Tests & Lab Work
What to ask your doctor to test, why each test matters, and what the results mean — in plain English.
Most standard check-ups don't include these tests
A routine annual physical typically includes a TSH, basic metabolic panel, and lipid panel — but not the hormone panel, AMH, ApoB, ferritin at optimal levels, or bone density scan that would give a complete picture of where you are. You may need to specifically request these tests and explain that you are investigating possible perimenopause.
Core Hormone Panel
The primary hormones that define where you are in the transition.
FSH (Follicle Stimulating Hormone)
Your brain sending stronger signals trying to stimulate ovaries that are becoming less responsive.
FSH rises as the ovaries become less responsive. Persistently elevated FSH (>10 IU/L in reproductive years, >30 at menopause) is the primary lab marker of perimenopause. A single reading is less meaningful than a pattern.
Varies by lab; trend matters more than a single value
Estradiol (E2)
The main estrogen your ovaries produce. Erratic in perimenopause — not just low.
Measures your main form of estrogen. In perimenopause, levels are variable — they can be abnormally high on some months and low on others. Low consistent readings confirm estrogen deficiency.
30–400 pg/mL in reproductive years; <30 pg/mL post-menopause
LH (Luteinising Hormone)
Works with FSH to stimulate the ovaries. Rises as ovarian function declines.
Rises alongside FSH. The FSH:LH ratio can help distinguish perimenopause from other conditions.
Progesterone
Only produced after ovulation. Low levels mean cycles may not include egg release — common in perimenopause.
Confirms whether ovulation occurred. Low progesterone in the luteal phase indicates anovulatory cycles — a hallmark of early perimenopause.
>5 ng/mL confirms ovulation
AMH (Anti-Müllerian Hormone)
A measure of how many eggs remain. Falls steadily through your 40s regardless of symptoms.
Reflects ovarian reserve — the number of eggs remaining. Declines gradually from the mid-30s. Low AMH indicates reduced reserve and approaching menopause.
Free & Total Testosterone
Yes, women have testosterone — and it matters for libido, energy, hair, and skin.
Relevant for libido, energy, hair, skin changes, and clitoral/vaginal health. Often not tested but clinically significant.
SHBG (Sex Hormone Binding Globulin)
A carrier protein — high levels mean less free, active hormone in circulation.
A protein that binds testosterone and estrogen. High SHBG reduces free (active) hormone availability. Important for interpreting testosterone levels.
DHEA-S
Made by the adrenal glands, converted to other hormones. Declines gradually from the 30s.
An adrenal androgen that serves as a precursor to estrogen and testosterone. Declines with age. Relevant for energy, mood, libido, and skin.
Thyroid Panel
Thyroid disorders are common in perimenopausal women and mimic or amplify almost every symptom.
TSH (Thyroid Stimulating Hormone)
The most important thyroid test. Elevated = underactive thyroid = many symptoms overlap with perimenopause.
The primary screening test for thyroid dysfunction. Hypothyroidism causes fatigue, weight gain, brain fog, depression, hair loss, dry skin, cold intolerance — identical to perimenopausal symptoms. Always test this.
0.4–4.0 mIU/L (some practitioners aim for 0.5–2.5)
Free T4
The main thyroid hormone. Measured alongside TSH for a complete picture.
The main thyroid hormone produced. Low Free T4 with high TSH confirms hypothyroidism.
Free T3
The active thyroid hormone. Some people convert T4 to T3 poorly — T3 testing catches this.
The active form of thyroid hormone. Some people have normal TSH/T4 but low T3 due to poor conversion (influenced by the DIO2 gene variant). Important for women with persistent symptoms despite normal TSH.
TPO Antibodies
Tests for the autoimmune form of an underactive thyroid — common in perimenopausal women.
Elevated anti-TPO antibodies indicate Hashimoto's thyroiditis (autoimmune hypothyroidism), which peaks in incidence in perimenopausal women.
Metabolic & Cardiovascular
Cardiovascular risk shifts significantly during perimenopause. These tests establish your baseline.
Fasting Glucose + Insulin
Checks how well your body handles blood sugar. Resistance can develop during perimenopause.
Calculate HOMA-IR (insulin resistance index). Insulin resistance often develops during perimenopause even in previously metabolically healthy women.
HOMA-IR <1.5 is generally normal
HbA1c
A 3-month average of blood sugar. Convenient and doesn't require fasting.
Reflects average blood glucose over 3 months. A better long-term marker than fasting glucose alone.
Full Lipid Panel + ApoB
Cholesterol levels change with estrogen decline. ApoB is more informative than standard LDL.
LDL rises and HDL falls as estrogen declines. ApoB is a more accurate cardiovascular risk marker than LDL-C alone — each ApoB particle represents one potentially atherogenic lipoprotein.
hs-CRP (high-sensitivity C-reactive protein)
Measures inflammation in the body. Rises as estrogen's protective effects are lost.
A marker of systemic inflammation, which rises as estrogen's anti-inflammatory effects are lost. Predicts cardiovascular risk independently of cholesterol.
Lipoprotein(a)
A cholesterol-like molecule that is genetically determined. Worth knowing once.
A genetically determined lipoprotein that significantly increases cardiovascular risk. Level is fixed from birth — test once and know your baseline risk.
Nutrients & Inflammation
Deficiencies in these nutrients cause symptoms identical to perimenopause — always check before attributing everything to hormones.
25-OH Vitamin D
Vitamin D deficiency is very common and causes symptoms identical to perimenopause. Always check.
Deficiency is extremely common and causes fatigue, bone pain, muscle weakness, low mood, and immune dysfunction. Essential for calcium absorption and bone health.
>50 nmol/L; many practitioners aim for 75–125 nmol/L
Ferritin (iron stores)
Iron stores. Heavy periods are very common in perimenopause and frequently cause iron depletion.
Heavy perimenopausal bleeding is a common cause of iron deficiency. Low ferritin causes fatigue, hair loss, poor concentration, and cold intolerance — easily mistaken for hormonal symptoms.
>50 µg/L for optimal function (not just >12 which avoids clinical deficiency)
B12
B12 deficiency mimics brain fog and fatigue. Common with age.
B12 deficiency causes fatigue, cognitive symptoms, mood changes, and nerve tingling. Becomes more common with age. Vegetarians/vegans especially at risk.
Folate
Important for mood and methylation. Often tested alongside B12.
Important for methylation pathways involved in mood, cardiovascular health, and DNA repair.
Magnesium (RBC)
RBC magnesium (not serum) is the correct test. Deficiency affects sleep, mood, and muscle function.
Serum magnesium is unreliable — RBC magnesium reflects intracellular stores. Deficiency causes sleep problems, muscle cramps, anxiety, and headaches.
Bone Health
Bone loss begins silently in perimenopause. Establish your baseline now.
DEXA Scan (Bone Density)
An X-ray scan that measures bone density. Silent bone loss starts years before menopause.
The gold-standard test for bone density. Bone loss accelerates significantly in late perimenopause — establishing a baseline allows tracking. Many women only find out they have osteopaenia or osteoporosis after a fracture.
CTx (C-terminal telopeptide)
Measures the rate of bone breakdown. Useful when monitoring treatment.
A blood marker of bone resorption (breakdown). Useful for tracking whether treatment is working.
P1NP (Procollagen type 1 N-terminal propeptide)
Measures the rate of bone building. Paired with CTx to see the full picture.
A blood marker of bone formation. Used alongside CTx to understand the resorption/formation balance.
This page is designed to be used at a doctor's appointment. Print it or save it to your phone before you go — it gives you the exact test names, timing, and reference ranges to ask about.
Talking to your doctor
How to ask for these tests
- › “I'm having symptoms that may be perimenopausal. Can we do a hormone panel including FSH, estradiol, and AMH?”
- › “I'd like to check ApoB and Lp(a) as part of a cardiovascular baseline.”
- › “Can we check ferritin (not just haemoglobin) given my heavy periods?”
- › “I'd like a DEXA scan as a bone density baseline.”
Things to know
- › A single hormone test is often uninformative. Repeat testing and trends matter more.
- › Normal ranges are often population averages — “within range” doesn't always mean optimal for you.
- › Symptoms matter as much as lab values. Treat the person, not just the number.
- › If you feel dismissed, seek a second opinion or a menopause specialist.