In perimenopause? You want cholesterol

There is a moment during perimenopause when many women start to feel that something is shifting, but it is not always easy to explain.

Often, the conversation quickly turns to hormones, and rightly so. But one piece that is frequently overlooked is cholesterol.

Cholesterol has been given a poor reputation over the years, usually framed as something to keep as low as possible. Yet inside the body, cholesterol is not simply a number on a blood test. It is a raw material. In fact, it is the starting point from which the body produces key hormones such as progesterone, estrogen, and testosterone.

During perimenopause, hormone levels do not just decline in a straight line. They fluctuate. Some days production is higher, other days it drops. This creates a situation where the body needs to be flexible and efficient in how it produces hormones. If the building blocks are not readily available, or if the body is not using them well, that process becomes less reliable.

This is where cholesterol plays a key role. It is involved in the very first step of hormone production. Without it, the body simply cannot make these hormones. That means that excessively low levels or poor cholesterol metabolism can work against the body at a time when it needs support the most.

What makes this even more relevant is the connection with mitochondria. These are the parts of your cells responsible for producing energy. When people describe feeling tired, flat, or unable to cope with physical or mental demands in the same way, mitochondrial function is often part of that story.

Cholesterol contributes to the structure and stability of cell membranes, including those within mitochondria. It also supports the processes that allow energy to be produced efficiently.

There is another layer to this. The early stages of hormone production actually take place within mitochondria themselves. This means that mitochondrial health and hormone production are closely linked. When one is compromised, the other tends to be affected as well.

So during perimenopause, it is not just about hormones in isolation. It is about how well the body can produce them, and how well the cells can generate the energy needed to support that process. Cholesterol sits right in the middle of both.

This is why a blanket statement of lower is better when it comes to cholesterol could be doing a disservice to women entering perimenopause. A more helpful way of thinking about cholesterol is not simply in terms of lowering it, but in terms of supporting how the body uses it. Factors such as overall metabolic health, blood sugar stability, inflammation, and nutrient intake all influence how effectively cholesterol is converted into hormones and how well mitochondria function.

Perimenopause is not just a hormonal transition. It is a whole body adjustment that involves metabolism, energy production, and cellular function. When cholesterol is viewed through that lens, it becomes much easier to understand why it deserves a more balanced and informed perspective.

Rather than seeing it as something to fight against, it can be seen as one of the key components that helps the body adapt to this stage of life.