Dr. Heidi Queen, MD | Energize Health & Hormones

For many women, the midlife health conversation starts with a familiar sentence: “Your labs are normal.” And sometimes, that is reassuring news. But a standard blood panel is designed to answer specific questions about things such as blood counts, kidney and liver function, electrolytes and cholesterol. It is not necessarily designed to give you a complete picture of how your health is changing during the menopause transition. That distinction matters.

Dr. Mary Claire Haver, MD, recently highlighted this issue in a detailed discussion of laboratory testing during menopause. Her approach is a useful reminder that midlife is an important time to look beyond symptoms alone and consider the broader picture of cardiovascular, metabolic, bone and thyroid health. For women in their 40s and 50s, the better question may not be, “Which lab tests should every woman have?” It may be, “What should I and my doctor be paying attention to right now?”

Start with the basics—but don’t stop there

A complete blood count and comprehensive metabolic panel remain valuable. So does a standard lipid panel. These tests provide important information about blood counts, kidney and liver function, electrolytes, glucose and cholesterol. They form part of a good health assessment. But depending on your age, symptoms, medical history and risk factors, your clinician may also want a closer look at specific areas of health.

Cardiovascular health deserves a closer look in midlife

Menopause is associated with changes in cardiovascular risk, and cholesterol and other metabolic markers can change during the transition. A standard lipid panel measures total cholesterol, LDL cholesterol, HDL cholesterol and triglycerides. In some women, additional testing may provide useful information.

One example is lipoprotein(a), or Lp(a), an inherited cholesterol-related risk factor that is not included in a standard lipid panel. Current cardiovascular guidance recommends that adults have Lp(a) measured at least once, because an elevated level can add to long-term cardiovascular risk.

Another is Apolipoprotein B (ApoB). Rather than measuring the amount of cholesterol carried by certain particles, ApoB provides information about the number of atherogenic particles. It can be particularly useful in certain people with elevated triglycerides, diabetes, metabolic syndrome or other cardiovascular risk factors. The takeaway isn’t that every woman needs every advanced lipid test every year. It is that cardiovascular risk deserves a more individualized conversation than a single LDL number may provide.

What about blood sugar and insulin?

Metabolic changes can become more noticeable during perimenopause and after menopause. Fasting glucose and hemoglobin A1c are familiar tests, but your clinician may also consider the broader picture if you have symptoms or risk factors for insulin resistance, including changes in weight or body composition, a family history of diabetes, elevated triglycerides or other metabolic concerns.

Fasting insulin and calculations such as HOMA-IR are sometimes used in functional and preventive medicine to explore insulin resistance. However, unlike glucose and A1c, there is not a universally accepted “optimal” fasting insulin or HOMA-IR target endorsed by major diabetes organizations. That distinction is important. A useful health conversation doesn’t require pretending that every number has one universally agreed-upon ideal range. It requires understanding what a test can tell you, what it cannot tell you, and whether the result would actually change your care.

Bone health shouldn’t wait for a fracture

Bone health is another area worth discussing as women move through menopause. Bone loss can accelerate during the menopausal transition, and osteoporosis can develop silently. But that doesn’t mean every woman needs a baseline DEXA scan at a particular age.

Current USPSTF recommendations call for osteoporosis screening in women 65 and older and in younger postmenopausal women who have risk factors that place them at increased risk. Risk assessment can help determine whether a DEXA scan makes sense earlier. Your personal history matters here: family history of hip fracture, low body weight, smoking, excess alcohol use, certain medications and medical conditions can all influence fracture risk.

Vitamin D may also come up in a bone-health discussion. Here again, more testing isn’t automatically better. The Endocrine Society’s 2024 guideline recommends against routine vitamin D testing in generally healthy adults without an established indication. In other words, test because there is a reason—not simply because a test exists.

Thyroid symptoms can look a lot like menopause

Fatigue, brain fog, changes in weight, sleep problems, mood changes and hair loss can occur during perimenopause. They can also occur with thyroid disorders. That overlap is one reason a thoughtful medical history is so important.

Depending on your symptoms and history, your clinician may consider thyroid testing beyond a single TSH measurement. Whether additional testing is appropriate depends on the individual situation and what the results would mean for treatment. The goal isn’t to order the biggest possible panel. It is to avoid assuming that every new symptom has only one possible explanation.

Don’t overlook iron and B12

For women who have experienced years of heavy or irregular menstrual bleeding, iron status can be particularly relevant. A CBC can identify anemia, but ferritin provides information about iron stores and may help explain symptoms when anemia has not yet developed. B12 deficiency can also contribute to fatigue, cognitive symptoms and neurologic complaints, particularly in people with certain dietary patterns, gastrointestinal conditions or medications that affect B12 absorption. These tests aren’t automatically necessary for everyone. They become more useful when symptoms, history or risk factors give your clinician a reason to investigate.

Do you need hormone testing?

This is one area where more testing can sometimes create more confusion rather than clarity. During perimenopause, estrogen and other reproductive hormones can fluctuate considerably. A single hormone measurement may therefore provide only a snapshot rather than a reliable picture of where someone is in the menopause transition.

For many women with typical symptoms and menstrual changes, menopause and perimenopause can be assessed clinically. There are situations in which hormone testing can be helpful—for example, when menstrual patterns cannot be used to assess the transition, when menopause occurs unusually early, or when a clinician is evaluating a specific symptom or treatment question. The question to ask is not simply, “Can we test my hormones?” It is “What will this test tell us, and will the result change what we do?”

The most important test may be the conversation

A comprehensive midlife health assessment isn’t about collecting the longest possible list of laboratory numbers. It is about putting those numbers into context. Your family history, blood pressure, body composition, menstrual history, medications, sleep, nutrition, physical activity, symptoms, cardiovascular risk and bone health all contribute to the picture. Laboratory testing is one piece of that larger assessment.

And that may be the most useful lesson to take from the growing conversation around menopause and laboratory testing: “Normal” doesn’t always mean there is nothing worth discussing, but neither does every result outside a preferred range mean something is wrong. Good preventive care is more individualized than either extreme. Midlife is an important time to pay attention to the whole picture—and to establish a baseline that can help you and your physician recognize meaningful changes over time.

A better question for your next appointment

Instead of arriving with a long list of tests you found online, consider asking: “Given my age, symptoms, family history and health goals, are there areas of cardiovascular, metabolic, bone, thyroid or nutritional health that we should be looking at more closely?” That opens the door to a much more useful conversation. DOWNLOAD THIS PDF >> MIDlife Health Conversation Checklist

At Energize Health & Hormones, Dr. Heidi Queen takes a personalized approach to women’s health that considers the whole picture—not just an isolated lab result or a single symptom. If you’re looking for a more individualized approach to your health during perimenopause, menopause or beyond, contact Energize Health & Hormones to learn more about working with Dr. Queen. Call (415) 548-7901 to learn more and to schedule your appointment today. 

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Article Source:
Dr. Haver’s June 3, 2026 Substack article, The Labs I Run on Every Menopausal Patient.
Dr. Mary Claire Haver’s original Substack article