The Best Blood Tests for Women Over 40

Turning 40 marks the beginning of important physiological changes for women — perimenopause typically begins, metabolic rate shifts, cardiovascular risk increases, and bone density starts to decline. The right blood tests can detect these changes years in advance.

Full Blood Count and Iron Studies

An FBC is particularly relevant for detecting anaemia from heavier perimenopausal bleeding. A dedicated iron studies panel (serum iron, ferritin, transferrin, transferrin saturation) is essential. Ferritin below 30 μg/L is associated with fatigue and hair loss even when haemoglobin is normal. After menopause, watch for excessively high ferritin, which may indicate inflammation or haemochromatosis.

Thyroid Function

Thyroid disorders affect approximately 1 in 8 Australian women. Hypothyroidism is particularly prevalent after 40 and causes fatigue, weight gain, and mood changes easily mistaken for normal ageing. Test TSH at minimum; add free T4, free T3, and thyroid antibodies if symptoms are present.

Lipid Panel

Cardiovascular disease is the leading cause of death in Australian women. As oestrogen declines during menopause, LDL and triglycerides tend to rise while HDL may decline. Annual lipid tracking through your 40s reveals how your cardiovascular risk is shifting with hormonal changes.

Blood Glucose and HbA1c

Diabetes risk increases significantly after 40, especially for women with a history of gestational diabetes or PCOS. Both fasting glucose and HbA1c should be included annually.

Vitamin D, B12 and Folate

Vitamin D is crucial for bone health as density begins declining pre-menopause. The AIHW reports one in four Australian adults are deficient. B12 deficiency becomes more common with age due to declining stomach acid. Both are essential inclusions.

Hormonal Panel

FSH rises as ovarian function declines and is the most common marker for menopausal transition. Oestradiol, testosterone, DHEA-S, and SHBG provide a comprehensive hormonal picture. The Australasian Menopause Society emphasises interpreting levels alongside symptoms, as they fluctuate widely during perimenopause.

Inflammatory Markers

High-sensitivity CRP (hs-CRP) provides additional cardiovascular risk information beyond lipids. Liver function tests can detect non-alcoholic fatty liver disease, which is increasingly prevalent in women.

References

1. RACGP. Guidelines for Preventive Activities in General Practice, 9th Edition. East Melbourne: RACGP, 2018.
2. Australasian Menopause Society. Information Sheets on Menopause. Available at: www.menopause.org.au.
3. National Heart Foundation of Australia. Guidelines for Diagnosis and Management of Hypertension. Melbourne, 2016.
4. Davis SR, et al. Menopause. Nat Rev Dis Primers. 2015;1:15004.