I often have women complain about added weight gain during the peri-menopause and menopausal years. After going through a thorough search of any lifestyle changes such as intake of sugar or carbs, lack of exercise, recent surgery, etc. I try to let women know that 
even if you continue to have healthy eating habits and exercise. When women are struggling with night sweats, hot flushes, lack of sleep, fatigue and mood swings, it tends to exacerbate the problem. Offering bio-identical hormones not only helps symptoms but can assist in weight management. Again, hormone replacement therapy does NOT cause weight gain! That is, if hormones are started less than 10 years after starting menopause.
Studies indicate that estrogen therapy improved insulin-stimulated glucose uptake among women in early menopause. What does that mean?
Many women have something called insulin resistance which occurs sometimes as early as age 35 and increases as we age. The insulin receptors on our cells stop functioning adequately and this dysfunction causes us to make more insulin which then has a very easy time converting excess glucose into fat.
Investigators in one study assessed the effects of short-term high dose transdermal (topical patch) estradiol on these insulin receptors in 22 women. These women were on average 56 years old and less than 6 years into menopause. They compared this group with 24 women that were on average age 63 and over 10 years after menopause. Mean BMI (basal metabolic index-weight) and GDR (A measure of insulin-stimulated glucose uptake) were the same in both groups.
After 1 week of transdermal estrogen where women used a patch delivering 0.05 mg daily, investigators found that the women using the estrogen patch raised the GDR in the women who were less than 6 years after menopause, but lowered the GDR in those women more than 10 years after menopause.
This demonstrates a difference in the change in glucose uptake due to years since menopause. There was a beneficial metabolic effect only in recently menopausal women. Another popular study, known as the Women’s Health initiative, also found a similar reduction in risk for diabetes with estrogen therapy across all age groups. This supports the “timing hypothesis” which proposes that hormone therapy slows atherosclerosis progression in recently menopausal women but has neutral or adverse effects in women who are at least 10 years past menopause onset.
Talk to your health practitioner on whether hormones may give you additional benefit of preventing diabetes in additional to helping other symptoms.
Reference: Pereira RI et al. Timing of estradiol treatment after menopause may determine benefit or harm to insulin action. J Clin Endocrinol Metab 2015 Dec; 100: 4456.