Taking Charge of My Health in Perimenopause

Time for a little update about my recent midlife therapeutic interventions.

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Women navigating the chaotic experience of the extended perimenopause transition (up to 10 years), spend much of that time figuring out a ton of uncomfortable things. I’m no different, and like most other facets of my existence, I like to have some degree of control over what happens to me.

I’ve been hyper-focused on making lifestyle and healthcare refinements since entering perimenopause. I can’t pinpoint exactly when it started, but I can say that it started smacking me in the face about two years ago. My way of processing (and remembering) all of the commotion has been to write about it as it happens.

• In July 2023, I started becoming aware of my symptoms and wrote about them for the first time in Not For The Faint of Heart. I was almost 52 and the reality of my midlife transition was making itself known to me.
• Fast forward to August 2024, I wrote Improving My Cholesterol in Perimenopause all about my personal battle with getting my numbers under control with nutrition and exercise.
• My May 2025 post, Reflecting On My Peri Journey, provided a year-long overview since my perimenopausal symptoms started to ramp up.
• Most recently, October 2025, I wrote another post called GLP-1 and Me discussing my decision to start on Zepbound to help me refine my nutrition habits. I needed a new strategy to tackle the insidiously upwards perimenopausal creep on the scale, around my waist and in my blood work.

It’s now November 2025 and I have some good news to report.

Slow and steady

First, I am happy to say that my early Zepbound experience has been a good one. I stayed on the starting dose (2.5 mg) for longer than most. As of 13 weeks, while I hadn’t quite hit the 10-pound mark, I was pretty close, depending how much salt I’d ingested the day before. Yes, that matters. Sometimes, salt is responsible for a 2-3 pound swing on the scale. I’ve become very salt-sensitive in my 50s. It sucks. But I digress…

My approach to taking this drug is to keep the dose as low as possible. Maximize the drug’s effectiveness by maintaining the behavioral changes it induces. What I’ve noticed is that as my body gets used to the drug, the intensity of how it makes me feel (slowed digestion, feeling fuller sooner, less interest in snacking) decreases. I think there’s a diminishing returns situation the longer you stay on it.

My translation: these drugs require the user to keep doing the hard work. Recognize the habit shifts that the drug initially causes so we can maintain them when the natural dip in efficacy occurs. It’s still working, but I do think you have to be more vigilant the longer you’re on it.

Around the 13-week mark, I felt the first plateau. Not surprising, since the starter dose isn’t meant for hefty weight loss. Rather, it’s meant to get your body used to the new chemistry. So, I asked my doctor to order the 5 mg dose. I’d finish the box of the 2.5 mg, start the increased dose, and see where it takes me.

I imagine that this dose will be the one I stay on if the weight loss kicks in a little more. At this point, I’m not looking for a full 20-pound loss. If it happens, fine, but I think there will be a sweet spot in another 7 or 8 pounds.

As for uncomfortable symptoms, the initial ones are gone. Fortunately, I still feel the beneficial effects:

• I feel fuller sooner, and I can’t eat the same volume of food as before.
• I don’t have the urge to snack more often.
• I don’t get “hangry” anymore, especially in a way that scares my family. When I do feel hunger, I know it’s time to eat something, but it doesn’t come on as strongly as before.
• I don’t like to order big plates when I’m out to eat, and if I do, I take most of it home for a future lunch.
• I’m also feeling less inclined to drink alcohol. It just doesn’t do much for me anymore, and I don’t need the extra useless calories.
• My go-to dessert is now a couple of squares of dark chocolate. Anything more than that makes me uncomfortably full.

Basically, the drug is helping me reshape my nutrition plan on an ongoing basis. I can see the weight loss as well as feel the difference in my clothing. Doing my gymnastics stuff is a little easier. Even 8-9 pounds makes a difference when you’re swinging from a bar. Even if I were to stop here, I’d be pretty happy. But I’d like to see where 5 mg takes me.

Zepbound’s effect on cholesterol

In addition to the weight-loss benefits of tirzepatide (Zepbound), there are significant cholesterol-lowering benefits as well. A 2023 meta-analysis called Effect of tirzepatide on blood pressure and lipids: A meta-analysis of randomized controlled trials concluded:

Tirzepatide induced clinically meaningful reductions in the levels of systolic and diastolic blood pressure, total cholesterol, LDL cholesterol and triglycerides, along with increases in the level of HDL cholesterol.

Given that my cholesterol numbers spiked from last year to this year, and my weight was slowly creeping upwards, I thought it couldn’t hurt to be a guinea pig and test it out for myself.

What do my numbers say?

The really good news was in my most recent blood workup. I started Zepbound a few weeks after the August 2025 blood draw. Below are the last four results from August 2023 through November 2025:

Test (mg/dL)	August 2023	August 2024	August 2025	November 2025
Total Cholesterol (0-200)	216 (high)	188	206	188
Triglycerides (0-199)	111	142	160	93
HDL (35-100)	63	62	60	56
LDL (40-130)	130.8 (high)	97.6	114	113.4
VLDL (0-38)	22	28	32	19
Chol/HDL (0-4.5)	3.4	3.0	3.4	3.4

There are some significant improvements in this first set of blood labs after starting the drug. My eyes bugged out when I saw the shifts in the numbers.

Takeaways

Overall, the GLP-1 seems to have performed miraculously for my cholesterol numbers. Without changing any of my movement habits, and cutting back on the volume of food that I consume, my total cholesterol, triglycerides and VLDL levels lowered to (and below) my August 2024 levels. There was a huge sigh of relief when I saw that.

Interestingly, my HDL (the “good” cholesterol) lowered by about 4 points, but since the total cholesterol number reduced to 188, the ratio remained the same. That ratio of 3.4 is actually optimal when it comes to the risk of coronary heart disease.

I would be remiss if I didn’t consider the fact that I have been taking transdermal estradiol since June 2024. Estrogen plays a major role in women’s cardiovascular health. It’s absence after menopause is what causes cardiac disease, the leading cause of mortality in women.

I don’t know exactly what the effect on my cholesterol it has had, since my August 2025 numbers had increased. Perhaps in that year, my natural estrogen was declining more and I was just playing catch-up. Or, I was not as careful with my diet. Or, maybe both things were true. I can’t say for sure. But in the time between late August (when I started taking Zepbound) and early November, the marked difference in my lipid numbers is eye-opening.

I’ll do another blood panel in February (6 months from starting) and see what those numbers say. Until then, I march forward with my commitment to the daily habits I’ve worked hard to maintain.

Lifestyle choices still matter

In my August 2024 blog about improving cholesterol levels, I talked about seven everyday “rules” that I follow:

• Prioritize protein and fiber
• Aim for 4 fat grams per serving
• Drink a ton of water
• Supplement
• Sleep
• Move and lift heavy things
• A bit of hormone therapy

These rules, for the most part, remain true. If I’m being honest, I’m not quite as strict about the four fat grams per serving, especially now that my calories are naturally more restricted. If I have something with a higher fat count, I eat a small amount of it. With the GLP-1, I don’t go hungry, and I eat until I’m full. Then, I stop and move on, happily.

The more I listen to the wisdom of the doctors of the growing Menoposse (especially Dr. Mary Claire Haver and Dr. Vonda Wright), the more motivated I am to reinforce these practices. I’m not eating to be skinny, I’m eating to be strong. My habits now will affect my bones, brain and heart for the rest of my life. My ultimate goal is to provide the environment for optimal life from the inside out. And with these numbers, I feel more assured that the steps I’m taking are leading me towards that goal.