Blood Tests Every Woman Over 45 Needs—a Doctor Says Most Women Are Asking for the Wrong Ones
Plus learn which common screenings you can actually skip
Key Takeaways
- Hormone blood tests may not reveal the full picture of women's health in perimenopause.
- Routine screenings like A1C, CBC and lipid panels are especially crucial after age 45.
- Specific blood tests can reveal the root cause of hair loss, brain fog and other symptoms.
Your blood offers a treasure trove of health clues, but what are the top recommended blood tests for women—and which may be misleading or unnecessary? We spoke with a leading women’s health expert to break down the best screening tests for routine care, as well as more targeted testing for specific symptoms. Keep reading for everything you need to know.
The truth about blood tests and hormones
The surprising big picture when it comes to women’s health and blood tests? We’re often asking for the wrong ones, observes Pelin Batur, MD, medical director of the Cleveland Clinic Women’s Comprehensive Health and Research Center.
“Women in perimenopause will come in asking to have their hormones checked, but the studies are pretty clear that checking estradiol or FSH [follicle stimulating hormone] are not helpful in diagnosing or even helping understand patient symptoms during the menopause transition,” she says. “That disconnect is a source of frustration for both patients and practitioners.”
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The problem with hormone blood tests during perimenopause
“Perimenopause is like puberty—there’s so much fluctuation in the hormone levels, it’s really like a roller coaster, which is why people feel so miserable,” she explains.
One phenomenon that makes testing particularly unreliable is something called a “LOOP cycle,” where one ovulation happens right on top of another. “You can see sky-high estrogen levels, so high that if we caught it randomly on blood tests, we’d be worried that you have some sort of cancer,” Dr. Batur says. Two weeks later, those same hormone levels might test completely normal, leading to confusing and contradictory results.
This fluctuation can lead to misdiagnoses. A woman might be told her hormone levels are low and she’s in menopause, when the only true way to define menopause is one year without a period—not blood tests. Dr. Batur has even seen patients who were told they were menopausal after chemo and radiation, with months of testing suggesting menopause and no bleeding, only to return pregnant.”Using those hormones can be a good way to make a mistake in interpretation and tell the patient the wrong thing,” she cautions.
When blood tests for hormones are helpful
Of course, there are cases when blood tests for hormones make sense. Here, Dr. Batur notes these specific “carve-outs”:
Premature ovarian insufficiency
“When people have premature menopause, we call that premature ovarian insufficiency. That means you’re going into a menopause-like state before age 40. In that case, hormone testing is necessary and very helpful,” Dr. Batur explains.
Troubleshooting hormone therapy
If someone is on a higher dose of menopausal hormones and still experiencing symptoms like hot flashes, Dr. Batur will check levels to see how well they’re absorbing the medication. “Otherwise it’s a waste of the patient’s blood, money and time,” she notes.
Younger women without periods
For women under age 45 who’ve had uterine ablation, which destroys the lining of the uterus to treat heavy bleeding, or have an IUD that stops their menstrual cycle, hormone testing can help determine if they would benefit from hormone therapy. “It will tell me if a 39-year-old with an IUD who’s having symptoms is starting to look like they’re getting low estrogen levels,” says Dr. Batur. “That might be an indication to start estrogen a little sooner.”
Tier 1: Blood tests women need for preventative health
Now that we’ve explored the nuanced intersection of blood tests and hormones, let’s dive into what Dr. Batur calls tier one blood tests you would get at your primary care doctor. “Make sure these routine, preventive blood tests are up to date during your annual visit, but especially if you’re not feeling well during the menopause transition.”
Hemoglobin A1C
“We’ll check blood sugar to see if you’re prediabetic, and we also do something called a hemoglobin A1C that gives a three-month measure of your blood sugar levels,” says Dr. Batur. Why is this important? “As we go into menopause, we know our cardiovascular risk profiles change,” she explains. Catching prediabetes early gives you the power to make changes before it becomes full-blown diabetes.
Chemistry panel
The comprehensive test assesses how well your liver, kidneys and adrenal glands. It’s especially important if you’re experiencing unexplained fatigue or starting new medications.
Complete blood count (CBC)
This test gives your doctor a snapshot of your overall health by checking for anemia, which can cause fatigue, and monitoring your white and red blood cell counts to catch potential issues in the early stage.
Lipid panel
This test measures your cholesterol, both the “good” HDL and “bad” LDL, plus triglycerides. It’s crucial for understanding your heart health risk, which becomes especially important during and after menopause.
Tier 2: Blood tests women may need for specific symptoms
While tier one blood tests are preventive and important for everyone, not all of us need what Dr. Batur calls tier two tests, because they depend on your specific symptoms.
“One major thing I want women to know: If you go to your annual gynecological exam and expect this kind of comprehensive evaluation for menopause, it ain’t going to happen,” she says bluntly. It’s simply not possible in a 10- to 15-minute appointment—that’s often all insurance allows. This is such an important point so that women don’t feel like they’re falling through the cracks.”
Here, she shares a few symptoms that could signal it’s worth talking to your primary care doctor about additional blood testing.
Hair loss? Check zinc, iron and thyroid levels
Hair loss is a perfect example of why blood tests matter for women. “Right now, menopause is having a moment, and there’s a lot of awareness, which is wonderful, but it also means a lot of things are quickly brushed under the rug as perimenopause or menopause without looking for other reasons,” she explains.
“If you assume your hair loss is just menopause based on what you’ve read on social media, you could be missing the real cause, like zinc or iron deficiency or a thyroid function problem that’s actually treatable,” she adds.
Acne or chin hair? Check testosterone and DHEA levels
“If a patient is talking about acne or chin hair, it could be due to hyperandrogenism, and we might check testosterone and DHEA levels,” she says.
Sexual dysfunction? Check prolactin levels
Low sexual interest or issues with orgasms may be caused by abnormal levels of prolactin, a hormone produced in the brain that affects libido, she explains.
Brain fog? Check vitamin B12 levels
“I can’t tell you how many women come in with mood concerns, brain fog and fatigue and believe it’s because of menopause when it’s low B12 levels,” she notes.
Body aches and pains? Check CRP and ESR levels
For people who feel like something is really wrong—their joints and body ache—checking inflammation markers ESR (erythrocyte sedimentation rate) and CRP (C-reactive protein) can provide important answers, Dr. Batur explains.
Because these tests look for inflammation, make sure you come in when you don’t have a cold, flu or are nursing an injury. Dr. Batur learned this firsthand: “I went in for my blood test and I forgot I had fallen on the ice days before and my body was inflamed, and my levels were sky high. I was like, ‘Oh my gosh, why? Do I have cancer?’ A few weeks later, I retested and it was fine.” Temporary inflammation from injuries or illness can skew results, so timing matters.
An important tip from Dr. Batur: Stop taking supplements at least five days before your blood work, especially if you’re getting a prolactin test, since supplements can throw off your results.
The bottom line on blood tests for women’s health
Blood tests are powerful tools for understanding what’s really happening in your body during perimenopause and menopause—but not all tests are created equal. While hormone testing has limited value during the transition, targeted blood work based on your specific symptoms can uncover treatable conditions like thyroid issues, iron deficiency or inflammation that might be mistaken for menopause. Talk to your doctor about the best plan for you.
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