women who already had diabetes, MHT modestly improved fasting glucose, HbA1c (by about half a percent), LDL cholesterol, and systolic blood pressure. Now the honest part, and credit to the authors for stating it plainly: they rate the certainty of evidence for the headline diabetes finding "very low," only 7 of the 49 studies had a low risk of bias, and their own conclusion is that the effects, while real, are too small to be clinically meaningful. So here is what this means for you: MHT is a symptom treatment, not a metabolic one. If you take it for hot flashes and your blood sugar drifts a little better, that's a bonus - not a reason to start, and not a reason to skip the boring fundamentals. For my PMOS readers, this one matters directly: PMOS is at its core an insulin-resistance condition, and you carry an elevated diabetes risk into midlife. This analysis tells you what hormone therapy at menopause will not do about that. Muscle, movement, sleep, and food remain the fix. (Liang C, et al. Diabetologia. 2026. doi:10.1007/s00125-026-06856-6)
PMOS in pregnancy: the first big prospective numbers under the new name. Neven and colleagues analyzed 3,645 pregnant women enrolled in the international TOBOGM trial - all already at risk for high blood sugar - and found that 17.1% met criteria for PMOS. Compared with the other women, the PMOS group had 37% higher adjusted odds of early gestational diabetes, 28% higher odds of a composite of adverse newborn outcomes, and 32% higher odds of the baby needing intensive or special care, with delivery about a day and a half earlier on average. The detail I find most important: these risks did not shrink after adjusting for body weight, and they did not vary by ethnicity. The syndrome itself carries the risk, not just the weight that often travels with it. What this means: PMOS should be treated as its own pregnancy risk factor - earlier diabetes screening and closer fetal monitoring, not extra worry. The limits: this was an observational cohort nested inside a trial, PMOS was identified by clinical criteria rather than one universal test, and the women were all preselected for metabolic risk, so these numbers don't describe every pregnancy with PMOS. For my perimenopause and menopause readers: early gestational diabetes is not only a pregnancy event. It is one of the strongest early flags we have for lifetime type 2 diabetes and cardiovascular risk. If this was you twenty years ago, midlife is exactly when that flag should change how closely you and your doctor watch blood sugar, blood pressure, and arteries. (Neven ACH, et al. Diabetes Care. 2026. PMID: 42747940)
Exercise and the menopause brain: from advice to prescription. Sanz Simon and colleagues at Rutgers, with collaborators at Einstein and Columbia, randomized 93 women aged 20 to 67 - all with below-average fitness, none regular exercisers - to six months of either aerobic exercise or a stretching-and-toning program. The postmenopausal women in the aerobic group improved their executive function (task-switching speed, error management) more than both the stretching group and the premenopausal women doing the identical program. The gains were measurable at three months and still growing at six. Memory and processing speed didn't budge - the benefit was specific to executive function, the set of skills you use to plan, switch tasks, and stay organized. What this means: the menopause transition may be a window when the brain is especially responsive to aerobic training, and the studied dose is doable - 45 minutes of moderate cardio, three to four times a week, after a short warm-up. Brisk walking counts. The limits: 93 women is small, about 7 in 10 completed the full program, and we cannot yet say whether better task-switching at six months means less dementia at seventy-five. For my PMOS readers: brain fog is one of your community's most common complaints too, and this is the rare intervention that treats that and insulin resistance at the same time. (Sanz Simon S, et al. J Alzheimers Dis. 2026. rutgers.edu/news)
What's trending this week - and how it holds up. Three things are moving. First, grounded: on September 16 the US Senate Special Committee on Aging held Congress's first-ever hearing devoted entirely to menopause - we flagged the run-up in Issue 2, and now it has happened. The tangible outcome: Senators Gillibrand and Scott announced a bipartisan request for a Government Accountability Office investigation into how Washington funds and coordinates menopause research. The testimony put hard numbers on the gap: under 1% of federal women's-health research funding goes to menopause, 80% of OB-GYN residents say they feel unprepared to treat it, and menopause costs the US economy an estimated $26.6 billion a year. A hearing doesn't change your care by itself, but a GAO audit is how funding fights get their ammunition. Second, grounded coverage with my inference on the motive: creatine is being marketed hard to menopausal women this month - CNBC, Yahoo, and supplement outlets are all riding a small meta-analysis (7 trials, 608 women) of mostly muscle and bone outcomes. Plausible for muscle and bone if you also lift; unproven for hot flashes, mood, or brain fog. Same lesson as Tuesday's chasteberry trial: small, short studies tell you something works a little, not that it works for you. Third, grounded: the PMOS name keeps spreading - this week brought plain-language explainers from a major physician outlet and a large health system, which is exactly the shift Sunday's Part 4 update tracked from journals into patient-facing channels.
That's the cycle. Bring your doctor the papers, not just the headlines - and bring me your questions.
Dr. Herman Weiss
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