Women's health
Blood Tests for Women Over 40: What Is Worth Checking
Reviewed by a qualified clinician · analysed at UKAS-accredited UK labs (ISO 15189)
Last reviewed September 20267 min read
Every Helvy guide is written by our health editors, then checked by a qualified clinician before it goes live and re-checked as the science moves. We name clinical roles, not individuals, until each reviewer has agreed to be credited publicly. This is wellness guidance to help you understand your own data, not a diagnosis.
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The NHS Health Check covers ages 40 to 74 every 5 years, and it looks at blood pressure, cholesterol and diabetes risk. It does not measure thyroid, iron, vitamin D or hormones. Those four are what most women in their forties are actually asking about.
Not sure which markers you need? Build your test →You are tired in a way sleep does not fix. Your periods have shifted. Someone said get your bloods done, and nobody said which bloods.
Here is what the NHS already offers you from 40, what sits outside it, and the one hormone test NICE says is worth doing in a narrow age window and not after it. If the shifted periods are your main worry, start with the perimenopause symptom list.
1. What does the NHS already check from 40?
One appointment, once every 5 years. The NHS Health Check is offered to people aged 40 to 74 who do not already have one of a list of conditions. Your GP or local council invites you.
Already past your last period? The picture changes again, and blood tests for women over 50 covers what shifts after the menopause.
The NHS says it usually includes “measuring your height and weight, measuring your waist, a blood pressure test, a cholesterol test, and possibly a blood sugar level test”. In blood terms that is a lipid panel, and sometimes HbA1c.
It is a good check and it is free. It is also built around one question: your risk of heart disease, stroke and diabetes over the next 10 years. That question does not include how you feel. Our guide to the cholesterol blood test covers the lipid half in detail.
One thing genuinely changes at this age. Cholesterol after menopause tends to shift upward as oestrogen falls, which is part of why the check starts when it does.
2. Which markers does it leave out?
Four, and they are the four that explain most of the symptoms women bring to a GP in their forties.
| Marker | What it tells you |
|---|---|
| Ferritin | How much iron you have banked. Falls with heavy periods |
| TSH and free T4 | Whether the thyroid is behind the tiredness or the weight change |
| Vitamin D | A common UK shortfall, and one that shows up in winter |
| Vitamin B12 and folate | Two nutrients tiredness is often blamed on, correctly or not |
Ferritin is the one to start with if your periods are heavy. It is the protein that stores iron, so it drops before your haemoglobin does. The ferritin blood test explains how to read it, and heavy periods covers what NICE asks for alongside it. On timing, your cycle moves serum iron but leaves ferritin fairly still, so any week works.
Vitamin D deserves a mention of its own, because UK sunlight cannot make it from about October to March. See the vitamin D blood test for what the numbers mean. If blood sugar is your worry rather than iron, the HbA1c blood test guide covers the marker the Health Check sometimes includes.
3. When is a hormone blood test actually useful?
This is where most advice goes wrong, so it is worth being exact. NICE draws a line at 45, and the answer is different either side of it.
From 45, perimenopause is identified without a blood test at all. NICE asks clinicians to spot it “without laboratory tests” in otherwise healthy women aged 45 or over, from vasomotor symptoms such as hot flushes plus a change in the menstrual cycle. A blood test cannot improve on that.
Between 40 and 45 it flips:
“Consider using the person’s serum FSH level to confirm menopause only: in people aged 40 to 45 with menopause-associated symptoms, including a change in their menstrual cycle; in people under 40 in whom menopause is suspected.”
NICE guideline NG23, recommendation 1.3.6
FSH is follicle stimulating hormone, the signal your brain sends to the ovaries. It climbs as the ovaries respond less. In the 40 to 45 window, with symptoms, it is worth measuring. Past 45 it adds little, and NICE also says not to use oestradiol or anti-Mullerian hormone to identify menopause at that age.
One practical catch: NICE says not to use an FSH test at all if you are on combined hormonal contraception or a high-dose progestogen. The perimenopause blood test guide goes further into the timing, and the menopause blood test covers what a full hormone set includes.
4. Could it be the thyroid rather than the menopause?
NICE flags this directly. Its thyroid guideline tells clinicians to “be aware that in menopausal women symptoms of thyroid dysfunction may be mistaken for menopause”.
The overlap is genuinely awkward. Tiredness, weight change, low mood, poor sleep and thinning hair belong to both lists. An underactive thyroid in your forties is easy to file under perimenopause and leave there.
Which is why a TSH is often the cheapest useful test in this whole piece. Menopause or thyroid walks through the symptoms that do separate the two, and normal thyroid levels sets out the UK ranges. If your result lands just outside one, borderline thyroid results explains what happens next.
Testosterone belongs on this list too, quietly. Women make it in smaller amounts and it falls gradually with age, which testosterone levels in women by age sets out.
5. Which blood test covers what?
Take the free one first. If you have not had your NHS Health Check and you are eligible, book it. Nothing here replaces it.
For the markers it leaves out, three Helvy panels are relevant. Hormone Balance reads FSH, LH, SHBG and total testosterone, which is the set behind the questions in section 3. It does not include oestradiol or progesterone, so if a clinician wants oestrogen tracked directly, that is not part of it.
General Energy & Wellness is the broad first look: thyroid, vitamin D, vitamin B12, cholesterol, kidney and liver markers in one go. Vitamins & Minerals is the iron-focused one, reading ferritin with iron, transferrin, B12 and folate.
All are home finger-prick kits, processed by a UKAS-accredited UK lab. They measure biomarkers and offer wellness insight rather than diagnosing anything, and a blood test cannot confirm perimenopause after 45. If you are unsure which fits, the build-my-test tool takes about a minute.
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Frequently asked questions
What blood tests should a woman over 40 have?
Start with the free NHS Health Check, which covers cholesterol and diabetes risk. Beyond it, the four most useful are ferritin, thyroid, vitamin D and vitamin B12.
Is the NHS Health Check a blood test?
Partly. It includes a cholesterol test and sometimes a blood sugar test, alongside blood pressure, height, weight and waist measurements.
Can a blood test tell if you are perimenopausal?
Not after 45. NICE identifies perimenopause from symptoms and cycle changes alone at that age. Between 40 and 45, with symptoms, it suggests considering an FSH level.
Should women over 40 have their thyroid checked?
It is worth asking about if you have symptoms. NICE warns that thyroid symptoms in this age group are easily mistaken for the menopause.
How often should you have blood tests after 40?
The NHS Health Check runs every 5 years from 40 to 74. Anything beyond that depends on your symptoms and your history, so ask your GP what applies to you.
Why is ferritin worth testing in your forties?
Because periods often get heavier before they stop, and ferritin falls before haemoglobin does. It shows an iron shortfall earlier than a standard blood count.
Does an FSH test work if you take the pill?
NICE says not to use one if you are taking combined oestrogen and progestogen contraception, or a high-dose progestogen. Talk to your GP about the timing instead.
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