Tests and Labs for Perimenopause: A Complete Guide for Women 40+
Perimenopause is a time of hormonal shifts — and with that hormonal chaos can come symptoms like fatigue, weight changes, sleep issues, mood swings, irregular cycles, hot flashes, and more.
But here’s the truth:
👉 Most women are never given the right lab testing to understand what’s happening in their bodies.
👉 Many are told everything is “normal” when clearly they don’t feel normal.
This guide breaks down which tests matter, which don’t, when to run them, how to interpret trends, and which labs I order every day in my functional medicine practice.
Tests & Labs for Perimenopause: What to Test, When, and Why It Matters
What This Guide Covers
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The most important blood tests for women 35–55
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Which hormones are worth checking — and which are misleading
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The best time in your cycle to run labs
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Specialty testing: DUTCH, GI-MAP & more
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How to advocate for testing with your provider
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Links to deeper-dive blog posts for each topic
Why Tests and Labs in Perimenopause Matter
Hormones don’t decline steadily — they swing, spike, crash, and fluctuate dramatically during perimenopause.
That’s why:
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Symptoms change month to month
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Standard blood tests often miss what’s happening
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Women are told “you’re fine” despite feeling awful
Testing helps you:
✔ Understand what stage of perimenopause you’re in
✔ Identify metabolic risks early
✔ Personalize nutrition, supplements, and lifestyle
✔ Track progress and trends over time
✔ Make informed decisions about HRT (hormone replacement therapy) or non-hormonal support
SECTION 1: The Most Important Serum Perimenopause Tests and Labs
These are the labs I run most often in my functional medicine practice because they give a comprehensive picture of hormone balance, thyroid function, metabolic health, and inflammation.
1. Sex Hormones
While hormone levels fluctuate, they can still provide valuable information when interpreted in context.
✔ Estradiol (E2)
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Can swing widely — it is not about the number alone
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Low estradiol = sleep issues, night sweats, vaginal dryness, mood instability
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High estradiol swings = heavy periods, breast tenderness, irritability, and also sleep problems (hormone excess and deficiency symptoms can very much mimic each other)
✔ Progesterone
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The first hormone to decline in perimenopause
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Low levels = anxiety, insomnia, spotting, PMS, mid-cycle bleeding
✔ Testosterone (Total & Free)
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Low = low libido, low energy, muscle loss (which can then affect metabolism as less muscle= less metabolically active tissue)
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High = hair shedding, chin hairs, acne, difficulty losing weight
Blog posts to explore:
2. Thyroid Panel (FULL panel—not just TSH)
Many perimenopause symptoms overlap with thyroid dysfunction, so it can be hard to figure out how to properly treat and monitor if you don’t check both thyroid function and female hormone function.
Recommended Complete Thyroid Panel:
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TSH
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Free T4
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Free T3
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Thyroid peroxidase antibodies (TPO)
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Thyroglobulin antibodies
- Reverse T3
Why this matters
Women 35–55 are at increased risk of autoimmune thyroid disease, yet it is often missed. Checking thyroid antibodies can help us determine if autoimmunity is part of the picture. Checking free thyroid hormone levels helps us determine how much of your thyroid hormones, T3 and T4, are actually available to you and not bound up by carrier proteins. Reverse T3 becomes important too, particularly if you are under increased stress as this can show us if your stress is causing you to store your active thyroid hormone, T3. If you are storing it then you are not using it, and your thyroid function can be impaired.
Related Blogs to Dive Into:
Thyroid Supportive Minerals: Copper, Iodine, and Selenium
Understanding Female Hormone Labs
3. Metabolic & Inflammation Markers
✔ Fasting Insulin
The most important early marker of metabolic dysfunction. Insulin helps us rid our body of excess glucose, so it the cells get too used to high insulin levels they will start ignoring that signal. This can lead to all of the following symptoms, as well as diabetes and all of the complications that go with it!
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High levels = weight gain, belly fat, fatigue, cravings, worsening hot flashes
✔ Hemoglobin A1c
Shows 3-month glucose patterns. This lab is able to show us our average blood glucose over the last 3 months. If we see a pattern of rising fasting insulin, then falling, then rising of a1c then diabetes is potentially just around the corner!
✔ Lipid panel
But beyond the basics, I always check:
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ApoB
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Lipoprotein(a)
Thes additional markers show us risk for plaque (ApoB) and independant, inherited cardiovascular risk (LPa). You could have normal cholesterol and have an elevated LPa and still be at high risk of heart disease. Taking a proactive stance can really help reduce your risk and prevent early heart attack or plaque, particularly since our risk as women increases as we age and our hormones get more sluggish.
✔ hs-CRP
Inflammation marker linked to cardiovascular and metabolic health. This marker can show us overall body inflammation- and inflammation= higher risk for heart disease, diabetes, and a sluggish metabolism, as well as injury and fatigue.
Best blog to check out for all of these labs:
Complete guide to understanding female hormone labs!
4. Iron Studies
If you are still having periods, particularly the heavy periods associated with early to mid-periemenopause, then I highly recommend getting a full iron and ferritin panel checked including:
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Ferritin
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Serum iron
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TIBC
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% saturation
Low ferritin contributes to fatigue, hair loss, anxiety, and exercise intolerance.
5. Vitamin & Nutrient Levels
Helpful baseline labs to determine if these hormone supportive nutrients are in check are:
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Vitamin D
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B12 + MMA
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Folate
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Magnesium RBC
SECTION 2: When to Test in Perimenopause
For most hormone blood tests:
Cycle Day 19–22 (if you’re still cycling)
Why?
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Progesterone should be at its peak
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Estradiol is relatively stable
If cycles are irregular, you can test anytime — just interpret with context.
For thyroid, metabolic, and nutrient panels:
Any day of the cycle is fine.
At home tests can help, if you don’t have a doctor who will check your labs when you want. Check out this blog to learn more:
At home perimenopause lab kits: 5 points to consider
Best at-home perimenopause test kits
**SECTION 3: Specialty Tests and Labs for Perimenopause
(The Functional Medicine Tools That Give Deeper Answers)**
These tests are not required for everyone — but they are powerful when symptoms don’t match standard bloodwork. They can be costly, but if you want to dive deeper here’s what we like to test in our functional medicine practice:
1. The DUTCH Hormone Test (Dried Urine)
My favorite test for:
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How your body metabolizes estrogen (methylation, 2/4/16 pathways)
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Progesterone & testosterone metabolites
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Cortisol production and cortisol rhythm
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Organic acids and hormone supporitve nutrients (B vitamins, methylation markers, neurotransmitters, oxidative stress)
Ideal for women with:
✔ Anxiety/insomnia
✔ Estrogen dominance symptoms
✔ Unexplained weight gain
✔ Severe PMS
✔ Perimenopause with “normal” bloodwork
✔Women on bioHRT or menopause/perimenopause treatment and trying to determine if their plan is addressing their hormone imbalances
Related blogs:
2. GI-MAP or GI Standard Stool Test
Because gut health and hormones are deeply connected, I often like to look into the microbiome. A detailed microbiome test like the GI-Map or GI Standard can help us take a deep dive into how the gut could be affecting the hormones.
Reveals:
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Dysbiosis
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Candida, parasites, or bacterial overgrowth
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Leaky gut markers
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Microbiome diversity
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β-glucuronidase (important for estrogen clearance)
Related blog:
3. Cortisol Testing
Cortisol can be tricky to test. A serum morning cortisol (blood test) can give us some info, but a pattern over time, and a salivary or urinary metabolite collection, is much more helpful and accurate. I often recommend a DUTCH or salivary 4-point cortisol.
Great for:
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Burnout
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Morning fatigue
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Sleep issues
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Blood sugar instability
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Stress intolerance
Check out this blog to dive deeper:
Cortisol and Perimenopause: Taming the cortisol chaos
What no one tells you about cortisol and estrogen dominance
SECTION 4: How to Advocate for the Right Labs
Most women need to request tests directly because many standard providers only run:
❌ TSH
❌ CBC
❌ Basic metabolic panel
These are helpful but not sufficient. A complete metabolic panel helps us look at your liver and gallbladder function- important in perimenopause. So, a CMP is recommended OVER a BMP, which just shows kidney, electrolytes, and blood sugar ( a CMP includes all markers in a BMP, so you aren’t missing out on those). See the thyroid section above to learn why just a TSH is inadequate.
Use this script:
“Because I’m experiencing symptoms consistent with perimenopause, I’d like a full hormone, thyroid, metabolic, and nutrient panel so we can evaluate underlying causes. Can we order these today?”
**SECTION 5: Your Next Steps
(Where to Go From Here)**
✔ If you’re still cycling
Run blood tests on Cycle Day 19–22. If your cycles a little irregular or not a typical 28 day cycle, then try checking ovulation strips at home and arrange blood tests for 7-10 days after your first positive ovulation strip.
✔ If your cycle is very irregular- meaning only every few months then either do the above or-
Test anytime — track symptoms alongside the results.
✔ If your bloodwork looks normal but you feel terrible
Consider the DUTCH test or a GI-MAP.
✔ If you’re starting or adjusting HRT (bio-identical HRT is what is recommended)
Testing gives you a baseline and helps personalize your plan after starting bioHRT.
Related Blog Posts to Dive Deeper into Perimenopause Tests and Labs
(Use these as linked bullets on your page)
Closing
Testing is not about chasing perfect numbers — it’s about understanding your body so you can support it with nutrition, lifestyle changes, supplements, and (if needed) hormone therapy.
You deserve clear answers, not guesswork.
This pillar page is the home base to help you get them. Dive deeper into the content here- it’s here to support, guide, and fill in the blanks for you during this chaotic time!
