10 Numbers Midlife Women Need to Know for Metabolic, Hormonal and Long-Term Health
As women move through midlife, the body starts sending new signals (some subtle, some loud) about how our metabolism, cardiovascular system, and hormones are changing. The good news? You can get ahead of many of these shifts by tracking a handful of key biomarkers. These numbers give you a roadmap for understanding inflammation, metabolic flexibility, and long-term disease risk before symptoms ever show up. These aren’t random lab values. They’re the numbers I check every single day in my practice and the ones I want every woman in her 40s, 50s, and beyond to know. Let’s break them down.
1. Blood Pressure: <120/<80 mmHg
Blood pressure tends to creep up as estrogen declines, and even “high-normal” readings in midlife can signal vascular changes that elevate the risk of heart disease (still the No. 1 killer of women). Keeping blood pressure below 120/80 mmHg supports healthy arteries, kidney function, and brain aging.
2. Waist Circumference: <35 inches
For some ethnic groups, <31.5 inches is considered the high-risk cutoff. Waist measurements tell us far more than the scale does. It reflects visceral fat, the metabolically active fat around the liver and abdominal organs that drives inflammation, insulin resistance, and cardiometabolic disease. If your waist is increasing year to year, it’s a sign your metabolism needs attention long before labs shift.
3. Fasting Glucose: 70–99 mg/dL
This number alone doesn’t give the full picture but trends matter. Midlife is when insulin resistance often begins. Fasting glucose creeping into the high 90s signals that your cells aren’t responding to insulin efficiently. This is one of the earliest predictors of future diabetes risk.
4. A1c: <5.7%
A1c reflects your 3-month average blood sugar. Even “normal” levels between 5.5–5.7% can indicate metabolic dysfunction in midlife women, especially when paired with symptoms like increased belly fat, low energy after meals, or difficulty losing weight.
5. LDL-C (Low-Density Lipoprotein Cholesterol): “Optimal” <100 mg/dL
LDL is only one part of the lipid story, but it matters. For women with metabolic risk factors, inflammation, or a strong family history of cardiovascular disease, a lower LDL target may be ideal. But LDL concentration doesn’t always equal LDL risk so keep watching.
6. HDL-C: ≥50 mg/dL
HDL helps clear excess cholesterol from the bloodstream and has anti-inflammatory effects. Levels often fall during perimenopause due to hormonal shifts and changes in body composition. Raising HDL through nutrition, strength training, and metabolic health habits makes a meaningful difference.
7. Triglycerides: <150 mg/dL
Triglycerides respond quickly to dietary changes, stress, alcohol, and insulin resistance. Lower levels typically indicate better metabolic flexibility. A TG level under 100 mg/dL is even more protective.
8. ApoB: <90 mg/dL (Primary Prevention)
ApoB is one of the most powerful yet under-ordered markers for cardiovascular risk. It measures the number of atherogenic particles, not just their cholesterol content. For midlife women, ApoB gives a far clearer picture of true risk than LDL alone.
9. Lp(a): <50 mg/dL (≈ <125 nmol/L)
This is genetically determined and doesn’t change much with lifestyle. High Lp(a) increases cardiovascular risk independent of cholesterol levels. I encourage every woman to get it checked once so we know your baseline.
10. TSH: ~0.4–4.0 mIU/L (Follow Your Lab’s Range)
Thyroid symptoms often overlap with perimenopause: fatigue, weight changes, hair loss, mood shifts. TSH is just the starting point but it’s essential. If your TSH is borderline, we often pair it with free T3, free T4, and thyroid antibodies to understand the full picture.
Why These Numbers Matter
During perimenopause and menopause, women experience:
Shifts in estrogen and progesterone
Changes in fat distribution
Reduced muscle mass
Declines in insulin sensitivity
Increased cardiovascular risk
Tracking these 10 numbers helps us:
Catch metabolic issues earlier
Personalize nutrition and exercise
Prevent cardiovascular disease
Support brain health
Optimize weight wellness
Improve energy, sleep, and longevity
Midlife is not a decline! It’s a window where informed action can have the biggest long-term payoff.
What I Tell My Patients
You do not need perfect numbers overnight. What matters is knowing your baseline and having a plan to move them in the right direction. Small steps compound:
Prioritizing protein
Building muscle mass
Reducing visceral fat
Supporting metabolic flexibility
Managing stress
Prioritizing sleep
Reducing ultra-processed food
Balancing blood sugar
Every improvement matters.