Aim To study the characteristics of coronary lesions and the relation with serum estrogen level in perimenopausal women with coronary artery disease (CAD). Methods The coronary angiograms and the serum estradiol (E 2)and lipid levels were compared between 26 perimenopausal women and 38 postmenopausal women with acute myocardial infarction (AMI). Results There were more cases with mild to moderate coronary artery stenoses and single-vessel diseases in perimenopausal women patients than in postmenopausal ones (P<0.01). In perimenopausal women patients, the serum levels of E 2 and high density lipoprotein cholesterol (HDLC) were significantly lower than in normal control (P<0.01), but higher than in postmenopausal patients (P<0.01). And the serum levels of total cholesterol (TC),triglyceride (TG) and low density lipoprotein-cholesterol (LDLC) were significantly higher than in control (P<0.01), but lower than in postmenopausal patients (P<0.01). Conclusions The coronary lesions in perimenopausal women with CAD were characterized by mild to moderate stenoses and single-vessel diseases. Meanwhile, there were less decrease of serum estrogen level and less abnormality of lipid metabolization in this group of patients.