Inflammation Markers and Perimenopause: What to Test and Why It Matters
Learn which inflammation markers change during perimenopause, how to test them, and what you can do to reduce chronic inflammation.
Why Perimenopause Raises Inflammation
Oestrogen has significant anti-inflammatory properties. It modulates immune responses, suppresses pro-inflammatory signalling, and helps regulate the gut microbiome, which is a major source of systemic inflammation. As oestrogen falls during perimenopause, these protective effects weaken. The result is a rise in low-grade systemic inflammation, which is now understood to contribute to many perimenopause symptoms including joint pain, brain fog, fatigue, and mood changes. This is sometimes called the inflammatory menopausal transition.
Key Inflammation Markers to Know
C-reactive protein (CRP) is the most widely tested inflammation marker in clinical practice. High-sensitivity CRP (hs-CRP) is more precise and detects lower levels of inflammation associated with cardiovascular and metabolic risk. Interleukin-6 (IL-6) and TNF-alpha are cytokines that drive inflammation and rise with oestrogen decline, though they are less commonly tested outside research settings. Ferritin, an iron storage protein, can also act as an acute-phase reactant and rise with inflammation. Fibrinogen and homocysteine are additional markers sometimes included in cardiovascular risk assessments.
How to Get Tested
Your GP can order CRP and hs-CRP as part of a routine blood panel. If you have symptoms suggestive of an inflammatory condition, other markers like ESR (erythrocyte sedimentation rate) may also be included. Some private clinics offer expanded inflammatory panels. It is worth requesting hs-CRP specifically if cardiovascular risk is a concern, as this is more sensitive than standard CRP for detecting the low-grade inflammation relevant to perimenopause. Testing is most useful when paired with a broader metabolic panel.
What Elevated Markers Mean in Perimenopause
A mildly elevated hs-CRP (above 1 mg/L, and especially above 3 mg/L) in the absence of acute infection signals chronic low-grade inflammation. In perimenopause, this is often driven by the hormonal shift itself, as well as by associated factors like disrupted sleep, insulin resistance, and a less diverse gut microbiome. Chronically elevated inflammatory markers are linked to increased risk of cardiovascular disease, type 2 diabetes, and cognitive decline, all of which become more relevant after the menopause transition.
Lifestyle Strategies to Reduce Inflammation
An anti-inflammatory diet rich in oily fish, vegetables, berries, olive oil, and whole grains has good evidence behind it for lowering CRP. Strength training and moderate aerobic exercise both reduce inflammatory cytokines over time. Improving sleep quality is one of the most effective but underrated ways to lower inflammation. Managing blood sugar through reduced refined carbohydrate intake also helps. Chronic stress keeps cortisol and inflammatory markers elevated, so stress reduction strategies are not optional for women with high inflammatory markers.
Can HRT Reduce Inflammation?
Research suggests that oestrogen therapy has anti-inflammatory effects and can lower CRP and IL-6 in perimenopausal women. However, oral oestrogen can raise CRP in some women, while transdermal oestrogen tends to have a more neutral or beneficial effect on inflammation. This is one reason why many clinicians favour transdermal routes, particularly for women with metabolic concerns. If you have elevated inflammation markers and are considering HRT, discussing the route of administration with your prescriber is a useful part of that conversation.
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