5 Tests Every Woman in Perimenopause Should Ask For

September 2025 | Women’s Health | Perimenopause

By Karen Miller, LCSW-S, BCD | Karen Miller Counseling & Consulting, PLLC.

Perimenopause is more than hot flashes and irregular cycles; it’s a transition that impacts your hormones, mood, metabolism, and long-term health. Yet many women are told that their annual exam is “enough.”

In my clinical work and doctoral research, I’ve seen the gaps this leaves behind. Recently, I worked with a client convinced she was only struggling with depression. The truth? Her B12 and iron levels were critically low. Once treated, her symptoms began to improve.

This is why comprehensive testing in perimenopause is essential. In this article, I’ll share five key areas to discuss with your provider, along with why they matter.

Tests to Consider in Perimenopause

1. Foundational Health Panels

Tests: CBC, CMP, Lipid Panel

Screens for anemia, blood sugar issues, kidney and liver function, and cholesterol changes.
As estrogen declines, cardiovascular and metabolic risks rise, making these labs crucial.

Evidence: According to the American Heart Association, women’s risk of heart disease increases after menopause, highlighting the importance of early screening.

2. Thyroid Function Tests

Tests: TSH, Free T4, Free T3, Thyroid Antibodies

Thyroid dysfunction can mimic perimenopause: fatigue, mood swings, weight changes, brain fog.
Often overlooked unless you advocate for it.

Evidence: The American Thyroid Association reports that thyroid disorders are 5–8x more common in women, especially midlife.

3. Reproductive Hormones

Tests: FSH, Estradiol, Testosterone

Levels fluctuate, so they don’t “diagnose” perimenopause, but they help explain certain symptoms like irregular bleeding or severe mood changes.
Useful for context in tailoring treatment options.

4. Nutrient Deficiency Panels

Tests: Vitamin D, B12, Iron/Ferritin, Magnesium

Deficiencies can mimic depression, anxiety, or fatigue.
Addressing them prevents misdiagnosis and ensures treatment supports your whole health.

Example: Low ferritin (iron storage) can look like depression, fatigue, irritability, low energy; leading women to treatment plans that miss the real issue.

5. Age-Appropriate Screenings

Mammogram: begin at 40 (or earlier with risk factors).
Pap/HPV testing: as recommended.
Colorectal screening: start at 45.
Bone density scan (DEXA): to assess osteoporosis risk.
Vaccines: flu, shingles, pneumonia, COVID as appropriate.

When Deficiencies Masquerade as Mental Health

Iron deficiency → fatigue, brain fog, irritability.
B12 deficiency → memory loss, low mood, anxiety.
Vitamin D deficiency → worsens depression and low energy.
Magnesium deficiency → tension, poor sleep, restlessness.
Thyroid dysfunction → often looks like panic, mood swings, or depression.

Medication and therapy save lives, but without labs, women can spend years treating symptoms instead of causes.

Seasonal Awareness: SAD + Perimenopause

As days shorten in the fall, Seasonal Affective Disorder (SAD) can worsen low mood, fatigue, and fog overlapping with perimenopause. Light therapy, Vitamin D, and grounding routines can make a difference.

Clinician Notes

Perimenopause is not the end of vitality; it’s a recalibration. With the right labs and screenings, you can step into this season informed and empowered.

Action Step: Bring this list to your next provider visit. Advocate for comprehensive testing. Your health is too valuable for shortcuts.

References

American Heart Association: www.heart.org
American Thyroid Association: www.thyroid.org
National Institute of Mental Health (on depression and deficiencies): www.nimh.nih.gov