Blood tests for women: the core panel, what to add at each age, and what skews the results

Most women need the same short core panel as men: a blood count, ferritin, TSH, lipids with ApoB, HbA1c, a one-time Lp(a), and kidney and liver chemistry. Three parts of a woman's history decide what to add and how to read each number: how much blood she loses each month, whether she has been pregnant and how those pregnancies went, and where she is in the menopausal transition. A lab report records none of it, so the history has to come first.

A core panel to discuss with your doctor

Five areas cover most of what a routine panel can tell an adult woman: blood and iron, thyroid, cholesterol, blood sugar, and kidney and liver function. In the UK this bundle is often sold as a well woman blood test; what matters is the markers on it, not the package name. Two of the five behave differently in women. Monthly blood loss drains iron stores, and autoimmune thyroid disease (Hashimoto's) is far more common in women than in men. There is no single official list, so your doctor will tailor it; the table shows what each test measures and why it carries extra weight for women.

The CBC guide reads each line of the blood count, the thyroid panel guide covers TSH and free T4, and the metabolic panel guide covers the CMP.

Ferritin is the test a standard panel most often leaves out, and it is the one most likely to change something for a woman who still has periods. The 2026 American Society of Hematology (ASH) guideline puts the iron-deficiency line at a ferritin of 30 ng/mL or less in adults, and 50 ng/mL or less for anyone with heavy periods or symptoms ⁵. Ferritin also rises with inflammation, so it can read falsely normal during an infection or flare ⁶. As the iron deficiency page puts it, "a clean CBC is not an all-clear when the symptoms fit." Ferritin vs iron explains why ferritin is the number to track.

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Rough and educational, not a diagnosis. Thresholds follow WHO-style adult cut-offs (ferritin depletion under 15 ng/mL; anaemia under 12 g/dL for women, 13 for men) and vary by lab, age, pregnancy and inflammation. Always read your result with a clinician.

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Vitamin D and vitamin B12 belong on the list when there is a reason to check them: a vegan or vegetarian diet, a gut condition that limits absorption, gut surgery, long-term metformin or acid-suppressing medicine, numbness or memory change, or bone loss. The vitamin D deficiency and B12 deficiency pages cover those results. Without one of those reasons, routine testing adds little (see the tests you probably don't need, below).

In your 20s and early 30s: build a baseline

Heavy periods drain iron. Bleeding that lasts more than seven days, needs changing every one to two hours, or passes large clots can empty iron stores, and ferritin is the test that shows it. Painful heavy periods can also point to endometriosis; no blood test diagnoses it, though CA-125 can rise with it. A first lipid panel and a one-time Lp(a) in your 20s give a baseline that every later result can be compared with.

Irregular or absent periods point to a different work-up. Polycystic ovary syndrome (PCOS) affects about 10 to 13% of women of reproductive age ⁷. The 2023 international guideline recommends checking blood sugar (HbA1c, fasting glucose or a glucose tolerance test) and a lipid panel in every woman diagnosed with it, and advises against routine insulin-resistance tests because they are unreliable ⁷. The blood tests usually include total and free testosterone, SHBG (sex hormone binding globulin, the protein that holds testosterone in the blood), HbA1c and a lipid panel. The PCOS page walks through those numbers, and irregular periods covers the other causes, including thyroid disease, high prolactin and periods stopping from low energy intake with heavy training.

Low testosterone in women is tested less often. It is measured mainly when low sex drive is being assessed and other causes have been ruled out, not as a routine check.

Cervical screening and STI tests use swabs and urine, but they belong on the same list. The US Preventive Services Task Force (USPSTF) recommends cervical cytology (the smear test) every 3 years from 21 to 29 ⁸.

Planning a pregnancy, and what pregnancy leaves behind

Before a pregnancy, the useful blood tests are ferritin (pregnancy raises the recommended daily iron intake by half, from 18 to 27 mg ⁹), rubella and varicella immunity, and HbA1c when there is PCOS, overweight or a family history of diabetes. TSH is worth adding if you have thyroid symptoms, a past thyroid result that was off, another autoimmune condition or a family history of thyroid disease. USPSTF advises 0.4 to 0.8 mg (400 to 800 µg) of folic acid daily for anyone who could become pregnant ¹⁰; some women need a higher dose, which a doctor sets.

CalculatorOvulation calculatorA calendar estimate of your fertile window from your cycle length.Work it out

AMH (anti-Müllerian hormone) is sold as a fertility test, but it does not predict natural conception. AMH estimates how many eggs remain in the ovaries. In a JAMA study of women aged 30 to 44 trying to conceive naturally, the estimated chance of conceiving by 6 cycles was 65% with low AMH and 62% with normal AMH, and by 12 cycles 84% versus 75% ¹¹. AMH helps plan IVF; it does not tell a woman her chances of conceiving this year. Anyone worried about fertility, especially after 12 months of trying, or 6 months from age 35, should see a doctor or fertility specialist.

Where a test points to a gap

Strongest evidenceIronRestores ferritin and hemoglobin when a test confirms iron deficiency; the cause of the loss still needs finding. Your doctor sets the dose and length, and iron is not for anyone whose ferritin is normal or highIn our shop

Strongest evidenceFolateFolic acid before conception lowers the risk of neural tube defects (spine and brain defects such as spina bifida)

Blood tests for women over 40: perimenopause and the trend

FSH (follicle-stimulating hormone, the pituitary signal that climbs as the ovaries slow) and estradiol swing from week to week during perimenopause, so one result can look menopausal one month and normal the next. NICE, the UK's clinical guidance body, identifies perimenopause at 45 or over from new hot flashes or night sweats plus a change in the cycle, and is explicit about the blood tests ¹³:

Do not use the following laboratory and imaging tests to identify perimenopause or menopause in people aged 45 or over: anti-Müllerian hormone, inhibin A, inhibin B, oestradiol, antral follicle count, ovarian volume.NICE guideline NG23, Menopause: identification and management (2024 update)

The perimenopause page is blunt: "a normal FSH such as 5.4 mIU/mL does not rule it out." Blood tests in your 40s do a different job: they rule out conditions that mimic perimenopause. An underactive thyroid causes tiredness, weight gain, heavy or irregular periods and feeling cold, which are easy to mistake for perimenopause (hypothyroidism covers the TSH numbers). Iron deficiency, raised blood sugar and pregnancy are the others to exclude. FSH still has a place under 45, or when periods stop early. The female hormone panel guide explains each hormone.

Cholesterol is the number to watch through the 40s. The SWAN study followed 1,054 midlife women through menopause: most heart risk factors changed steadily with age, but total cholesterol, LDL and ApoB jumped in the year either side of the final menstrual period ¹⁴. A single result can look fine while the trend climbs, which is why a trend beats a single reading. If your LDL has stepped up, ask for ApoB and a one-time Lp(a) if you have never had them, and whether to repeat the lipid panel sooner than every 4 to 6 years. ApoB vs LDL explains what ApoB adds. USPSTF also recommends a mammogram every 2 years from 40, and bowel screening from 45 ⁸.

Blood tests for women over 50: heart, sugar and bone

Menopause arrives at an average age of about 51, and heart disease is the leading cause of death in women. After menopause, the lipid panel, ApoB and HbA1c become the priority tests; the lipid panel guide explains each line. Menopause before 40 is an ACC/AHA risk enhancer for heart disease ² and an early flag for bone loss.

Bone is measured with a DEXA scan (a low-dose X-ray that measures bone density), which USPSTF recommends from 65, or earlier after menopause for women at higher fracture risk ⁸. Blood tests for calcium, vitamin D, PTH (parathyroid hormone, which controls blood calcium) and kidney function explain why bone is thin; they cannot measure bone density. The bone markers guide sets out which test answers which question, and osteoporosis covers T-scores. B12 is worth checking at any age when there is a reason: metformin, acid-suppressing medicine, a vegan diet, gut surgery, or numbness or memory change.

Women's blood tests by age, in one table

What changes your results

• Cycle day: FSH, LH (luteinizing hormone, which triggers ovulation) and estradiol are read on days 2 to 5 of the cycle; progesterone about 7 days before the next period, which confirms ovulation.
• The combined pill raises SHBG, which lowers free testosterone, and can raise triglycerides and total thyroxine (the thyroid hormone count that includes the protein-bound form; free T4 is usually unaffected); see birth control and blood tests. NICE also advises against using FSH to diagnose menopause while on combined hormonal contraception ¹³.
• Pregnancy dilutes hemoglobin, lowers TSH in the first trimester and raises cholesterol and triglycerides late on, so pregnancy results use their own ranges (WHO puts anemia below 11.0 g/dL in the first and third trimesters, 10.5 in the second ¹).
• High-dose biotin, common in hair and nail supplements (see brittle nails), can push TSH, free T4 and hormone results falsely high or low; tell the lab and your doctor you take it.
• Fasting matters for glucose and triglycerides; how to prepare for a blood test covers timing, water and supplements.

Tests you probably don't need yet

• Routine vitamin D: the Endocrine Society's 2024 guideline advises against testing healthy adults under 75 without a specific reason ¹⁵.
• Thyroid screening with no symptoms: USPSTF found insufficient evidence for or against it in non-pregnant adults ¹⁶; symptoms, pregnancy plans or a family history change that.
• CA-125: it rises with periods, endometriosis and fibroids, and USPSTF recommends against screening for ovarian cancer in women without symptoms ¹⁷. The tumor markers guide explains why.
• A one-off hormone panel to "balance hormones": a single snapshot of swinging hormones rarely answers a question. The hormonal imbalance guide covers when hormone tests do help.

Reading your results

Several reference ranges differ by sex: hemoglobin and ferritin run lower in women, and so does creatinine, which shifts the eGFR estimate. A result inside the lab's range can still matter, as a ferritin of 22 ng/mL does for a woman with heavy periods. The reference ranges guide explains where those ranges come from. Read each result against your own history and your last result. If a result is flagged or has moved since last time, take both results to your doctor and ask what would explain the change and when to retest; how to read any lab result walks through it, and what blood tests should I get covers the adult list beyond this page.

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