Walk into your appointment knowing what to ask for
You know something has changed. Tired in a way sleep doesn't fix, brain fog, weight shifting, moods all over the place. Blood work won't explain everything, but it can rule things out and show you where you stand.
Our free checklist covers:
- The full thyroid panel, including antibodies
- Iron, B12, vitamin D and blood sugar, including fasting insulin
- Heart markers that change around your final period, including ApoB and Lp(a)
- Hormone tests, and the honest truth about what they can and can't tell you
- Beyond blood work: calcium score and bone density scans
Every test comes with a plain-English reason and the guideline or study behind it.
Is there a blood test for menopause?
If you're over 45, not really. In perimenopause, hormones like FSH and estradiol can swing from one day to the next, so a single blood test can come back "normal" even when nothing feels normal. That's why the NICE menopause guideline says women over 45 should be diagnosed by their symptoms, not a blood test. Under 45, or if your periods stopped early, hormone tests are more useful, so ask your doctor.
So why bother with blood work? Because so much of what we blame on perimenopause and menopause, like exhaustion, brain fog, hair thinning and weight that won't budge, can also come from your thyroid, low iron or low B12. Testing helps rule those out, and gives you a baseline for the years ahead.
The blood tests on our checklist, and why
| Test | Why it's worth asking about |
|---|---|
| Thyroid panel: TSH, Free T4, Free T3, TPO and TG antibodies | Thyroid symptoms overlap with perimenopause and menopause. TSH and Free T4 are the core tests, and TPO antibodies show whether your immune system is involved (Garber 2012). |
| Ferritin | Your stored iron. Heavy or irregular periods in perimenopause can run it down. |
| A1C, fasting glucose, fasting insulin | Shows blood sugar changes early, while there's still lots you can do. Ask for HOMA-IR, which reads glucose and insulin together. |
| Vitamin D (25-hydroxyvitamin D) | Part of bone health, which changes after menopause. |
| Vitamin B12 | Low B12 can cause tiredness and brain fog that are easy to blame on menopause. |
| CBC (complete blood count) | Checks for anemia and other blood changes. |
| Lipid panel | In the SWAN study, LDL cholesterol rose most in the year before and after the final period (Matthews 2009). |
| ApoB | Counts the particles that carry cholesterol into artery walls. It also rises fastest around the final period (Matthews 2009), and the 2026 ACC/AHA guideline uses it to find risk that LDL can miss. |
| Lp(a), once in your life | Mostly set by your genes. The 2026 ACC/AHA guideline says every adult should have it checked at least once. |
| hs-CRP and homocysteine | hs-CRP is one of the markers doctors use when they weigh heart risk (Arnett 2019). |
| CMP (comprehensive metabolic panel) | Liver and kidney function in one routine panel. |
| Hormones: estradiol, progesterone, FSH, testosterone, DHEA-S | Useful context, with a catch: over 45 they don't diagnose perimenopause or menopause (NICE). |
Beyond blood work
Coronary artery calcium (CAC) score. A quick, low-dose CT scan that shows calcium in the arteries of your heart. The 2026 ACC/AHA guideline supports it for adults whose 10-year heart risk is borderline or intermediate, when the result would change the plan. Heart disease is the leading cause of death for women in the US (CDC), and the menopause years are when risk factors shift.
Bone density scan (DEXA). Recommended for all women 65 and older, and for younger postmenopausal women with risk factors for fracture (US Preventive Services Task Force 2025).
Blood pressure. Every visit. It's free, and it counts.
Tests you may hear about on social media
Reverse T3 is an inactive form of thyroid hormone. It isn't part of the standard thyroid workup, which uses TSH and Free T4 (Garber 2012). DHT is a stronger form of testosterone linked to hair thinning, but a blood level doesn't show what's happening at the hair follicle, so the global consensus on testosterone in women uses total testosterone instead (Davis 2019). Pregnenolone is a blood test sent to a specialty lab, mainly used to diagnose rare adrenal conditions. None of these are wrong to ask about. They just aren't routine.
How to use the checklist. Book the appointment, bring the list, and ask: "Which of these make sense for me, and why?" Some tests may not be covered by insurance, so ask about that too. Keep copies of your results so you can see how your numbers change over time.
Related reading: Menopause and hypothyroidism: what you should know
Sources: National Institute for Health and Care Excellence. Menopause: identification and management (NG23), updated 2024. Garber JR et al. Clinical practice guidelines for hypothyroidism in adults (AACE/ATA). Thyroid 2012;22(12):1200-1235. Matthews KA et al. J Am Coll Cardiol 2009;54(25):2366-2373. Blumenthal RS, Morris PB et al. 2026 ACC/AHA Guideline on the Management of Dyslipidemia. J Am Coll Cardiol 2026. Arnett DK et al. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease. Circulation 2019;140(11):e596-e646. US Preventive Services Task Force. Screening for Osteoporosis to Prevent Fractures, 2025. Davis SR et al. Global Consensus Position Statement on the Use of Testosterone Therapy for Women. J Clin Endocrinol Metab 2019;104(10):4660-4666. CDC. Women and heart disease.
This page is for education and is not medical advice. Talk with your healthcare provider about which tests are right for you.
Like a menopause masterclass — straight to your inbox.
Get weekly tips, tools, and a dose of humor for your menopause journey. Because some days, you just gotta laugh about it. Subscribe & save 15% off your first order.
Support worth sharing.
Got fellow pausers in your life who are looking for guidance? Invite them to join our judgment-free community.
