Perimenopause and Menopause. A multi-system transition, not a hormone problem

• Carbohydrate and fatty acid metabolism: How efficiently you process fuel. Usually the first panel to move as body composition starts to shift.
• B-complex and functional micronutrient status: Including iron. Heavy perimenopausal bleeding is a common and often missed cause of low ferritin, and low iron produces fatigue well before anaemia appears.
• Inflammation score: The accessible readout of background inflammatory signalling, tracked over time rather than read as a single value.
• Neurotransmitter and precursor markers: Read alongside mood and cognition symptoms, not as a standalone diagnosis.
• Overnight cortisol markers: Read against your separate sleep and energy scores, which is how eight hours in bed with daily exhaustion gets identified as a recovery finding.
• Daily energy requirement: Set against the requirement for a healthy weight, and used to calibrate the nutrition plan.

• Shannon diversity index: A broad, even microbial community absorbs disruption better. Diversity tracks with dietary fibre intake, which is the lever you actually control.[14]
• β-glucuronidase gene abundance: The estrobolome. Microbial capacity to deconjugate oestrogens excreted into the gut and return them to circulation. Reported for tracking rather than as a target.[11]
• Butyrate-producing species: Faecalibacterium prausnitzii and relatives. Butyrate supports the barrier that keeps inflammatory signalling low.
• Equol-producing capacity: Whether your microbiome can convert soy isoflavones into equol. Only a minority of people can, which is one reason dietary phytoestrogen responses differ so much between individuals.
• Endotoxin-producing taxa: Proportion of gram-negative organisms whose lipopolysaccharide can drive low-grade systemic inflammation.
• Fibre fermentation capacity: Microbial ability to ferment the fibre you actually eat, which sets how much short-chain fatty acid production a dietary change will buy you.

• Cycle length, variability and bleeding pattern: The primary input to STRAW+10 staging. Seven days or more of variation between cycles, then gaps of 60 days or more, is the sequence that defines the transition.
• Vasomotor symptom frequency and severity: Days per fortnight, daytime versus nocturnal. Tracked as a trend, because this is the symptom most likely to persist for years and most responsive to being measured properly.
• Sleep onset, night waking and unrefreshed mornings: Recorded separately from night sweats, because the two do not always travel together and they call for different responses.
• Resistance training frequency and protein intake: The two levers with the most direct bearing on the lean-mass loss described above, and the ones the plan will lead with.
• Waist circumference and weight trend: Waist carries information weight does not, because fat can rise while the scales hold steady.
• Alcohol, caffeine timing, and current medications: Including menopausal hormone therapy and contraception, both of which change how the hormone results should be interpreted.

Context, cycle-timed where you are still bleeding. Read as one input to STRAW+10 staging alongside your bleeding pattern, never as a standalone verdict: these swing widely through the transition.

Anovulatory cycles show up as low luteal progesterone. SHBG determines how much testosterone is actually available, so the free fraction matters more than the total.

The first thing to rule out. Thyroid disease is common in midlife women and produces fatigue, weight change, low mood and cold intolerance that are routinely attributed to perimenopause.

Where the body-composition shift shows up first. Fasting insulin usually rises years before fasting glucose, so glucose alone misses the window where change is easiest.

Cardiovascular risk changes shape across the transition. ApoB counts the atherogenic particles rather than the cholesterol inside them.

High-sensitivity C-reactive protein. The accessible readout of background inflammatory signalling, which rises as visceral fat does.

Bone-relevant nutrients plus iron status. Heavy perimenopausal bleeding is a common and often missed cause of low ferritin, and low iron produces fatigue well before anaemia appears.

Context. Both change how the rest of the panel should be read.