The Lab Work Every Woman Over 40 Should Ask Her Doctor For

You can leave an annual physical with a clean bill of health and still be tired, foggy, and carrying weight that showed up without an invitation. Sometimes that is a normal part of midlife. Sometimes the routine bloodwork simply did not look in the places that would explain it.

A standard visit usually covers a blood count, a metabolic panel, a basic cholesterol test, and a glucose check. Those are useful tests. They were designed to catch common problems in the general population, and they leave out several that matter more once estrogen starts to change. What follows is a short list of what to ask about, why each test earns its place, and how to bring it up without turning the appointment into a standoff.

Lipoprotein(a), the heart test most women never get

Heart disease is the leading cause of death for women in the United States. The CDC reports that it killed 304,970 women in 2023, about 1 in every 5 female deaths, and that only 56 percent of women recognize it as their number one killer. The CDC also notes that after menopause, women are at higher risk of coronary heart disease because of hormonal changes.

Lipoprotein(a), written Lp(a), is a cholesterol-carrying particle that can raise the risk of heart attack and stroke. The standard cholesterol panel does not include it. The American Heart Association recommends that every adult be tested at least once. Your level is mostly inherited, and lifestyle changes do not lower it, so a high result will not be fixed by a better diet. What it does is tell you and your doctor to be more serious about everything you can control, like blood pressure, LDL cholesterol, and blood sugar. The AHA considers 125 nmol/L or higher a high level, and it points out that Lp(a) and heart risk may rise around menopause, which makes a repeat test after menopause a fair question to raise.

ApoB, a second look at cholesterol

Some menopause specialists, including Dr. Mary Claire Haver, suggest an advanced lipid panel that adds ApoB, a measure of the number of cholesterol-carrying particles in your blood, alongside Lp(a). The reasoning is that menopause shifts cholesterol patterns, and the standard numbers can miss part of the picture. ApoB is not part of every routine screening guideline yet, so treat it as a conversation to have with your clinician, especially if heart disease runs in your family or your cholesterol numbers do not match the rest of your history.

Blood sugar

The US Preventive Services Task Force recommends screening for prediabetes and type 2 diabetes in adults ages 35 to 70 who have overweight or obesity, and says screening every 3 years is a reasonable interval when results are normal. The same body of evidence found that only 15.3 percent of adults with prediabetes reported being told by a health provider. That means a lot of women are walking around with a number nobody mentioned.

Ask for an A1c or a fasting glucose, and ask for your actual result. A borderline number is worth knowing about while there is still plenty of room to act on it. The CDC also advises talking with your doctor about diabetes testing because uncontrolled diabetes raises the risk of heart disease.

Blood pressure

Blood pressure is measured with a cuff instead of a blood draw, and it still belongs on this list. The CDC reports that 45.7 percent of women in the United States have high blood pressure, defined as 130/80 or higher, or take medicine for it. High blood pressure is often underdiagnosed in women, it has no symptoms, and fewer than 1 in 4 women who have it have it under control. Black women are nearly 60 percent more likely to have high blood pressure than white women. Ask for your numbers at every visit, and consider a home cuff so you have readings from outside the exam room.

Thyroid

A 2022 clinical guideline on evaluating women at midlife notes that thyroid disease is common in aging women and can raise illness and death rates. It recommends TSH as the first test for women over 60 and for any woman with symptoms of thyroid dysfunction. Thyroid problems can mimic menopause, with fatigue, mood changes, and weight changes showing up in both. If your TSH comes back normal and your symptoms continue, ask whether a free T4 is worth adding.

Ferritin

A standard blood count does not tell you how much iron you have in storage. Ferritin does. Years of heavy periods can drain those stores, and low iron can show up as exhaustion and trouble concentrating. Ask for ferritin by name, and talk with your clinician before you start an iron supplement, since the test is what tells you whether you need one.

Vitamin D and bone density

Estrogen loss can weaken bone faster than most women expect. Dr. Haver recommends a baseline DEXA scan and a vitamin D level for women in perimenopause and menopause, because a scan can find weak spots before a fracture does, and low vitamin D is one of the more fixable problems. Ask whether a baseline scan makes sense for you and when.

What hormone tests can and cannot do

The same 2022 guideline says that for women over 45 with typical hot flashes, the diagnosis of menopausal symptoms is made from the symptoms themselves. Lab testing is recommended for women under 45 who have irregular bleeding and infrequent cycles. So if you are 47 with hot flashes and night sweats, you do not need to pay for a hormone panel to be taken seriously. If you are under 45 and your cycle has changed, testing is worth pursuing.

How to ask

Write your list down before the appointment. Something like this works: “I’m 46, and I’ve noticed changes in my energy, sleep, and weight. I’d like to talk about Lp(a), A1c, thyroid, and ferritin. Are any of those reasonable to order?” If your doctor says no to a test, ask for the reason, and ask that your request be noted in your chart. Coverage varies, particularly for Lp(a) and ApoB, so ask what a test will cost before the blood draw.

A few vials of blood will not answer everything. They do give you and your doctor facts to work with in place of guesses, and that is a better starting point for every conversation that follows.

Take this further

Want more to bring to that appointment? Perimenopause & Menopause: The Complete Guide is free in the Guides & Tools library.

When you’re ready for care

Full disclosure, I founded Sovra Health because I wanted women to have the kind of care I needed. If you want a clinician who focuses on women in midlife to walk through these numbers with you, Sovra Her starts with an online visit with a licensed clinician who focuses on women in midlife. There’s no bloodwork required to start. Bloodwork at a partner lab near you is an optional add-on through Sovra Longevity, and not everyone qualifies.

Sources

• CDC. About Women and Heart Disease
• American Heart Association. Lipoprotein(a) and Women’s Heart Health and Lipoprotein(a), Go Red for Women
• US Preventive Services Task Force. Screening for Prediabetes and Type 2 Diabetes, JAMA 2021, and the American College of Cardiology summary
• Initial evaluation in the climacteric, 2022 clinical guideline (National Library of Medicine, PMC)
• Dr. Mary Claire Haver’s recommended lab list, as summarized in Be Your Own Advocate: The Top Lab Tests Every Woman Should Request
• Corral P, et al. Lipoprotein(a) throughout life in women, American Journal of Preventive Cardiology, 2024

This article is for education and is not medical advice. Talk with your own clinician about which tests fit your health history.