PCW Clarity · Bloodwork
What bloodwork should I ask for in perimenopause and menopause?
"Your labs are normal." But you don't feel normal. Here's what blood tests can and can't tell you.
The short answer
There's no single blood test that diagnoses perimenopause or menopause. For women over 45 with typical symptoms, it's usually diagnosed by age, symptoms and changes in your cycle. The Endocrine Society's guideline and The Menopause Society both take this approach, because hormone levels like FSH and estradiol swing from day to day during perimenopause, so one test may not mean much (Stuenkel 2015; NAMS 2022). Testing can help in some cases, like symptoms before 40 to 45 or an unclear picture. Saliva and at-home hormone panels aren't supported by society guidance for diagnosis or treatment.
What blood tests can do is check the things that change around midlife and can cause symptoms of their own. Common labs to discuss include a lipid panel, fasting glucose or A1C, a thyroid test (TSH) and a blood count, plus iron, B12 or vitamin D depending on your symptoms. Bone density scans are recommended at 65, or sooner for postmenopausal women at higher risk (USPSTF 2018). Your clinician decides what fits you. Your symptoms are real data, so write them down.
Why does this matter?
- Cholesterol can jump around your final period. In SWAN, total cholesterol, LDL cholesterol and apolipoprotein B rose sharply within the year before and after the final period (Matthews 2009). The AHA calls the transition a window for early prevention (El Khoudary 2020).
- Blood sugar can drift for years. The American Diabetes Association defines prediabetes as an A1C of 5.7% to 6.4%, or a fasting glucose of 100 to 125 mg/dL. An A1C of 6.5% or higher is in the diabetes range (ADA 2024).
- Thyroid problems look like menopause. Fatigue, weight change, mood and brain fog can come from the thyroid. TSH is the main screening test in thyroid guidelines (Garber 2012; Jonklaas 2014).
- Heavy periods can drain iron. Heavy bleeding in perimenopause is a reason to ask about a blood count and iron.
- Trends beat snapshots. One result inside the range can hide a steady climb. Ask for your last few years side by side.
How do I make my lab visit count?
- Bring a symptom log. Sleep, hot flashes, mood, periods, energy and memory, with dates. It's often more useful than a hormone level.
- Pull your old results. Lipids, A1C or glucose, TSH and blood counts from the last 3 to 5 years, so you can see trends.
- Ask what each test would change. "Would this result change what we do?" is a fair question for any test, including hormone tests.
- Ask about bone density timing. USPSTF recommends screening at 65, and earlier for postmenopausal women at higher risk (USPSTF 2018).
- Be wary of big panels that promise answers. Expensive panels and saliva tests aren't how societies diagnose menopause or guide treatment (Stuenkel 2015; NAMS 2022).
- If you're under 40 to 45 with symptoms, ask specifically about early menopause checks. That's when hormone testing is most useful.
Who on my care team handles what?
- Your clinician chooses the tests, interprets them in context and decides next steps.
- The lab or phlebotomist draws the blood. Ask whether you need to fast.
- A registered dietitian uses your lipid and blood sugar results to shape an eating plan.
- A pharmacist flags medications or supplements that can affect results.
Where it breaks: results land in a portal, nobody compares them to last year, and the dietitian and trainer never see them. Keeping your own one-page trend sheet fixes most of it.
How does the DAITT® Method connect to this?
DAITT® (say it like “date”) is our five-part way to look at a whole life. In wellness, the letters stand for Discipline of the body, Awareness, Intellect, Trust and Treasury. Here's how each one touches this question:
- Discipline of the body: Get the basics checked on a schedule your clinician sets.
- Awareness: Notice if "normal" made you feel dismissed, and say so.
- Intellect: Learn what each number means and what range you're in.
- Trust: Trust your own body's story alongside the numbers.
- Treasury: Ask what labs cost and what your plan covers before ordering extras.
Have you made a DAITT® with your future self? Take the free wellness DAITT® quiz on drpat.co. No forms, and nothing is saved.
What does a trend look like?
Illustration
An illustration with made-up numbers, not a client story. Here's how one woman's A1C might look over 3 years:
| Year | A1C | What the ADA range says |
|---|---|---|
| Year 1 | 5.3% | Below the prediabetes range |
| Year 2 | 5.5% | Below the prediabetes range |
| Year 3 | 5.7% | Prediabetes range starts at 5.7% (ADA 2024) |
Each year alone looked fine. Side by side, it's a steady climb, and year 3 crosses into the prediabetes range. That's a conversation about sleep, strength, food and how often to re-check, long before anything is out of control.
What do the experts say, and where does the evidence land?
Dr. Mary Claire Haver (in The New Menopause) emphasizes that symptoms, not a single hormone number, should drive the conversation. Dr. Sara Gottfried (on Huberman Lab) and Dr. Peter Attia (in Outlive) discuss broader testing. Gary Brecka promotes detailed hormone panels; that's non-clinical wellness opinion. Society guidance favors diagnosis by age and symptoms, and we go with society guidance.
Related questions
Can a blood test tell if I'm in perimenopause?
Usually not on its own. For women over 45 with typical symptoms, guidelines diagnose the transition by age, symptoms and cycle changes, because hormone levels swing day to day (Stuenkel 2015; NAMS 2022). Testing can help if symptoms start before 40 to 45.
What A1C level means prediabetes?
The American Diabetes Association defines prediabetes as an A1C of 5.7% to 6.4%. An A1C of 6.5% or higher is in the diabetes range (ADA 2024).
When should women get a bone density test?
The USPSTF recommends osteoporosis screening for women 65 and older, and for younger postmenopausal women at increased risk (USPSTF 2018).
Sources
Peer-reviewed research
- Harlow SD et al. (2012). Executive summary of the Stages of Reproductive Aging Workshop + 10: addressing the unfinished agenda of staging reproductive aging. Menopause, 19:387-95.
- Matthews KA et al. (2009). Are changes in cardiovascular disease risk factors in midlife women due to chronological aging or to the menopausal transition?. J Am Coll Cardiol, 54:2366-73.
Medical societies and government
- Stuenkel CA et al. (2015). Treatment of Symptoms of the Menopause: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab, 100:3975-4011.
- The North American Menopause Society (now The Menopause Society) (2022). The 2022 hormone therapy position statement of The North American Menopause Society. Menopause, 29:767-794.
- El Khoudary SR et al. (2020). Menopause Transition and Cardiovascular Disease Risk: Implications for Timing of Early Prevention: A Scientific Statement From the American Heart Association. Circulation, 142:e506-e532.
- American Diabetes Association Professional Practice Committee (2024). 2. Diagnosis and Classification of Diabetes: Standards of Care in Diabetes-2024. Diabetes Care, 47:S20-S42.
- US Preventive Services Task Force (2018). Screening for Osteoporosis to Prevent Fractures: US Preventive Services Task Force Recommendation Statement. JAMA, 319:2521-2531.
- Garber JR et al. (2012). Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. Endocr Pract, 18:988-1028.
- Jonklaas J et al. (2014). Guidelines for the treatment of hypothyroidism: prepared by the american thyroid association task force on thyroid hormone replacement. Thyroid, 24:1670-751.
Expert voices (commentary, not research)
- Dr. Mary Claire Haver (OB/GYN). The New Menopause (book, Rodale, 2024).
- Dr. Sara Gottfried on Huberman Lab. How to Optimize Female Hormone Health for Vitality & Longevity (podcast episode, Jan 2023).
- Dr. Peter Attia. Outlive: The Science and Art of Longevity (book, 2023).
- Non-clinical wellness opinion: Gary Brecka, The Ultimate Human, Ep. 227. Menopause: Symptoms, Hormones, Tests & Solutions (podcast episode, Dec 2025).
What's a good next step?
Start by learning, not buying. Read the short summary of this topic in the Women's Metabolic Clarity library at Pinnacle Coordinated Wellness, take the wellness DAITT® quiz, and bring the questions above to your clinician. If you'd like to see how a coordinated, done-with-you care team works, visit pinnaclecoordinatedwellness.com.
Read the library summaryTake the wellness DAITT® quiz
Questions to ask a licensed clinician
- Which labs are right for me this year, and why?
- Would hormone testing change my care?
- Can we look at my lipid, A1C and TSH trends over the last few years?
- Do I need a bone density scan, and when?
- Should we check iron or a blood count, given my periods?
- How often should we re-check?
Bring these, a short symptom log and your medication list to your next visit.
Who is Dr. Pat Pachciarz®?
Dr. Pat Pachciarz® is the founder of Pinnacle Coordinated Wellness and Founder & CEO of The Pinnacle Group in Aurora, Illinois. He is a Certified Personal Trainer and Certified Nutrition Coach through the National Academy of Sports Medicine. He's the guide and educator here, not a clinician: he teaches how to think about coordination and what to ask your licensed clinicians. More about Dr. Pat Pachciarz®.
More answers
- Why is my blood sugar creeping up after menopause?
- Why am I gaining weight in perimenopause when nothing else changed?
- Is my brain fog perimenopause, and will it go away?
- Is menopause hormone therapy safe? What changed in 2025?
- How much protein do I need to keep muscle after 40?
- Why can't I sleep through the night in perimenopause?
- Is cortisol causing my belly fat in menopause?
- Should I lift weights or do cardio after 40?
- Why do I feel so guilty when I can't keep up with my workouts?
Also see Pinnacle Coordinated Wellness, drpat.co for the wealth and wellness crossover, and drpatclarity.com for family money questions.