Myths vs facts: HbA1c and Wechseljahre

Menopause (Wechseljahre) affects HbA1c through multiple pathways, leading to common myths and misconceptions. Fact: HbA1c reflects average blood glucose over 2–3 months, but is modulated by red blood cell turnover, iron status, and hormonal shifts. During menopause, declining estrogen reduces insulin sensitivity and may slightly raise fasting glucose. Simultaneously, changes in erythrocyte lifespan and iron metabolism can alter HbA1c independently of glucose. A persistent myth is that HbA1c becomes completely unreliable during menopause – this is false. The test remains valid but requires nuanced interpretation. Women with anemia or iron deficiency (common in perimenopause) may show falsely elevated HbA1c. Impaired kidney function or hemoglobin variants can also interfere. Clinical practice suggests that when HbA1c is borderline, an oral glucose tolerance test or continuous glucose monitoring should be considered. In summary: HbA1c is a useful but not standalone marker during menopause. Evidence is moderate – good studies exist but no specific guidelines for this subgroup. Avoid blanket statements dismissing the test as a 'myth' or over-relying on it as the sole diagnostic criterion.