Objective: The aim of this study was to examine the changes in serum lipid profile related to the stages of the menopausal transition as defined by prospective menstrual pattern. Methods: A total of 593 healthy women aged 35 to 64 years were followed annually for up to 3 years (average, 1.6 y), and 1,549 observations were provided. Blood samples were collected from all participants. Serum total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol, TC/HDL-C, estradiol, and follicle-stimulating hormone were assessed. Menopause status was defined by the menstrual change criteria of the Stages of Reproductive Aging Workshop. Results: After adjusting for age, body mass index, physical activity, and antihypertensive medication use, TC, TG, and TC/HDL-C increased to peak in the late perimenopause (increased by 7.1 mg/dL in TC, 12.3 mg/dL in TG, and 0.19 in TC/HDL-C; all P < 0.05) compared with the premenopause status group. We did not find any statistically significant difference between the premenopause and postmenopause status groups in all lipid profile variables. Among postmenopausal women, only TG decreased by 8.2 mg/dL in the late postmenopause (P < 0.01). In contrast, there is no significant change in HDL-C among the different menopause status groups. Conclusions: Our data suggest that the menopausal transition instead of menopause per se is associated with serum lipid profile in community-based women in China. Late perimenopause status is significantly associated with accelerated increase in TC, TG, and TC/HDL-C. HDL-C seemed to have no relationship with menopause status. © 2010 by The North American Menopause Society.