5 Labs Every Woman Over 40 Should Ask For

If you’re in your 40s doing everything “right”, eating well, exercising, managing stress, but still feel off, you’re not imagining it. Unpredictable energy, mood shifts, and brain fog are common complaints that often get waved away with a “your labs look normal.” The problem, according to OB-GYN and integrative medicine physician Jennifer Roelands, M.D., is that standard panels weren’t built with midlife women’s changing physiology in mind, and the tests that would actually explain what’s happening often aren’t part of routine care.

Here are the five categories of labs worth requesting at your next appointment.

1. Heart health: ApoB and Lp(a) A basic cholesterol panel gives you LDL, HDL, and triglycerides, but it can miss the fuller risk picture. ApoB is the structural protein found on every atherogenic lipoprotein particle, functioning essentially as a direct particle count, and large-scale research has linked excess ApoB to significantly higher risk of heart attack, atherosclerotic disease, and mortality beyond what LDL alone captures. As women move through menopause, total cholesterol, LDL, and ApoB all tend to rise, increasing cardiovascular risk during a stretch of life when most women aren’t being monitored for it.

Lp(a) is the second piece. It’s a heritable cardiovascular risk factor that may climb as estrogen declines during the menopausal transition, and research suggests estrogen normally helps suppress it. Most women have simply never had it checked, even though it’s a one-time test that can meaningfully reshape a risk assessment.

2. Metabolic health: fasting insulin Most routine screening relies on hemoglobin A1C, but fasting insulin is rarely tested, which represents a significant blind spot since insulin resistance can be present for up to a decade before blood glucose rises enough to register as prediabetes. This matters especially in perimenopause: elevated fasting insulin at midlife has been independently linked to earlier onset of hot flashes and night sweats, suggesting insulin resistance may be driving symptoms many women attribute purely to falling estrogen. Insulin resistance has also been tied to plaque formation and increased cardiovascular risk after menopause. Pairing fasting insulin with fasting glucose (often via the calculated HOMA-IR ratio) gives a much clearer picture than glucose alone.

3. Nutrients: vitamin D and ferritin Nutrient gaps are extremely common in women over 40 and are frequently mistaken for depression, burnout, or “just perimenopause.” More than four in ten U.S. adults are deficient in vitamin D, and the odds climb even higher for women with Hashimoto’s thyroiditis, deficiency tends to track with how active the disease is, with some studies putting deficiency rates in Hashimoto’s patients as high as 50 to 90%. Since autoimmune conditions become more common around menopause, this is a test worth prioritizing.

Ferritin, your iron storage protein, is just as overlooked. It can be depleted even when hemoglobin and hematocrit look completely normal, meaning someone can be told they’re “not anemic” while their reserves are critically low, a pattern linked to fatigue, poor concentration, and hair loss. Many specialty societies now argue that standard ferritin reference ranges are set too low and recommend targeting levels above 30 ng/mL.

4. Thyroid: more than just TSH A TSH-only thyroid check can miss a lot. TSH can sit comfortably in the “normal” range while underlying hormone levels or autoimmune activity tell a different story, and subclinical hypothyroidism is estimated to affect roughly 3 to 9% of women, consistently higher than in men. Hashimoto’s, the leading cause of hypothyroidism in women, can progress for years without showing up on TSH alone, and clinical endocrinology guidance notes that TSH testing is inadequate for women with more pronounced symptoms since it doesn’t capture T4 production or T4-to-T3 conversion. That matters because thyroid dysfunction and perimenopause share nearly identical symptoms, fatigue, weight changes, brain fog, anxiety, hair thinning, making it easy to treat one issue while missing the other. A fuller panel (free T3, free T4, and thyroid antibodies) closes that gap.

5. Hormones: testosterone and SHBG Testosterone isn’t just a male hormone. Women produce it in the ovaries and adrenal glands, and low levels are linked to fatigue, bone loss, decreased muscle strength, and mood changes, symptoms that get chalked up to “just getting older” instead of something measurable and nameable.

Testing is nuanced, though. Current global consensus limits testosterone prescribing to a specific condition (HSDD) in postmenopausal women in the U.S., and there’s no FDA-approved testosterone product for women. Still, testing has value for establishing a baseline before treatment, with guidance recommending a recheck 3 to 6 weeks after starting and then every six months. One catch: most commercial testosterone assays are calibrated for men, whose levels run roughly tenfold higher, and a major 2019 consensus statement concluded no single blood cutoff can reliably distinguish women with low testosterone from those without. In other words, one low number doesn’t confirm a deficiency, and one “normal” number doesn’t rule it out.

The takeaway

None of these five categories show up on a standard annual panel, you have to specifically ask for them. That’s frustrating, but it’s also useful information: if a provider isn’t willing to discuss or order these tests, that tells you something about whether they’re the right partner for this stage of your health. Print the list, bring it to your next appointment, or look into ordering the labs yourself if needed. The goal isn’t more testing for its own sake, it’s trading vague reassurance for actual data, so you can catch and address what’s really going on instead of chalking every symptom up to “just perimenopause.”

***information pulled from mindbodygreen

****This article is for informational and educational purposes only. It does not constitute medical advice, diagnosis, or treatment, and is not a substitute for a conversation with a qualified healthcare provider. Individual health needs vary. If you have questions about your health, we invite you to schedule a consultation with one of our providers.