Perimenopause and midlife can bring a whole host of symptoms: crushing fatigue, brain fog, poor sleep, anxiety, weight changes, low mood and energy dips that suddenly make you feel unlike yourself. The problem is, many women are told this is ‘just ageing' or ‘just hormones' when, in reality, there are several important health markers worth checking too.
“Women are often very good at soldiering on through symptoms,” says registered nutritionist Emma Bardwell, “but things like low iron, thyroid issues or poor blood sugar control can quietly creep up during midlife and massively affect how you feel day to day.”
The good news is that a few fairly routine checks can offer valuable insight into what’s going on under the bonnet and help you make more informed decisions about your health. “This is such an important time of life to carry out what I call a 'health audit’”, says Emma.
Here are just a few of the tests Emma recommends discussing with your GP if you’re over 40.
1. Ferritin, iron and haemoglobin
Heavy periods or more frequent periods during perimenopause can leave many women depleted in iron without realising it. Low iron stores can contribute to fatigue, dizziness, poor concentration, breathlessness, hair shedding, restless legs, itchy skin, anxiety and feeling constantly wiped out.
Ferritin is particularly important because it reflects your stored iron levels, not just what’s circulating in the blood that day. You can technically fall within ‘normal’ ranges but still feel symptomatic if your stores are low, which is why it’s always good to ask your GP for a copy of your results. Emma says: “I like to see ferritin sitting comfortably within range, rather than scraping along the bottom end of ‘normal’.
“Many women assume they’re exhausted because of menopause, when in fact it’s low iron that’s to blame. I see this all the time, particularly in women who have had heavy periods or pregnancies and never fully rebuilt their iron stores afterwards.”
Foods rich in iron include red meat, lentils, tofu, beans, dark leafy greens and fortified cereals. Emma recommends pairing plant sources with vitamin C-rich foods, and says that avoiding drinking tea or coffee with meals can also help improve absorption. However, you may still need supplementation or in some cases, an IV infusion.
2. HbA1c
This blood test gives an overview of your average blood sugar levels over the previous three months and can help identify insulin resistance, pre-diabetes or type 2 diabetes risk.
Hormonal shifts, loss of muscle mass, poor sleep and increased abdominal fat during menopause can all affect blood sugar regulation. The result is more energy crashes, cravings, hunger and that constant feeling of needing to snack. Women often blame themselves for lacking willpower, but unstable blood sugar can have a huge impact on appetite, energy and food noise. Building meals around a plan-sized portion of protein, plenty of fibre-rich plants and some healthy fats can help support steadier glucose levels throughout the day.
Emma says: “In case you’re tempted, please ignore the faddy CGMs being marketed to healthy people. For most people without diabetes, they’re expensive, unnecessary and often anxiety-provoking. HbA1c gives a far more meaningful picture of what’s been happening with your blood sugar over time.”
3. Cholesterol
Cholesterol levels often rise after menopause due to changes in oestrogen, even in women who eat well and exercise regularly. While cholesterol itself isn’t something you can feel, elevated LDL cholesterol is one of the biggest risk factors for cardiovascular disease, which becomes increasingly important for women in midlife and beyond.
As a menopause expert, and co-author of the bestselling The Periminopause Solution, Emma strongly believes that the conversation around menopause needs to include heart health far more than it currently does. She says: “Women are often shocked when cholesterol rises seemingly out of nowhere in their forties and fifties. Increasing viscous soluble fibre intake from foods like oats, beans, lentils, chia seeds, flaxseeds and barley can help support healthy cholesterol levels, alongside exercise and overall diet quality.”
4. Thyroid function (TSH and T4)
Thyroid issues become increasingly common in women as we age, yet symptoms are often mistaken for menopause. An underactive thyroid can cause fatigue, weight gain, constipation, low mood, dry skin, brain fog and hair thinning, all of which overlap heavily with perimenopausal symptoms.
Emma advocates for requesting a test of thyroid function if something feels ‘off’. She says: “Women are sometimes told they simply need to accept feeling tired and sluggish, when there may actually be an underlying thyroid issue contributing.
“If you’re diagnosed with Hashimoto’s you will probably need to take thyroxine, which can help you feel back to normal. Nutrition won’t cure thyroid conditions, but eating enough protein, iodine, selenium and iron can help support normal thyroid function alongside any medical treatment prescribed.”
5. Vitamin D
Vitamin D deficiency is known to be incredibly common in the UK, particularly during autumn and winter, and even low levels (under 50 nmol/L) can contribute to fatigue, low mood, muscle aches and poorer bone health. This becomes even more relevant during and after menopause, when declining oestrogen levels can increase the risk of bone loss and osteoporosis.
Emma tells us that Vitamin D is one of the nutrients she is asked about most in her clinics.
“Vitamin D plays a key role in immune health, muscle function and bone health, all of which become increasingly important as we age,” she says. “The problem is that it’s pretty much impossible to get enough vitamin D from foods, so people in the UK are advised to consider a supplement during the winter months. The recommended dose is 10mcg (or 400IU), but you may need more. That’s why it’s so important to know your levels.”
Plus: the one non-blood test every woman should know her numbers for
Blood pressure might not involve a needle, but it’s one of the most important health checks women over 40 should keep an eye on. High blood pressure often has no obvious symptoms, which is why it’s sometimes referred to as a silent risk factor. Hormonal changes, stress, poor sleep, weight gain and genetics can all contribute.
Emma says: “The good news is that lifestyle changes can make a meaningful difference.
“Regular movement, reducing excess alcohol, improving sleep quality and eating a diet rich in fibre, potassium and minimally processed foods can all help support healthy blood pressure.
“Ultimately, midlife shouldn’t be about ignoring symptoms or putting everything down to hormones. Understanding what’s happening inside your body can be incredibly empowering and often allows you to make simple changes that help you feel significantly better.”
Emma Bardwell is the UK’s leading nutritionist for midlife women, author of The Fibre Effect, and creator of The 30g Plan. Her latest book, The 30g Plan Cookbook, is out now.
