The InsideGuide

13 Biomarkers to Watch During Menopause and Perimenopause

Written by Caitlin Carlson | Dec 9, 2025


Menopause marks the end of your menstruating years. On average, this happens sometime between the ages of 45 and 55. But the lead-up can begin years earlier.

This transitional lead-up phase is called perimenopause. Both of these phases, menopause and perimenopause, can be difficult. They come with big health changes.
  • During perimenopause, two hormones—estrogen and progesterone—can rise and fall erratically. This can trigger symptoms like hot flashes, night sweats, brain fog, weight gain, and irritability. 
  • Menopause occurs when you’ve gone 12 months without a period. At this point, the hormonal fluctuations settle. Estrogen and progesterone drop to new lower levels where they'll stay for the rest of your life.
These hormonal shifts are more than just irritating. They can also come with health risks. Falling hormones can increase your risk of heart disease, stroke, weight gain, type 2 diabetes, and osteoporosis. 

This is why many women respond by adopting new health routines. 

Staying healthy through menopause

“Perimenopause is an ideal time to take on a healthy lifestyle, even if you have not done it before,” says Nanette Santoro, MD, a professor and chair of obstetrics & gynecology at the University of Colorado School of Medicine. 1

And it's never too late to make improvements. If you don't feel like yourself, start making changes. And don't let your concerns be brushed off. “Women should not accept that ‘it’s just menopause,’ because some important health issues might be missed,” says Dr. Santoro.

If menopausal symptoms are making your life difficult, talk to your doctor. If you’re looking to take a proactive approach, InsideTracker can help. 

With InsideTracker, you’ll measure key blood biomarkers—many of which are linked directly to symptoms of menopause. Then you’ll get personalized recommendations for optimizing anything that’s out of range.

This can have a big impact on your day-to-day life. By giving your body the foods, supplements, and exercises it needs, you may be able to reduce symptoms and unlock years of healthy living.

When you get started, here are the blood biomarkers you’ll want to pay close attention to. 

Biomarkers to monitor during perimenopause and post-menopause
Keep a close eye on these markers to manage your health through menopause. 

ApoB, HDL cholesterol, LDL cholesterol, and triglycerides
Measures of heart health

Estrogen has a protective effect on your cardiovascular system. So when it falls, biomarkers associated with heart health can suffer.2

Apolipoprotein B (ApoB), LDL cholesterol, and triglycerides could all rise. Meanwhile, HDL cholesterol might initially go up, but then fall, says Dr. Santoro. 

To keep your biomarkers in the safe zone, you may want to rethink your exercise routine and double-down on heart-healthy foods.

Note: Women on hormone therapy may see misleading trends: Their HDL cholesterol can go up, and their LDL cholesterol can go down. But studies suggest that this may not be linked to a lower risk of heart disease, says Dr. Dr. Santoro.


Glucose and HbA1c
Measures of metabolic health

Unfortunately, menopause often comes with weight gain around the midsection. This can impact your glucose tolerance, which is how well your body handles sugar from food and drinks.

Poor glucose tolerance can increase your risk of diabetes. So glucose and hemoglobin A1c (HbA1c) are important biomarkers to watch.
  • Glucose is the sugar currently in your blood. You'll measure it after fasting for 12 hours, and it will give you an in-the-moment snapshot of your metabolic health.
  • HbA1c provides a fuller picture of your metabolic health. It shows how well your body has managed sugar over the past 3 to 4 months. 
» Check out these 5 Effective Supplements for Menopausal Symptoms



HsCRP, calcium, vitamin D
Measures of bone health and inflammation

The SWAN study, a long-term study of women’s health, found that bone loss begins well before menopause. The loss accelerates during the year before and can ultimately lead to osteoporotic fractures.3 

Calcium is of course linked to bone health. As is vitamin D, which helps your body absorb calcium. Women in the SWAN study who had adequate vitamin D levels had fewer fractures than those without.

High-sensitivity C-reactive protein (hsCRP) also plays a role here. It’s a marker of inflammation.
According to the SWAN study, higher hsCRP is linked with a faster decline in bone density. 

Watch these three biomarkers and address anything that’s above or below the optimal range. By doing this, you’ll give your body a better shot at maintaining bone health.

And for more help, Dr. Santoro recommends considering a bone density test every 2 or 3 years. It can give you insight into how strong your bones are, and whether there are any concerning changes over time. 

»  Related: Menopause and Osteoporosis: How to Manage Bone Health After 40



Thyroid-stimulating hormone (TSH)

Measure of thyroid function

Thyroid conditions are common in women, and they share symptoms with menopause. Both can lead to sleep disturbances, menstrual cycle changes, and even hair loss.4

That makes it hard to know for sure whether your symptoms are due to menopause or a thyroid issue. Using a blood test to check your TSH levels can shed light on the situation.

“Even though the menopause transition is not specifically associated with thyroid disease, it is a good idea to check it,” Dr. Santoro says. 


Estradiol and progesterone
Measures of hormone health

Estradiol is a type of estrogen. As it falls, hot flashes, night sweats, and vaginal dryness are common.

Meanwhile, changes in progesterone can lead to difficulty falling and staying asleep.

Testing these hormones during perimenopause can give you insight into any symptoms you might be having.

“Contrary to popular belief, these hormones don't nicely drop off over time,” says Michelle Cawley, MS, a nutrition scientist at InsideTracker. “They can be quite variable.”

With periodic testing, you’ll see how they rise and fall. And you’ll have a better sense of what might be driving your symptoms. 

Once you hit menopause (that means going 12 months without a period), your body stops producing these hormones. At that point, it's generally no longer necessary to test them, says Cawley.

Note: Estradiol and progesterone tests are not included in InsideTracker’s Ultimate blood test. Rather, these are add-ons that you can select during checkout. 

»  Here’s How to Interpret Your Estradiol Blood Test Results



Testosterone
Measure of energy and libido

Testosterone is most commonly known as a male sex hormone, but it plays important roles in women too. It helps with energy and muscle growth, and low levels are commonly cited for problems with libido and sexual desire.

For some women, loss of libido impacts life quality. In these cases, doctors may prescribe testosterone to women to increase drive and arousal.

This is typically only done after other forms of hormone therapy fail. 

What else can you do to ease the menopausal transition? 

Keeping tabs on your biomarkers can give you insight into what’s happening inside your body, but you can also set yourself up for success with some simple lifestyle tweaks.  

“Physical activity helps with just about everything,” Dr. Santoro says. And it’s especially helpful for reducing your risk of heart disease. 

Other key recommendations: 
  • Eat a diet rich in whole foods, fruits, vegetables, lean protein, nuts, and seeds.
  • Prioritize 7 to 9 hours of sleep a night.
  • Consider talking to your doctor about hormone therapy. This is when you take supplemental estrogen, and sometimes progesterone, to replace what your body no longer produces. 
The changes that occur during menopause and perimenopause can be frustrating, but they also present an opportunity to get to know your body’s needs. 

So dig in and face the challenge head on. By doing so, you’ll set yourself up for a long and healthy future. 

References: 

  1. https://medschool.cuanschutz.edu/ob-gyn/divisions/division-of-reproductive-sciences/our-faculty/nanette-santoro-md
  2. https://www.frontiersin.org/journals/cardiovascularmedicine/articles/10.3389/fcvm.2022.895916/full#B3
  3. https://www.swanstudy.org/wps/wp-content/uploads/2023/04/SWAN-Fact-Sheets-Bone.pdf
  4. https://www.sciencedirect.com/science/article/abs/pii/S0378512224000860#:~:text=%E2%80%A2-,Menopause%20and%20thyroid%20dysfunction%20%28hyperthyroidism%20and%20hypothyroidism%29%20may%20be%20accompanied,detect%20co%2Dexisting%20thyroid%20disease.
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