Postprandial Triglyceride Excursions and the Potential Effect of Menstrual Cycle Phases: A Narrative Review of Human Physiology with Clinician and Patient Perspectives

Postprandial lipemia, the transient rise in circulating triglyceride-rich lipoproteins after consuming a meal, plays a significant role in cardiometabolic disease risk beyond the contribution of fasting lipid concentrations. While pharmaceutical therapies have been highly effective in reducing fasting cholesterol and fasting lipids, strategies to lower postprandial triglyceride excursions remain limited. Further, females have historically been underrepresented in research, partially due to concerns about hormonal variability across the menstrual cycle. Yet, understanding how menstrual cycle phases influence postprandial triglyceride metabolism is essential for designing inclusive studies and refining clinical approaches to reduce cardiovascular disease risk. This narrative review synthesizes current evidence on postprandial triglyceride metabolism, biological sex-related differences, hormonal fluctuations across the menstrual cycle phases, and potential menstrual cycle influences on postprandial triglyceride metabolism. Premenopausal females generally display lower postprandial triglyceride excursions than males, driven primarily by accelerated clearance of triglyceride-rich lipoproteins through enhanced skeletal muscle uptake and shorter particle residence times. The influence of menstrual cycle phase on postprandial triglyceride excursions remains unresolved. Of four known studies conducted to date, two reported no phase-dependent differences, and two observed lower triglyceride concentrations in the luteal phase. This heterogeneity may reflect methodological variability rather than a consistent biological effect. Nevertheless, mechanistic evidence linking estrogen and progesterone to hepatic lipoprotein production and tissue lipid handling provides biological plausibility for menstrual cycle modulation of postprandial lipemia and underscores the need for more rigorously designed studies with biochemical hormonal verification. Complementary perspectives from a community clinician and a patient partner are included to provide insights into the practical implications of postprandial lipemia for patient care and the lived experiences of cardiometabolic disease prevention.