My mum went through menopause in her early fifties without much clinical support.
She had hot flushes for about three years. Her sleep deteriorated. Her mood shifted, not dramatically, but enough that she noticed, and enough that my dad noticed. Her GP at the time told her it was "normal" and "would pass." And it did, eventually. But nobody checked her cholesterol during those years. Nobody monitored her bone density. Nobody screened her thyroid, despite symptoms that overlapped heavily with hypothyroidism. Nobody told her that the cardiovascular protection she'd had from oestrogen her entire adult life was receding, and that the metabolic picture would shift as a result.
She's sixty-two now. When she finally got blood work done last year (partly because I wouldn't stop talking about this series), her cholesterol had drifted into a range that warranted discussion. Her vitamin D was low. Her thyroid was borderline.
None of these things were crises. All of them were things that could have been caught and managed earlier if someone had framed menopause not just as a hormonal transition, but as a metabolic and cardiovascular inflection point that deserves monitoring.
That framing is what this article is about. Menopause isn't a disease. It's a natural biological transition that every woman experiences. But natural doesn't mean inconsequential. The hormonal shifts trigger measurable changes in cardiovascular risk, bone density, metabolic function, and thyroid dynamics. Blood tests are how you track those changes and respond to them before they become problems.
A note before we get into it
General information only. I'm not a gynaecologist or an endocrinologist. Menopause management, including decisions about hormone replacement therapy (HRT/MHT), should involve your GP or a clinician with menopause expertise.
This article focuses on which blood tests are relevant during and after the menopausal transition, and why. It does not provide guidance on HRT prescribing or management.
Blood tests don't diagnose menopause. Here's what they actually do.
This is the single most important point in this article, and it contradicts what most people expect.
If you're over 45 with typical menopausal symptoms (hot flushes, night sweats, menstrual changes), menopause is diagnosed clinically. Not by blood test. The Australasian Menopause Society is clear on this: measuring FSH and oestradiol is generally not indicated for women over 45, because hormone levels fluctuate dramatically during the transition and a single reading can be misleading.
The NICE guidelines (updated 2024) agree: do not use blood tests to diagnose menopause in women aged 45 or over with typical symptoms.
So what are blood tests for in the menopause context? Three things:
1. Confirming the transition when it's clinically uncertain. For women aged 40 to 45 with symptoms but an unclear picture, or for women under 40 where premature ovarian insufficiency is suspected, FSH testing is useful.
2. Ruling out other conditions that mimic menopause. Thyroid dysfunction, iron deficiency, depression, and sleep disorders all produce symptoms that overlap with menopause. Blood tests differentiate between them.
3. Monitoring the health consequences of the transition. This is where the real value lies. Cardiovascular risk, metabolic health, bone-related markers, and thyroid function all shift during and after menopause. Blood tests track those shifts.
Perimenopause vs menopause: what's actually happening
Perimenopause is the transition phase, typically beginning in the mid-to-late forties and lasting 3 to 5 years on average. Oestrogen levels fluctuate unpredictably (sometimes very high, sometimes very low), progesterone declines, FSH rises as the pituitary works harder to stimulate the ovaries, and periods become irregular.
About 40% of women aged 45, 75% of women aged 50, and 98% of women aged 55 have entered perimenopause or reached menopause.
Menopause is defined as 12 months after the final menstrual period. The average age in Australia is 51. After menopause, oestrogen settles at a consistently low level and stays there.
The distinction matters clinically because perimenopause is the volatile phase (symptoms can be severe, hormones unpredictable, blood test interpretation difficult), while post-menopause is the sustained low-oestrogen phase where the chronic health consequences accumulate.
When blood tests are useful for the transition
Women aged 40 to 45 with symptoms: FSH can help confirm menopausal transition. Elevated FSH on a single test is suggestive. Confirmation with a repeat test 4 to 6 weeks later strengthens the diagnosis.
Women under 40 (suspected premature ovarian insufficiency): FSH testing is important here. Two elevated FSH results (greater than 40 IU/L) taken 4 to 6 weeks apart, alongside amenorrhoea, are required for diagnosis. Premature ovarian insufficiency carries increased risks of cardiovascular disease, osteoporosis, and cognitive decline, and typically requires hormone replacement until at least the average age of menopause.
Women on hormonal contraception: Contraception can mask menstrual changes and make clinical diagnosis difficult. FSH may help determine menopausal status in women over 50 who are considering stopping contraception.
Women on HRT/MHT: Oestradiol levels can help assess whether transdermal oestrogen (patches, gel, spray) is being absorbed adequately. This is useful when symptoms persist despite treatment.
The health shifts that menopause triggers, and the tests that monitor them
This is the section that matters most for long-term health.
Cardiovascular risk
What changes
Oestrogen has a protective effect on cardiovascular health. It helps maintain healthy HDL cholesterol, supports endothelial function, and modulates inflammatory responses. As oestrogen declines, LDL cholesterol tends to rise, HDL can drop, triglycerides may increase, and cardiovascular risk accelerates.
Cardiovascular disease is the leading cause of death in Australian women. The risk gap between men and women narrows significantly after menopause.
What to test
Full lipid panel (total cholesterol, LDL, HDL, triglycerides), blood pressure, HbA1c, fasting glucose. These should be tested at the onset of menopause and monitored regularly afterward.
I covered the cardiovascular testing framework in detail in the heart health article and the cholesterol article.
Related tests:
Product: Cholesterol (Lipid Studies inc. HDL)
Product: HbA1c Blood Test
Product: Fasting Glucose Blood Test
Product: High-Sensitivity CRP Blood Test
Bone health
What changes
Oestrogen plays a major role in maintaining bone density. After menopause, bone loss accelerates, especially in the first 5 to 7 years. Osteoporosis and fracture risk increase significantly.
What to test
Vitamin D (for calcium absorption and bone health) and calcium. Blood tests alone don't assess bone density. A DEXA scan is the gold standard for measuring bone mineral density. But maintaining adequate vitamin D and calcium levels is foundational.
When to ask about a DEXA scan
Discuss with your GP if you have risk factors for osteoporosis: family history of osteoporotic fracture, low body weight, early menopause, prolonged corticosteroid use, smoking, or low calcium/vitamin D intake.
Metabolic changes
What changes
Perimenopause is a time when metabolic risk factors shift. Central adiposity increases, insulin sensitivity decreases, and the risk of type 2 diabetes rises. These changes are partly hormonal and partly driven by the lifestyle shifts (sleep disruption, reduced activity, stress) that often accompany the transition.
What to test
HbA1c, fasting glucose, fasting insulin (if insulin resistance is suspected), liver function (NAFLD risk increases alongside metabolic changes).
The metabolic picture connects directly to the HbA1c article and the weight gain article.
Related tests:
Product: HbA1c Blood Test
Product: Fasting Glucose Blood Test
Product: Liver Function Test (LFT)
Thyroid overlap
What changes
Thyroid dysfunction, especially hypothyroidism, becomes more common with age and disproportionately affects women. The symptoms of hypothyroidism (fatigue, weight gain, brain fog, mood changes, dry skin, hair thinning, cold sensitivity) overlap almost entirely with menopausal symptoms.
This means some women are being told their symptoms are "just menopause" when they actually have a thyroid problem. Or they have both, menopause and subclinical hypothyroidism, and only one is being addressed.
What to test
TSH, Free T4, Free T3. Thyroid antibodies (anti-TPO) if autoimmune thyroid disease is suspected. The thyroid article covers interpretation in detail.
Related tests:
Product: Thyroid Function Test (TFT)
Iron: the story changes
What changes
For women who menstruated heavily, iron deficiency may have been a lifelong challenge. After menopause, menstrual blood loss stops and ferritin levels often rise naturally. This is generally positive. However, iron overload can occasionally become relevant in postmenopausal women, especially those with haemochromatosis (which is relatively common in Australians of northern European descent).
What to test
Iron studies including ferritin. The interpretation shifts: in a postmenopausal woman, a very high ferritin isn't just "good iron stores." It may warrant investigation for haemochromatosis or chronic inflammation.
Related tests:
Symptoms that overlap with other conditions
One of the biggest challenges in perimenopause is that the symptoms are nonspecific. Hot flushes are fairly distinctive. But fatigue, brain fog, mood changes, weight gain, sleep disruption, joint pain, and hair thinning? These could be menopause. They could also be something else entirely.
Thyroid dysfunction: test TSH, Free T4
Iron deficiency: test ferritin
Vitamin D deficiency: test 25-OH vitamin D
Depression or anxiety: clinical assessment plus metabolic screening
Sleep disorders: clinical assessment, potentially sleep study
B12 deficiency: test B12 (especially if over 50, on metformin, or on PPIs)
Diabetes/pre-diabetes: test HbA1c, fasting glucose
Blood tests won't diagnose menopause in a woman over 45 with typical symptoms. But they will rule out these conditions so that menopausal symptoms are treated as menopause, not as something else entirely.
My mum's borderline thyroid is a good example. Her symptoms were attributed to menopause for years. When her TSH was finally checked, it was at the upper end of normal. Subclinical, probably not causing all her symptoms, but worth monitoring and potentially contributing to her fatigue and weight changes. Knowing that changed the conversation with her GP.
Tests to consider through Bloody Good
Menopausal transition monitoring panel
Thyroid Function Test (TFT): rule out thyroid dysfunction masquerading as menopause
Cholesterol (Lipid Studies inc. HDL): cardiovascular risk monitoring
HbA1c: metabolic screening
Vitamin D (25-OH): bone health foundation
Iron Studies (Including Ferritin): post-menstrual ferritin trajectory
Full Blood Count (FBC): baseline blood health
Hormonal context (when clinically indicated)
FSH Blood Test: for women 40 to 45 or under 40 where transition timing is uncertain
Oestradiol Blood Test: for women on HRT to monitor absorption
Testosterone Free/Total + SHBG: libido, energy, mood context
Extended metabolic and cardiovascular
Fasting Glucose: diabetes screening
Liver Function Test (LFT): metabolic liver health
High-Sensitivity CRP: inflammatory cardiovascular risk
Calcium Blood Test: bone health context
Vitamin B12: age-related absorption decline
One test, full coverage
The Bloody Good Test covers 100 biomarkers including everything in the monitoring panel plus liver, kidney, inflammation, B12, folate, and more. For menopausal-age women, it provides a full metabolic, cardiovascular, and nutritional baseline in a single blood draw.
What to do with your results
If lipids have shifted: Don't panic, but don't ignore it. Discuss your cardiovascular risk with your GP using the AusCVDRisk calculator. Post-menopausal lipid changes are expected, but they need to be managed. Lifestyle (diet, exercise) is first-line. Statins may be appropriate depending on overall risk.
If thyroid is borderline: Monitor. Subclinical hypothyroidism (mildly elevated TSH, normal Free T4) is common in this age group. It may warrant treatment if symptoms are present and attributable to thyroid dysfunction, or it may just need watching. Your GP will advise.
If vitamin D is low: Supplement. Bone health depends on adequate vitamin D, especially in the years immediately after menopause when bone loss is fastest.
If HbA1c is creeping up: Address the metabolic picture. Nutrition, activity, sleep, weight management. The metabolic shift of menopause is real, but it's modifiable.
If everything looks good: You have a clean baseline for comparison. Test annually. The changes from menopause are ongoing, not one-off. Regular monitoring catches drift before it becomes clinical.
What this whole series has been about
This is the twentieth and final article in a series I started writing because I got my own blood tested and was surprised by what I found.
Over these twenty articles, I've told you about my ferritin of 28. My vitamin D of 41. My ALT of 52 after too many beers. My panic about cortisol that turned out to be iron and vitamin D.
I've told you about my dad's cholesterol and pre-diabetes. My girlfriend's PCOS, iron infusion, fertility fears, and hair loss. Tom's B12 deficiency. Sarah's thyroid. My mate's ferritin of 19 after years of training. And now my mum's post-menopausal cholesterol and borderline thyroid.
None of these stories were dramatic. None of them involved a medical emergency. Every single one of them was a quiet discovery, something blood testing revealed before symptoms forced the issue.
That's the point. Blood testing isn't about finding disease. It's about understanding where your body stands and making decisions with data instead of guessing.
If any of this series has helped you understand your health a little better, or pushed you to order a test you'd been putting off, or gave you the vocabulary to have a better conversation with your GP, then it did what I wanted it to do.
Get tested. Save your results. Compare over time. Talk to your GP about what the numbers mean for you.
And if you're not sure where to start, start with The Bloody Good Test. One blood draw. One hundred biomarkers. One baseline to build on.
Browse all Bloody Good blood tests
Browse the Bloody Good Biomarker Directory
General information only. This article is not medical advice and is not a substitute for care from a qualified health professional. If you have concerning symptoms or urgent health issues, seek medical attention promptly.