Which Blood Tests Women
Over 40 Should Get

You are sitting in the consulting room, the results are on the desk, and the verdict is: "Everything looks fine." Outside, you are alone again with the tiredness, the lighter sleep and the sense that your body is running differently than it did five years ago. The question of which blood tests women over 40 should get almost always grows out of that gap. Not out of anxiety, but out of a need for data that matches what you actually feel.

Between the mid-thirties and the mid-fifties more changes in the body than most women expect. Cycles become irregular, recovery slows, sleep grows lighter. At the same time quieter values shift, ones nobody feels: lipids, blood sugar, iron stores, bone metabolism. Both happen in parallel, and the two have little to do with each other.

That makes a set of results two things at once at this stage: a search for explanations for current symptoms, and a baseline for the next thirty years. Making that distinction helps with the question of what genuinely needs testing. Skip it, and you end up with a forty-value panel that costs a lot and organises little.

Why the question changes after 40

Perimenopause starts far earlier for many women than expected and can last seven to ten years. During that time oestrogen and progesterone swing strongly, and the body responds in several places at once. What you notice is sleep, mood, energy and cycle. What you do not notice is the rest.

Lipids are a good example. The SWAN progress report in the journal Menopause describes sharp increases in total cholesterol, LDL cholesterol and apolipoprotein B within roughly a one-year window around the final menstrual period. In follow-up analysis the menopause-related acceleration in LDL was associated with a greater risk of carotid plaque later in life. That shift cannot be felt. It can only be measured.

Then there is the second layer: symptoms that feel hormonal but may have other causes. Exhaustion, hair loss, poor concentration and feeling cold fit perimenopause, and they fit iron deficiency, an underactive thyroid or a B12 deficiency just as well. Without lab work it stays guesswork. That is exactly why a structured look beats interpreting each symptom on its own. How closely the hormonal threads run together is covered in my article on perimenopause symptoms.

The basics: worth testing for almost every woman over 40

The following values cover what most often turns up at this stage of life while also being treatable. The list is deliberately short. A baseline panel you understand and can track over time is worth more than a long list ticked off once.

• Full blood count and ferritin The blood count shows anaemia. Ferritin shows iron stores and often drops years earlier, especially with heavy or frequent bleeding in perimenopause. It makes sense to measure an inflammatory marker such as hsCRP at the same time, because inflammation makes ferritin look falsely high.
• Thyroid: TSH, more if needed Thyroid disorders affect women considerably more often than men, and the symptoms overlap almost completely with perimenopause. TSH is the usual entry point. If it is abnormal, or if the symptoms do not fit the picture, fT3, fT4 and TPO antibodies belong with it. I have broken down the individual thyroid values and how to read them separately.
• Vitamin D (25-OH-D) Relevant for bone, muscle strength and immune function, and often low in northern latitudes over winter. Testing makes sense where there is reasonable suspicion or a risk factor, not as a routine repeat.
• Vitamin B12 Total serum B12 is imprecise. Holo-transcobalamin or methylmalonic acid are more informative. Particularly important on vegetarian and vegan diets, after gastrointestinal surgery, and with long-term use of acid blockers or metformin.
• Blood sugar: fasting glucose and HbA1c Insulin sensitivity often declines at this stage regardless of weight. Fasting glucose shows the moment, HbA1c the last two to three months. Together they give a realistic picture.
• Lipids including ApoB Total cholesterol, LDL, HDL and triglycerides are standard. ApoB reflects the number of potentially artery-damaging particles and is often more informative than LDL alone. Around menopause a check every one to two years is worthwhile.
• Liver, kidney, electrolytes Not the exciting part, but the basis for interpreting almost everything else. Most standard check-up panels include them anyway.

With ferritin, the scale matters. The WHO guideline on assessing iron status gives a threshold of 15 µg/L for menstruating women, below which iron deficiency is assumed. Where inflammation is present, a value below 70 µg/L in adults may indicate iron deficiency, because ferritin rises with inflammation. That explains why a result of 25 µg/L looks unremarkable on paper and still feels like nothing. More on this in my article on ferritin levels in women.

For vitamin D, the German Nutrition Society (DGE) sets out a clear classification: below 30 nmol/L is a deficiency, 30 to 49 nmol/L is insufficient, and from 50 nmol/L supply is considered good with respect to bone health. The DGE also notes that testing is only sensible where there is reasonable suspicion or a risk factor. Which symptoms point to vitamin D deficiency in women, and how to raise a low level, I have covered separately.

Photo: Andie Cumber / Pexels

When symptoms are present: extend deliberately

Beyond the baseline, testing pays off when there is a concrete question behind it. What follows does not replace a medical conversation, but it helps you walk in with a clear request rather than "something is wrong".

Persistent exhaustion

Ferritin, blood count, TSH, vitamin B12 and vitamin D. Add HbA1c if energy crashes follow meals. Why an unremarkable result is not the end of the search is covered in normal blood tests despite exhaustion.

Heavy or very frequent bleeding

Blood count and ferritin, and regularly. In perimenopause bleeding often gets heavier before it gets less frequent. Iron stores empty gradually over months. Persistently heavy bleeding needs gynaecological assessment regardless.

Hair loss, brittle nails, dry skin

Ferritin, thyroid, zinc, and B12 depending on your diet. Hair loss at this stage frequently has several causes at once, hormonal and nutritional.

Palpitations, inner restlessness, disturbed sleep

Thyroid values, ferritin, blood sugar. These three can produce symptoms that feel exactly like hormonal complaints. They are the reason lab work comes first with inner restlessness and palpitations.

Bone health

Vitamin D and calcium in blood, plus a bone density scan where risk is elevated. Worth knowing: blood calcium says little about calcium in bone, because the body regulates the blood level tightly and will draw on bone to do it. After menopause bone loss accelerates as oestrogen falls away as a protective factor. Blood values do not capture that, they only complement it.

Family history of cardiovascular disease

A lipid panel including ApoB, and lipoprotein(a) once in a lifetime. That value is largely genetically determined and therefore needs measuring only once. It changes risk assessment and with it the advice you get, independent of lifestyle.

What you can skip: hormone panels in perimenopause

Few expectations are as widespread and as often disappointed: that a blood test will show whether menopause has begun. Hormone values are poorly suited to exactly that during this phase.

The international staging system for reproductive ageing, known as STRAW+10, published in the journal Menopause, makes this explicit: menstrual cycle criteria remain the most important criteria for staging, while hormone values such as FSH and AMH count only as supportive. In the late transition FSH fluctuates so widely that one reading can sit in the menopausal range and the next in the range of a younger woman.

In practice: an FSH value on any given day says little about where you are in the transition. It can even mislead, when an unremarkable result is read as "so not perimenopause" and the symptoms are left unexplained. Your cycle pattern and your symptoms over several months carry more information.

There are situations where hormone values genuinely belong: women under 45 with absent or markedly changed periods, suspected premature ovarian insufficiency, unclear bleeding patterns, ahead of certain treatment decisions, and where there is a wish to conceive. That judgement belongs with a doctor, not with a self-test.

Similar restraint applies to salivary hormone profiles, IgG food tests and broad mineral panels from hair samples. They cost a great deal and, as a rule, change nothing about the sensible next steps.

"Normal" is not the same as "optimal"

A reference range is not a recommendation, it is a statistic. It describes where the middle 95 percent of a comparison group fall. Who that group is depends on the laboratory, and often it is people who give blood rather than especially healthy people. So a value just inside the boundary means only this: you are not an outlier. Nothing more.

Three things help when reading results:

• Check the unit. Vitamin D is reported in nmol/L or ng/mL, a factor of 2.5 apart. Ferritin in µg/L and ng/mL, by contrast, is the same thing.
• Trend beats single value. A ferritin that has fallen from 80 to 30 µg/L over two years tells you more than any single reading.
• Read in context. Ferritin without an inflammatory marker, TSH without symptoms, LDL without overall risk: isolated numbers lead to wrong conclusions in both directions.

And the most important point: good results do not invalidate your symptoms. They narrow down where the cause is not. That is a finding, not a verdict on what you feel.

Photo: Kaboompics / Pexels

How to prepare for the appointment

The difference between useful results and disappointing ones is usually made before the blood draw. Doctors work under time pressure. Come with a specific question and you are more likely to get specific testing.

• Write symptoms down, with timing. "For about eight months I have woken almost every night around three" is usable. "I am often tired" barely is.
• Track your cycle. Length, flow, spotting, over at least three months. For placing perimenopause that beats any hormone value.
• List everything you take. Supplements included. Biotin can distort thyroid results, iron supplements shift ferritin, acid blockers affect B12 absorption.
• Bring previous results. The trend is where the real information sits.
• Ask concretely. "Could we measure ferritin together with hsCRP?" gets further than "can we check everything?".
• Take a copy of your results. You are entitled to it. Keep them in one place, digital or on paper.

On timing: ferritin, blood count and thyroid values are not tied to a cycle phase. If hormone values are being measured after all, the point in the cycle matters and the practice will specify it. Straight after heavy bleeding or an infection it is worth waiting a week or two, as both distort the picture.

What to do when a value is abnormal

A single value outside the range is information, not a diagnosis. Before it turns into long-term treatment, three steps are worthwhile.

First, confirm it. Laboratory values fluctuate, and individual measurements can be off. With borderline results a second measurement is often the more honest route than acting immediately. With an abnormal TSH, for instance, a repeat after some weeks is standard before treatment is decided.

Second, look for the cause. Low ferritin is a finding, not a reason. The question behind it is: where is the iron being lost, or where is the intake missing? Heavy bleeding, an iron-poor diet, impaired absorption in the gut. Supplementing without clarifying that is filling a bucket with a hole in it.

Third, book the follow-up straight away. Anyone taking iron or vitamin D should have the effect measured after about three months. Without a check it stays open whether the dose is enough or long since too high. Both happen, and neither can be read off how you feel.

One point that often gets lost: supplementing on suspicion is not a harmless stopgap. Iron without a documented deficiency burdens the body, and high-dose vitamin D over longer periods can disturb calcium balance. Measure, then act, then measure again.

The FemBalance view: results are a map, not a verdict

Two camps have formed around blood values. One treats anything outside the range as harmless as long as it does not become a diagnosis. The other sells sixty-value packages promising that you will finally understand everything. Both miss the same woman.

Katharina, 37, describes the first version: "I went to the doctor because I felt permanently exhausted. But my blood results were unremarkable. So at some point I thought maybe it was just me. Deep down I knew something had changed: my sleep, my energy, my resilience." Roughly one in two women knows that feeling of not being well despite normal results. Usually because sleep, nervous system, recovery and hormonal dynamics never appear on the report at all.

In my view a set of results is a tool with a clearly limited brief. It answers whether a deficiency or a condition is in the way that can be treated. It does not answer how you are. Separating the two saves a lot of frustration: the lab settles what is treatable, everything else is decided by sleep, movement, nutrition and load. That is the order I work in in my digital guides.

Last updated: 30 August 2026

Frequently asked questions

This article is for general information and does not replace medical diagnosis or treatment. Which values make sense in your case, and how results should be interpreted, is decided in a medical consultation. Do not take supplements such as iron or high-dose vitamin D without prior testing and medical advice.