I have never believed that telling a woman she is perimenopausal or menopausal is enough to explain what is happening in her body, particularly when she is struggling with fatigue, brain fog, weight gain around her abdomen, declining muscle mass, poor sleep or a loss of libido that is affecting her quality of life.
These are real symptoms that deserve a thoughtful medical evaluation, not simply an explanation based on age.
Menopause is a biological transition, but it does not tell us everything about a woman's metabolic health, cardiovascular risk, insulin sensitivity, thyroid function or hormonal environment. Two women of the same age can have very different laboratory results, body compositions, symptoms and long term health risks, which is why I believe we need to look at the individual rather than rely on a label.
My approach to women's health has always been to look deeper, understand the underlying physiology and use appropriate biomarkers to help guide clinical decisions. I want to know how a woman is functioning today, what her results tell us about her future health and what we can do now to preserve her strength, cognitive function, metabolic health and independence as she ages.
This is the foundation of longevity and healthspan medicine.
Hormones do not function independently, and evaluating one result without considering the others can leave us with an incomplete picture of a woman's health.
Estradiol is important for bone health, vaginal and urinary tissue integrity, sexual function and several other physiological processes, while progesterone provides useful information about ovulation and reproductive function when measured at the appropriate point in the menstrual cycle. Testosterone also deserves attention because it contributes to sexual function and aspects of muscle and bone physiology, although a testosterone level alone cannot explain a woman's energy, libido or physical performance.
When clinically appropriate, I consider estradiol, progesterone, total testosterone, free testosterone, DHEA and AMH egg count alongside a woman's symptoms, menstrual history, medications and medical background.
Thyroid function also deserves consideration because thyroid disorders can contribute to fatigue, hair changes, menstrual irregularities, changes in weight and cognitive complaints that might otherwise be attributed to menopause. TSH is generally the starting point for thyroid evaluation, with free T4 and thyroid antibodies added when the clinical picture warrants further investigation.
I do not believe every woman needs an extensive hormone panel, nor do I believe that every symptom should be treated with hormones, but I do believe that when testing is indicated, the results should be interpreted carefully and used to guide an individualized plan.
One of the most important areas I evaluate in longevity focused medicine is glucose regulation, because metabolic dysfunction can develop gradually for years before a woman is diagnosed with diabetes.
Hemoglobin A1c provides an estimate of average blood glucose over approximately the preceding two to three months and can identify abnormalities that may not be apparent from a single fasting glucose measurement. An A1c between 5.7 and 6.4 percent falls within the accepted range for prediabetes, while an A1c of 6.5 percent or higher meets the laboratory threshold for diabetes when the appropriate diagnostic criteria are satisfied.
In my approach to preventive health, I prefer to look beyond simply remaining below the threshold for prediabetes, and an A1c below 5.2 percent is an aspirational target I consider when appropriate for an individual patient. This is not a universal medical guideline, and the result must be interpreted alongside other markers because conditions such as iron deficiency and certain disorders affecting red blood cells can influence its accuracy.
The reason I pay attention to this early is that glucose regulation is closely connected to metabolic health, and identifying a concerning trend gives us an opportunity to examine nutrition, physical activity, sleep, body composition and other contributors before more significant abnormalities develop.
Fasting glucose tells us how much glucose is circulating in the blood, but it does not directly measure how much insulin the body needs to produce to maintain that level.
In the early stages of insulin resistance, the pancreas may compensate by releasing more insulin to keep glucose within the normal range, which means a woman can have a reassuring fasting glucose result while metabolic dysfunction is beginning to develop.
Fasting insulin can provide additional information in selected patients, particularly those with PMOS, abdominal weight gain, elevated triglycerides or other features suggesting insulin resistance, although there is no universally accepted fasting insulin threshold that independently establishes the diagnosis in every individual.
When appropriate, fasting glucose and insulin can be considered together through the HOMA IR calculation, while an oral glucose tolerance test may provide additional information in selected cases.
This matters because insulin resistance is associated with type 2 diabetes and other cardiometabolic complications, and it can contribute to the hormonal abnormalities seen in PMOS. Identifying the pattern allows us to consider interventions that address the underlying metabolic problem rather than focusing exclusively on weight.
Cardiovascular disease remains a major cause of illness and death in women, yet many of the risk factors develop silently over decades, long before a woman experiences a symptom.
A standard lipid panel provides important information about total cholesterol, LDL cholesterol, HDL cholesterol and triglycerides, but in selected patients I believe additional markers can help us understand cardiovascular risk more completely.
Apolipoprotein B, or ApoB, is particularly useful because it reflects the number of circulating atherogenic lipoprotein particles that can contribute to plaque formation in the arteries. LDL cholesterol measures the amount of cholesterol carried within LDL particles, whereas ApoB provides information about the number of these potentially harmful particles, which can be especially helpful when the results of a standard lipid panel do not fully reflect the patient's metabolic risk.
Lipoprotein(a), commonly called Lp(a), is another important marker because its level is largely genetically determined and elevated levels are associated with increased risk of atherosclerotic cardiovascular disease and aortic valve stenosis. Unlike many conventional risk factors, Lp(a) may remain elevated despite excellent nutrition and regular exercise, which is why identifying it can influence how we approach the patient's other modifiable cardiovascular risks.
ApoE is also worth understanding, although it is a different type of test. ApoE genotyping identifies genetic variants associated with differences in lipid metabolism and Alzheimer's disease risk, but it is not interchangeable with ApoB and is not a routine cardiovascular screening test for every woman.
Depending on the patient's history and risk profile, I may also consider triglycerides, non HDL cholesterol, blood pressure, kidney function and other relevant markers, because cardiovascular prevention should be based on the complete clinical picture rather than one cholesterol number.
Chronic inflammation is associated with several conditions that become more common with aging, including atherosclerotic cardiovascular disease and metabolic dysfunction, which is why I believe it deserves attention when evaluating a patient's overall health.
High sensitivity C reactive protein, or hs CRP, measures low levels of a protein produced by the liver in response to inflammatory signals and can help refine cardiovascular risk assessment in selected patients.
A persistently elevated result may indicate an increased inflammatory burden, although it does not identify the cause on its own because infections, injuries, autoimmune conditions and other factors can also raise the level. A result of 2 mg/L or higher is recognized as a cardiovascular risk enhancing factor in relevant clinical guidelines, but it must be interpreted in context rather than treated as proof that a patient has a particular inflammatory disease.
When a result is unexpectedly elevated, the next step is to consider the clinical circumstances, determine whether repeat testing is appropriate and investigate possible contributors rather than simply trying to lower the number.
I am interested in what these markers can tell us about risk and what we can do with that information, because measuring a biomarker is only useful when it helps us make a better clinical decision.
Vitamin D is essential for calcium regulation and bone health, making it particularly relevant to women as they age and their risk of bone loss increases.
When testing is indicated, the appropriate measurement is 25 hydroxyvitamin D, which can help identify deficiency in patients with relevant symptoms, medical conditions or risk factors.
A level above 60 ng/mL is a target I prefer to consider in selected patients, but it is important to recognize that this is an individualized practice preference rather than a universally established threshold for disease prevention. Current evidence does not establish that every otherwise healthy woman benefits from maintaining vitamin D at this level, and excessive supplementation can cause harm.
My objective is to identify and correct deficiency where appropriate while considering the patient's bone health, medical history, supplementation and other relevant findings, rather than assuming that higher levels automatically translate into better longevity.
A comprehensive evaluation may also include a complete blood count to look for anemia, ferritin and iron studies when iron deficiency is suspected, vitamin B12 when relevant to the patient's history, and a metabolic panel to assess kidney function, liver function and electrolytes.
For women with diabetes, hypertension or relevant kidney disease, urine albumin testing may provide important information about early kidney damage, while assessment of body composition and muscle strength can help us understand aspects of health that laboratory testing alone cannot measure.
I am particularly interested in preserving muscle because strength, mobility and metabolic function are fundamental to maintaining independence as we age, and a normal body weight does not necessarily mean a woman has healthy body composition.
The appropriate tests will differ from one patient to another, and I do not believe in ordering an extensive panel simply to generate more numbers. The value lies in choosing the right measurements, understanding their limitations and using the results to guide care.
Testing is not the end goal; it is the beginning of a more informed conversation about health.
If a woman has evidence of insulin resistance, we can examine her nutrition, physical activity, sleep and body composition and consider additional treatment when appropriate. If her ApoB or Lp(a) indicates increased cardiovascular risk, we can evaluate her overall risk and determine whether more intensive prevention is warranted. If thyroid dysfunction, anemia or a nutrient deficiency is identified, we can investigate and address it, while women experiencing symptoms associated with the menopausal transition can discuss evidence based treatment options, including hormone therapy when appropriate.
Not every abnormal result requires medication, and not every woman needs hormone replacement or additional supplements. The objective is to understand the patient, identify what is clinically meaningful and make decisions that are supported by evidence.
I want women to understand that their health is not defined by their age, their weight or a single laboratory result, and that preventive medicine should be about more than waiting until a disease develops before we begin paying attention.
My approach is to evaluate the whole picture, including hormones, glucose regulation, insulin sensitivity, cardiovascular risk, inflammation, bone health and muscle strength, so that we can make informed decisions about the factors that influence how a woman feels today and how she may function in the years ahead.
I do not want to simply tell a woman that she is perimenopausal or menopausal and leave the conversation there. I want to understand her physiology, identify opportunities to improve her health and develop a thoughtful plan that supports her for decades to come.
That is what longevity and healthspan medicine should mean: using the best available evidence, appropriate testing and individualized care to help women remain healthy, strong and independent for as long as possible.
