What Blood Tests Should Women Get?

The standard annual physical for women typically includes a basic blood panel: CBC, CMP, lipid panel, and sometimes TSH. That's the same baseline as for men, but several markers matter MORE for women specifically — ferritin (because of monthly iron loss), full thyroid (women have 5-8x higher risk of thyroid disease), and hormonal markers (which most basic workups skip entirely).

The annual foundation (every year, regardless of age):

• Complete Blood Count (CBC) with Differential — screens for anemia (much more common in women due to monthly menstrual blood loss), infection, immune patterns.
• Comprehensive Metabolic Panel (CMP) — kidney function, liver function, electrolytes, fasting glucose.
• Lipid Panel — Total Cholesterol, LDL, HDL, Triglycerides. Standard cardiac baseline.
• TSH + Free T4 (full thyroid) — women have 5-8x higher risk of thyroid disease than men, peaking in the 40-60 window. TSH alone misses subclinical and conversion patterns; adding Free T4 catches more cases.
• Ferritin — the most under-checked critical marker for women. Iron stores deplete monthly through menstruation. Standard CBC measures hemoglobin (often normal even when ferritin is depleted), so ferritin needs to be ordered specifically. Optimal range for women is 50-100 ng/mL; below 30 commonly causes fatigue, hair thinning, brain fog, even when the CBC reads 'normal.'
• Hemoglobin A1c — 90-day average blood sugar. Annual diabetes screening. Women in their 40s+ are at increasing risk for type 2 diabetes as estrogen's metabolic protection fades.
• Vitamin D, 25-Hydroxy — ~40% of US adults deficient; critical for bone density (especially important as estrogen declines), immune function, and possibly cardiac health.

The Women's Health Panel ($X) bundles many of these in one order. The Essential Health Panel ($189.99) upgrades the standard wellness panel to include A1c + Vitamin D + hs-CRP + Ferritin + Fasting Insulin — our most-recommended annual workup for women.

Women's hormonal needs shift dramatically across life stages. The relevant testing differs significantly by age.

Reproductive years (20s-30s):

• Baseline data is valuable if you're someone who wants longitudinal hormonal tracking. The Women's Hormone Panel ($159.99) provides comprehensive baseline data.
• If you have irregular periods, acne, hirsutism, weight gain, or fertility concerns: consider PCOS evaluation. Markers: Total + Free Testosterone, SHBG, DHEA-S (often elevated in PCOS), Fasting Insulin + A1c (insulin resistance is core feature), LH:FSH ratio (often elevated in PCOS, opposite of perimenopausal pattern), Prolactin (rule out other causes of cycle irregularity).
• If preparing for pregnancy: add the Women's Fertility Panel — AMH (ovarian reserve), FSH (day 3), TSH + Free T4 (subclinical hypothyroidism affects fertility), Vitamin D, Ferritin (iron stores need to be repleted for pregnancy).

Perimenopause (typically late 30s to mid 40s):

• Most women enter perimenopause earlier than they (or their doctors) realize. Cycle changes, sleep disruption, mood changes, brain fog, hot flashes, weight gain, hair thinning, decreased libido — any combination of these in your late 30s to 40s warrants evaluation.
• The Women's Hormone Panel ($159.99) is comprehensive: Estradiol, Progesterone, FSH, LH, Testosterone (Free & Total), SHBG, DHEA-S, Prolactin.
• Time the test on days 2-5 of your cycle if still cycling, for the cleanest baseline.
• See our perimenopause guide for the full workup and interpretation.

Menopause (12 consecutive months without a period; average age 51):

• FSH consistently elevated (above 30-40 mIU/L) confirms menopause biochemically.
• Estradiol is typically below 30 pg/mL.
• Testosterone (Free + Total + SHBG) — often low; relevant for libido, energy, muscle mass.
• HRT decisions are increasingly guided by symptoms rather than precise hormone levels, but baseline testing provides useful context for monitoring response to treatment.

Postmenopause (10+ years after last period):

• Hormone testing less commonly indicated unless considering or monitoring HRT.
• Focus shifts to bone health (DEXA scan, Vitamin D, Calcium), cardiovascular risk (more aggressive screening as estrogen protection has faded for years), and metabolic health.

Cardiovascular disease is the #1 cause of death in women — surpassing all cancers combined. Yet women's cardiac risk is consistently underdiagnosed and undertreated because:

• Symptoms differ from the 'classic' male pattern. Women more often present with fatigue, nausea, shortness of breath, jaw or back pain, rather than the textbook crushing chest pain.
• Risk rises sharply after menopause. Estrogen has cardioprotective effects; after menopause, women's cardiac risk increases dramatically, and within 10 years approaches men's risk level.
• Standard cardiac risk calculators systematically underestimate women's risk — particularly for younger women and women with conditions like PCOS, gestational diabetes history, or preeclampsia history that aren't always captured in standard risk scoring.

The modern cardiac workup for women:

• Standard Lipid Panel — Total Cholesterol, LDL, HDL, Triglycerides. The basics.
• ApoB (Apolipoprotein B) — better predictor of cardiovascular events than LDL. Optimal <90 mg/dL.
• Lp(a) Lipoprotein(a) — genetically determined; test ONCE in your life. About 20% of people have elevated Lp(a) and don't know it; elevated Lp(a) carries 2-3x normal cardiac risk regardless of other markers.
• hs-CRP (High-Sensitivity C-Reactive Protein) — vascular inflammation marker. Independently predicts events. Women specifically: hs-CRP is also elevated by hormonal birth control, which is important to know for interpretation.
• A1c + Fasting Insulin — insulin resistance dramatically increases cardiac risk; women with PCOS or gestational diabetes history are at particularly elevated risk for both diabetes and cardiac events.

The Heart Health Panel ($74.99) bundles ApoB + Lp(a) + hs-CRP with a Lipid Panel and HbA1c — comprehensive cardiac evaluation in one draw.

Special situations for women's cardiac risk:

• History of pregnancy complications (preeclampsia, gestational diabetes, gestational hypertension): meaningfully elevated long-term cardiovascular risk. More aggressive screening warranted.
• PCOS: 2-4x elevated cardiovascular risk over baseline. Active cardiac monitoring from 30s+.
• Early menopause (natural menopause before 45 or surgical menopause from oophorectomy): elevated cardiac risk; HRT often appropriate to discuss with knowledgeable provider.
• Migraine with aura: associated with elevated stroke risk; relevant for considering hormonal birth control choices and overall cardiovascular monitoring.

20s:

• Annual basics (General Wellness Panel) + Ferritin (especially if heavy periods or vegetarian/vegan).
• Vitamin D, B12 if vegetarian/vegan.
• If sexually active: STI screening per CDC guidelines (chlamydia + gonorrhea annually if under 25, HIV at least once).
• If preparing for pregnancy: full preconception workup including TSH + Free T4, Vitamin D, Ferritin, folate, and a pregnancy-specific genetic carrier screen if interested.

30s:

• Add ApoB + Lp(a) to annual cardiac workup. Lp(a) is a once-in-lifetime test (genetically fixed); ApoB makes sense annually.
• Add Fasting Insulin alongside A1c — catches insulin resistance years before A1c becomes abnormal.
• Baseline hormone panel if you want longitudinal hormonal data or if symptomatic.
• Annual mammogram discussion typically starts in late 30s to early 40s (American Cancer Society recommends starting at 45 for average risk, 40 for elevated risk).

40s:

• Hormonal evaluation becomes critical — perimenopause typically starts in this decade. Women's Hormone Panel annually or biannually if symptomatic.
• Continue Heart Health markers; cardiac risk rises through this decade.
• Annual mammograms typically begin (timing depends on individual risk and guidelines).
• Cervical cancer screening per current guidelines (Pap every 3 years or co-testing with HPV every 5 years depending on age and history).

50s+:

• Continue comprehensive annual workup.
• Bone density (DEXA scan) at age 65 or earlier for risk factors. Vitamin D and Calcium monitoring throughout.
• Colon cancer screening through colonoscopy starting age 45.
• HRT decisions if perimenopausal/menopausal symptoms — modern data supports HRT for symptomatic women within 10 years of menopause without contraindications.
• Postmenopausal women: focus shifts to maintaining bone density, cardiovascular health, and cognitive health.