Perimenopause, Menopause, and BeyondMost women will spend up to 40% of their lives post-menopause. Midlife isn’t the time to wait for problems, it’s when you set the foundation for the decades ahead.
If you don’t have access to menopause-trained or endocrine care, this is what I would advocate for myself. Think of it as a roadmap you can take to your doctor. But this is also the framework I use every day in my practice: N of 1 medicine. Not one-size-fits-all, but care built around your risks, your priorities, and your biology.
Prevention is power. I focus on the conditions most likely to shorten healthspan, including metabolic disease, bone loss, and heart disease, while also protecting brain health, intimacy, and vitality.
01
The Baseline Labs I’d Want for Myself
If you’re navigating this without access to an expert, these are the labs I would ask for as a starting point. They touch the most important systems affected in midlife. From there, your personal history determines how far to go.
✓ Complete blood count (CBC)
✓ Comprehensive metabolic panel (kidney and liver function, electrolytes)
✓ A1C, fasting glucose
✓ Lipid panel (cholesterol, triglycerides; add advanced markers such as ApoB or lipoprotein(a) if risk indicates)
✓ Vitamin D
✓ Vitamin B12 and folate
✓ Iron studies (ferritin, iron, TIBC)
✓ Omega-3 index or fatty acid profile
✓ Thyroid panel (TSH, free T4 ± antibodies if indicated)
✓ Inflammatory markers (CRP, homocysteine)
✓ Sex hormones, sometimes measured, but often add little in perimenopause because levels fluctuate and don’t reliably reflect symptoms
This list is where I start. But in my practice, I rarely stop here. A strong family history of heart disease might lead me to order coronary calcium scoring. A woman concerned about bone health may need imaging sooner. For brain fog, energy, or weight changes, we often add a different set of tools.
That is the difference between generic checklists and precision care.
02
Heart and Metabolism After 40
Prediabetes, cholesterol changes, and blood pressure shifts often show up years before symptoms. Most women don’t get screened deeply enough, and that is a missed opportunity.
I also advocate for coronary artery calcium (CAC) scoring as an early tool to refine cardiovascular risk. I often recommend it around age 40-45 for patients with a history of high cholesterol or a strong family history of heart disease. CAC scoring is most helpful when there is uncertainty about whether to start preventive medications like statins.
The goal is to catch problems early, when lifestyle strategies and targeted treatments can make the biggest impact.
03
Bone Health in Midlife
This is one of the most overlooked pieces of women’s health. Guidelines recommend waiting until age 65 for a bone density scan, but I rarely wait that long. I often order a DXA scan within five years of menopause.
Why? Because bone loss can be silent. I want to identify changes early, when there is still a chance to prevent or even reverse disease, not after osteoporosis is already on the chart.
04
Hormone Replacement Therapy: A Conversation Every Woman Deserves
Too many women are told “it’s normal” or “you just have to live with it.”
I disagree.
Every woman deserves a real conversation about her options, whether that is hormone therapy (MHT) or non-hormonal treatments. The right path depends on your history, risks, and goals, but the discussion itself should never be skipped. In my clinic, it is a standard part of care.
05
Sleep, Stress, and Sex:
Menopause and perimenopause are times of profound change. This is when you should be talking with your clinician about sleep, stress, movement, nutrition, and relationships. Just as important, these years are the right time to address intimacy and sexual health.
Midlife changes in vaginal tissue and bladder function can affect confidence and connection. Local therapies, pelvic floor support, and open conversations about intimacy should be part of routine care.
Too often, women only get vague advice here. What they need is practical support that protects both health and quality of life.