Women's Health Blood Tests
From your first period to post-menopause, the blood tests that matter change with every stage of life. Here is your complete guide to the markers every woman should understand.
Core Panel Every Woman Needs
Regardless of age or life stage, these baseline blood tests form the foundation of women's health monitoring. They cover the conditions that disproportionately affect women — thyroid disease (5-8x more common in women), iron deficiency (due to menstrual blood loss), and bone health (osteoporosis affects 1 in 3 women over 50).
| Test | Why It Matters | Women-Specific Note |
|---|---|---|
| Full Blood Count (FBC) | Checks for anaemia, infection, and blood disorders | Women are more prone to iron-deficiency anaemia due to menstrual blood loss |
| Iron Studies (Ferritin, Serum Iron, TIBC) | Iron stores and iron metabolism | Menstruating women need regular iron checks — heavy periods can deplete stores within months |
| Thyroid Function (TSH, Free T4) | Thyroid regulation — affects energy, weight, mood | Women are 5-8 times more likely than men to develop thyroid disease |
| Vitamin D (25-OH) | Bone health, immune function, mood regulation | Critical for calcium absorption; deficiency accelerates bone loss especially after menopause |
| Vitamin B12 | Nerve function, red blood cell production, energy | Oral contraceptives can lower B12 levels; vegans and vegetarians at higher risk |
| Folate | DNA synthesis, red blood cell production | Essential before and during pregnancy to prevent neural tube defects |
| Lipid Panel (Total, LDL, HDL, Triglycerides) | Cardiovascular risk assessment | Women are protected by oestrogen until menopause, then lipids often worsen rapidly |
| HbA1c | 3-month average blood sugar | PCOS significantly increases type 2 diabetes risk; gestational diabetes increases lifetime risk |
| Liver Function (ALT, AST, GGT) | Liver health and enzyme levels | Oral contraceptives and HRT can affect liver function; fatty liver increasingly common |
| Kidney Function (eGFR, Creatinine) | Kidney filtration capacity | Pregnancy puts extra demand on kidneys; pre-eclampsia can affect kidney function |
Reproductive Years (18-40): Additional Tests by Concern
Fertility Assessment
If you are planning pregnancy or investigating difficulty conceiving, these hormone tests provide crucial information about ovarian function and ovulation. Timing matters — most reproductive hormones must be tested on specific days of your menstrual cycle for accurate results.
FSH + Estradiol (Day 2-5)
Baseline ovarian function. FSH >10 IU/L with low estradiol suggests diminishing ovarian reserve.
LH (Day 2-5)
Pituitary signal to ovaries. LH:FSH ratio >2:1 suggests PCOS. LH surge at mid-cycle triggers ovulation.
AMH (Anti-Mullerian Hormone)
Ovarian reserve indicator — can be tested any day. Reflects the number of remaining follicles. Declines with age.
Progesterone (Day 21)
Confirms ovulation occurred. Level >30 nmol/L indicates adequate ovulatory cycle. Must be timed 7 days after expected ovulation.
Menstrual Issues
Heavy periods (menorrhagia) are the leading cause of iron deficiency in young women. If your periods are heavy or irregular, the priority tests are iron studies (ferritin can drop alarmingly fast), thyroid function (hypothyroidism causes heavy periods), and a coagulation screen if bleeding is very heavy. Low ferritin (<30 mcg/L) is common in women with heavy periods, even when haemoglobin appears “normal.”
PCOS: The Most Common Hormonal Disorder in Women
Polycystic ovary syndrome (PCOS) affects 8-13% of women of reproductive age, making it the most common endocrine disorder in this group. Diagnosis uses the Rotterdam criteria — you need 2 of 3: oligo-ovulation or anovulation (irregular or absent periods), clinical or biochemical hyperandrogenism (acne, excess hair, elevated testosterone), and polycystic ovaries on ultrasound.
Insulin resistance is the driver in approximately 70% of PCOS cases. This is why fasting insulin is arguably the most important test — it often reveals the underlying metabolic problem even when glucose and HbA1c are still normal. High insulin stimulates the ovaries to produce excess androgens, which disrupts ovulation.
| Test | Significance in PCOS | Typical Finding |
|---|---|---|
| Total Testosterone | Primary androgen — elevated in ~60-80% of PCOS | Often 1.5-3x upper normal limit |
| Free Testosterone | Active (unbound) testosterone — more sensitive than total | Elevated even when total T appears normal |
| DHEA-S | Adrenal androgen — elevated in ~25% of PCOS | Mild elevation; very high levels suggest adrenal pathology |
| SHBG (Sex Hormone Binding Globulin) | Low SHBG = more free testosterone | Often low due to insulin resistance |
| Fasting Insulin | Insulin resistance drives PCOS in ~70% of cases | Often >10 mU/L; insulin:glucose ratio >0.3 suggests resistance |
| Fasting Glucose + HbA1c | Diabetes screening — 40% of PCOS develop by age 40 | May be normal even with high insulin (early stage) |
| LH and FSH | LH:FSH ratio >2:1 suggestive of PCOS | Elevated LH with normal/low FSH |
| Anti-Mullerian Hormone (AMH) | Reflects follicle count — often very high in PCOS | May be 2-4x upper normal |
Perimenopause (40-55): When Everything Changes
Perimenopause — the transition to menopause — typically begins in your early to mid 40s and lasts 4-8 years. Hormone levels fluctuate wildly, causing symptoms that overlap with thyroid disease, anxiety, and depression. Blood tests help untangle what is actually happening.
FSH (Follicle Stimulating Hormone)
Single FSH is unreliable as it fluctuates wildly in perimenopause. Two elevated readings 4-6 weeks apart are more meaningful.
Estradiol (E2)
Can swing from very high to very low within the same month. A low E2 with high FSH confirms ovarian decline.
TSH
Hot flushes, mood changes, weight gain, and fatigue are symptoms of BOTH menopause and thyroid disease. Always rule out thyroid before attributing symptoms to menopause.
Lipid Panel
Cardiovascular risk increases significantly after menopause. Oestrogen was protective — its decline shifts lipid profiles unfavourably.
Vitamin D + Calcium
Women lose up to 20% of bone density in the 5-7 years after menopause. Adequate vitamin D and calcium are critical.
HbA1c
Declining oestrogen increases insulin resistance. Metabolic syndrome becomes more common.
Post-Menopause (55+): Shifting Priorities
After menopause, the loss of oestrogen's protective effects shifts health priorities. Cardiovascular disease becomes the leading cause of death in women (overtaking breast cancer), bone loss accelerates dramatically, and metabolic changes increase diabetes risk. Testing priorities shift accordingly.
Bone Health
Women lose up to 20% of bone density in the 5-7 years after menopause. Vitamin D and calcium monitoring is essential. Elevated ALP with low calcium suggests active bone loss. A DEXA scan is recommended for all women at age 65 (or earlier with risk factors).
Cardiovascular Risk
LDL cholesterol rises an average of 10-15% after menopause. Combined with declining HDL, cardiovascular risk increases significantly. CRP adds inflammation risk assessment. Regular lipid monitoring becomes critical.
Metabolic Health
Declining oestrogen increases insulin resistance. The risk of type 2 diabetes doubles in the first 5 years after menopause. Annual HbA1c screening is recommended.
Thyroid Function
Hypothyroidism prevalence increases with age — up to 20% of women over 60 have subclinical hypothyroidism. Annual TSH testing is recommended.
Note on CA-125: CA-125 is sometimes discussed as an ovarian cancer screening tool. However, it is not recommended for routine screening in average-risk women — it has a high false-positive rate and is elevated in many benign conditions (endometriosis, fibroids, liver disease). It is used for monitoring known ovarian cancer, not screening. Discuss with your doctor if you have a family history.
Pregnancy Blood Tests by Trimester
Pregnancy involves a structured schedule of blood tests designed to protect both mother and baby. These are the standard Australian antenatal blood tests recommended by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG).
| Trimester | Tests | Why |
|---|---|---|
| First (0-12 weeks) | FBC, Blood Group + Antibodies, Rubella immunity, Hepatitis B/C, HIV, Syphilis, Iron studies, TSH, OGTT (if high risk), Urine culture | Establish baseline, screen for infections, identify anaemia and thyroid issues early |
| Second (13-27 weeks) | OGTT at 24-28 weeks (all women), FBC, Iron studies, Blood group antibodies (if Rh negative) | Screen for gestational diabetes — affects 12-14% of Australian pregnancies |
| Third (28-40 weeks) | FBC, Iron studies, GBS swab at 35-37 weeks, Blood group antibodies (if Rh negative) | Pre-delivery checks — iron stores deplete rapidly in third trimester, GBS colonisation affects delivery plan |
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This content is for informational purposes only and does not constitute medical advice. Blood test results should always be interpreted by a qualified healthcare professional in the context of your individual health history.