Several of my friends, who are all within five years of age of me, plus or minus, have been talking to me about perimenopause. One of my friends who is several years older is already considering doing hormone replacement therapy and proactively looking for “perimenopause symptoms,” which I learned can come on as early as age 38. Another friend, who is health obsessed and tracks every gram of fat, protein, and carbohydrate she consumes, is trying to optimize her current exercise regimen (which is so above what almost any average human does!) to ensure that she is strong and doesn’t lose too much muscle when menopause sets in. I must have done a search on perimenopause to read about it on my own in the last few weeks because now, I am constantly seeing ads for perimenopause supplements and products, all of which I have continued to block. There’s marketing and a product for literally everything and anything out there!
Because I recently went to see my primary care doctor and had my usual bloodwork done, I decided to take my lipid panel results and throw them into ChatGPT to see what it says regarding the results and what they say about my perimenopause trajectory:
Quick Summary
During perimenopause, declining estrogen tends to cause:
- LDL increases
- HDL may decrease slightly
- Triglycerides may rise
- Total cholesterol and non-HDL increase
But:
Women who start with an excellent lipid profile—like yours—generally experience smaller, slower, or less concerning changes.
Why Perimenopause Affects Cholesterol
Estrogen has powerful, protective metabolic effects:
- Raises HDL
- Lowers LDL
- Improves insulin sensitivity
- Helps regulate fat distribution
- Reduces inflammation
As estrogen fluctuates (and eventually declines), these benefits weaken.
How Your Current Profile Might Change
Here’s how each number typically shifts during perimenopause and what this likely means specifically for you.
1. HDL (Currently 77) — “Good” cholesterol
Typical change:
- Can decrease by 5–10 mg/dL over several years
- Some women maintain high HDL even after menopause
For you:
- Even with a 10-point drop, you would still be in the very healthy range (60s).
- Your high baseline gives you a lot of buffer.
2. LDL (Currently 76) — “Bad” cholesterol
Typical change:
- Often increases by 10–30 mg/dL
- Driven by hormonal shifts, not lifestyle
For you:
- Even if LDL rose by 20, you’d be at ~96 mg/dL—still great.
- You would remain well below the average levels seen in women your age post-menopause.
3. Total Cholesterol (Currently 166)
Typical change:
- Often increases by 15–25 mg/dL
For you:
- You’d still likely remain below 190, which is well within normal.
4. Triglycerides (Currently 45)
Typical change:
- Often rise by 20–40 mg/dL, depending on insulin response, sleep changes, and stress
- More sensitive to lifestyle during perimenopause
For you:
- Even with a significant rise (to ~80), you’d remain excellent.
5. Non-HDL Cholesterol (Currently 89)
Typical change:
- Often increases by 15–25 mg/dL
- This is a key predictor of cardiovascular risk post-menopause
For you:
- You’d likely still remain under 110, which is better than average even for younger women.
The Real Change: Body Fat Distribution
Estrogen decline affects where fat is stored:
- More visceral fat around the midsection
- Higher blood sugar variability
- Slight insulin resistance
This can gradually influence triglycerides and LDL more than diet itself.
But women who:
- exercise regularly,
- maintain good sleep,
- manage stress,
- eat balanced meals with healthy fats,
often blunt or even prevent these shifts.
⭐ Why Your Starting Point Matters
Your numbers are not just “normal”—they’re exceptionally protective.
This means:
- You have significant metabolic resilience going into perimenopause.
- You’re less likely to experience high-risk lipid levels even as hormones shift.
- Genetics + lifestyle appear to be working strongly in your favor.
What Helps Maintain Good Numbers During Perimenopause
Evidence-supported strategies include:
- Consistent aerobic activity (biggest impact on HDL and triglycerides).
- Strength training (reduces visceral fat and insulin resistance).
- High fiber intake (soluble fiber helps curb LDL rise).
- Healthy fats (olive oil, nuts, seeds, fatty fish).
- Stable sleep routines (sleep disruption increases LDL and triglycerides).
- Maintaining muscle mass (protects metabolic health).
- Limiting simple sugars and refined carbs (prevents triglyceride spikes).
Hormone therapy (HRT) also significantly blunts cholesterol changes for many women, but that’s a medical discussion for your clinician.
Based on the above, I suppose I feel comfortable about perimenopause, especially given I am turning 40 in less than two months. But the visceral fat point above is definitely frustrating. Hormones are definitely not in a woman’s favor as she passes her prime reproductive years, and it almost feels as though it’s nature’s way of saying, “hey, you! Your purpose in life is done, finito! Time to get a move on to your grave! Gain fat, especially around your abdomen because no one cares about you or wants to look at you anymore!”
