Evidence check: HbA1c in the context of Wechseljahre

HbA1c (glycated hemoglobin) is a well-established long-term blood glucose marker reflecting average glucose levels over the past 2–3 months. During menopause (perimenopause and postmenopause), declining estrogen levels can impair insulin sensitivity, potentially leading to a modest increase in HbA1c. However, the evidence is mixed: some observational studies show a slight rise, while others find no significant change. Importantly, HbA1c is also influenced by non-glycemic factors such as anemia, hemoglobin variants, and kidney function. For reliable assessment in the context of menopause, HbA1c should be interpreted alongside fasting glucose and possibly an oral glucose tolerance test. An elevated HbA1c during menopause is not a specific marker of menopause itself but indicates increased diabetes risk, which can be modified by lifestyle factors (diet, exercise). The evidence base is primarily epidemiological; randomized controlled trials directly linking menopause to HbA1c changes are lacking. For consumer tests, HbA1c is a useful biomarker but insufficient without medical interpretation and consideration of the full metabolic profile.