That bone-deep exhaustion you feel after a full night’s sleep? The brain fog that makes you forget why you walked into the kitchen? Many women in their forties assume these are just part of perimenopause. But there is a strong chance your body is sending signals about something else entirely. Registered nutritionist Emma Bardwell points out that low iron, thyroid imbalances, or unstable blood sugar can creep up during midlife and mimic menopausal symptoms. A handful of routine blood tests for women over forty can reveal what is truly going on behind the scenes.
Why Might Perimenopause Cause Fatigue Beyond Hormones?
Iron Studies (Ferritin, Iron, and Haemoglobin)
Heavy periods during perimenopause can quietly drain your body’s iron reserves. This depletion often leads to overwhelming fatigue, dizziness, poor concentration, breathlessness, hair shedding, restless legs, itchy skin, anxiety, and a general feeling of being wiped out. The problem is that many women blame menopause for these symptoms when low iron is the real culprit.
A standard blood test checks haemoglobin, which is the protein in red blood cells that carries oxygen. But Emma Bardwell emphasises the importance of ferritin as well. Ferritin reflects your stored iron levels, not just what is circulating in your bloodstream on the day of the test. You can technically fall within what the lab calls “normal” ranges and still feel symptomatic if your stores are scraping the bottom end of that range.
Emma Bardwell says she sees this pattern frequently, particularly in women who have had heavy periods or multiple pregnancies and never fully rebuilt their iron stores afterwards. If you suspect low iron is contributing to your fatigue, ask your GP for a copy of your full iron panel results, including ferritin. This is one of the most revealing blood tests for women in midlife because it can explain symptoms that are too often dismissed as just ageing.
How Can You Tell if Your Blood Sugar Is Unstable During Menopause?
HbA1c Test
Hormonal shifts during menopause, combined with loss of muscle mass, poor sleep, and increased abdominal fat, can disrupt how your body handles sugar. The result is more energy crashes, intense cravings, constant hunger, and that nagging feeling that you need to snack all day. Many women blame themselves for lacking willpower, but unstable blood sugar has a genuine physiological basis.
An HbA1c test provides a big-picture view of your average blood sugar levels over the previous three months. Unlike a single finger-prick glucose reading, this test can identify insulin resistance, pre-diabetes, or type 2 diabetes risk before symptoms become serious. Emma Bardwell advises against jumping on continuous glucose monitors marketed to healthy people. For most women without diabetes, they are expensive, unnecessary, and can cause unnecessary anxiety. HbA1c gives a far more meaningful and stable picture of what your blood sugar has been doing over time.
If your result comes back higher than expected, simple dietary adjustments can help. Building meals around a palm-sized portion of protein, plenty of fibre-rich plants, and healthy fats supports steadier glucose levels throughout the day. This is a key blood test for women over forty to discuss with your doctor, especially if you experience unexplained energy dips.
Why Does Cholesterol Rise in Midlife Women Despite a Healthy Lifestyle?
Lipid Profile (Total Cholesterol, LDL, HDL)
Many women are shocked when their cholesterol levels rise after menopause, especially when they eat well and exercise regularly. The culprit is declining oestrogen. This hormone helps maintain a favourable balance of cholesterol, and when its levels drop, LDL cholesterol (the kind linked to heart disease) often increases.
You cannot feel high cholesterol directly, but elevated LDL is one of the biggest risk factors for cardiovascular disease. Heart health becomes increasingly important for women in midlife and beyond. Emma Bardwell, co-author of The Perimenopause Solution, strongly believes that the conversation around menopause should include heart health far more than it currently does.
A standard lipid profile measures total cholesterol, LDL, HDL, and triglycerides. Even if your numbers are slightly above the recommended range, knowledge allows you to take proactive steps. This is not about panic. It is about having a clear baseline so you can monitor changes and adjust your diet or lifestyle accordingly.
How Can You Distinguish Thyroid Issues From Menopause Symptoms?
Thyroid Function Test (TSH and T4)
Thyroid problems become increasingly common in women as they age, and the symptoms overlap heavily with perimenopause. Fatigue, weight gain, brain fog, dry skin, hair thinning, and feeling cold can all come from an underactive thyroid. Yet many women accept these symptoms as just another part of midlife.
A simple thyroid function test checks Thyroid Stimulating Hormone (TSH) and thyroxine (T4). If your TSH is elevated and T4 is low, it suggests your thyroid is underactive. Emma Bardwell advocates for requesting this test if something feels off. She encourages women to trust their instincts. If you feel persistently unlike yourself, it is worth investigating.
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Thyroid issues are treatable with medication, and once levels stabilise, many women notice a significant improvement in energy, weight management, and mental clarity. This is a fundamental blood test for women over forty who suspect their symptoms go beyond typical hormone shifts.
What Else Could Be Draining Your Energy?
Complete Blood Count (CBC)
Even when iron stores look adequate on a ferritin test, a full complete blood count can reveal other underlying problems. This test examines the number and quality of your red blood cells, white blood cells, and platelets. It can detect anaemia from causes other than iron deficiency, such as chronic disease or borderline haemoglobin levels that still leave you tired.
Emma Bardwell notes that ferritin reflects stored iron, but a complete blood count shows how your body is actually using those resources. Women can have seemingly normal iron levels yet still experience symptoms because their red blood cells are not carrying oxygen efficiently. The CBC provides a more complete picture of your overall blood health.
If you have been feeling persistently drained, this routine test can identify issues that might otherwise fly under the radar. It is a straightforward, inexpensive way to check many potential causes of fatigue with a single blood draw.
Frequently Asked Questions
Do I need to fast before these blood tests?
Some tests require fasting for accurate results. The lipid profile and HbA1c are often taken after an 8 to 12 hour fast. Iron studies and thyroid function tests usually do not require fasting, but your doctor will give specific instructions. Always confirm preparation guidelines with your healthcare provider to avoid a repeat draw.
What is the difference between ferritin and a standard iron test?
A standard iron test measures the amount of iron currently circulating in your blood. Ferritin, on the other hand, evaluates your body’s stored iron reserves. You can have normal circulating iron but low ferritin, which means your body has little to fall back on when demand increases. This is why ferritin is so important for women with heavy periods.
How often should I have these blood tests for women after turning forty?
There is no single rule, but many health experts suggest a baseline set of tests around age 40, then follow up every one to two years depending on your results and symptoms. If you experience new or worsening fatigue, weight changes, or mood shifts, it is reasonable to ask for a repeat sooner. Your GP can help you build a testing schedule based on your personal health history.
