What role does HbA1c play in Wechseljahre?

HbA1c (glycated hemoglobin) is a long-term blood glucose marker reflecting average levels over 2–3 months. During menopause (perimenopause and postmenopause), declining estrogen reduces insulin sensitivity and impairs glucose tolerance, increasing the risk of metabolic syndrome and type 2 diabetes. HbA1c is therefore used to screen and monitor glucose metabolism disturbances in this life stage. However, fluctuations due to hormone replacement therapy, lifestyle changes, or inflammation can affect values. An HbA1c below 5.7% is normal, 5.7–6.4% indicates prediabetes, and ≥6.5% indicates diabetes. The evidence linking menopause to elevated HbA1c is human-strong, based on large cohort studies. Caveat: HbA1c alone is not sufficient – fasting glucose and oral glucose tolerance tests may provide additional insight. If values are abnormal, medical consultation is advised.