"Your results are normal" is the most common outcome and the least informative. Normal ranges are wide, some of them are wide for reasons that do not apply to you, and a result sitting just inside a boundary can still explain how you feel. Here is how to read the tests that matter around menopause.
Where we stand: Menova is an independent publication. We sell no tests, we are not your doctor, and this is general education, not a diagnosis. Reference ranges differ between laboratories — always use the range printed on your own report, and interpret results with your clinician.
Why "normal" is not always the end of it
A reference range typically covers the middle 95% of a reference population. Two consequences:
- Some healthy people fall outside it, and some unwell people fall inside it
- A result near the edge may be normal for the population and not optimal for you
That is not an argument for ignoring your doctor. It is an argument for asking for the number, not just the verdict — because a ferritin of 16 and a ferritin of 90 are both "normal" and mean completely different things for how you feel.
Ask for a copy of your results. In most health systems you are entitled to them.
Ferritin — the one worth pushing on
What it is: your iron stores. Ferritin falls before haemoglobin does, so you can be exhausted with "normal" full blood count results.
Why it matters now: heavy perimenopausal bleeding makes iron deficiency very common, and its symptoms — fatigue, breathlessness on stairs, brain fog, hair shedding, restless legs, feeling cold — are all attributed to menopause instead.
The catch: the bottom of the reference range is often very low, and many women feel unwell at levels technically inside it. There is genuine clinical debate about the threshold for treating symptomatic women.
What to ask: "What is my actual ferritin number, and given my symptoms and heavy periods, is it worth treating even if it's technically in range?"
Ferritin also rises with inflammation, so a normal result alongside raised inflammatory markers can be misleading. See low ferritin in perimenopause.
Thyroid
TSH is usually tested first. Counterintuitively, high TSH means an underactive thyroid — your body is shouting louder to get a response.
Free T4 is often added; free T3 and thyroid antibodies sometimes.
Why it matters: hypothyroidism is the closest mimic of menopause there is — fatigue, weight gain, feeling cold, dry skin, hair thinning, low mood, brain fog.
Points worth knowing:
- If you take levothyroxine and start oral estrogen, your requirement can rise. Recheck six to twelve weeks after starting — see HRT and thyroid medication
- Subclinical hypothyroidism — raised TSH with normal T4 — is a judgement call, and antibodies help decide
- Biotin supplements can interfere with thyroid assays. Stop them a few days before testing and say if you take them
See perimenopause versus thyroid.
Full blood count
- Haemoglobin — low means anemia, and it lags behind ferritin
- MCV, the average red cell size — small cells suggest iron deficiency, large cells suggest B12 or folate deficiency, or alcohol
- Platelets and white cells — usually context
A normal haemoglobin with a low ferritin is a very common midlife picture and still causes symptoms.
HbA1c
Average blood sugar over roughly three months. More useful than a single fasting glucose, which can look fine while post-meal control has deteriorated.
Insulin sensitivity declines around menopause, so this is a genuinely useful test in this decade — and prediabetes is the stage where intervention has most to work with. See insulin resistance in menopause.
Lipids
Total cholesterol, LDL, HDL, triglycerides, and often non-HDL — which many guidelines now prefer and which does not require fasting.
The important framing: a single number does not decide anything. Treatment decisions are based on overall cardiovascular risk, combining lipids with age, blood pressure, smoking, diabetes and family history.
Worth asking about once in your life: lipoprotein(a), largely genetic, rarely offered, and it changes how aggressively everything else is managed. See cholesterol after menopause.
Vitamin D and B12
Vitamin D — deficiency is common, matters for bone, and is cheap to correct. Note that units differ between countries, so compare against your own report's range.
B12 — deficiency causes fatigue, tingling, and cognitive symptoms, and is more likely if you eat little meat, take metformin, or use long-term acid-reducing medication. Symptoms can appear at levels near the bottom of the range, and folate should be checked alongside it.
Hormone tests — the ones usually not worth having
For women over 45, guidance generally advises against using FSH or estradiol to diagnose the transition. Levels swing enormously week to week, so a single sample means little.
This is also how women get told "your bloods are normal, so it isn't menopause" — which is not what a normal result means at this age. See was that my last period and what to do if your doctor says no.
Where testing is appropriate: under 40 for suspected premature ovarian insufficiency, sometimes between 40 and 45, and after hysterectomy where there is no bleeding to observe.
On HRT, routine estradiol monitoring is generally not recommended — dosing is guided by symptoms; see do you need blood tests on HRT.
AMH measures ovarian reserve for fertility purposes. It does not predict your last period, despite being marketed that way.
Saliva and urine hormone panels are not validated for guiding treatment.
Practical points before testing
- Ask what is being tested and why — "what would we do differently depending on the result?"
- Fasting is needed for some tests; check
- Timing matters for thyroid medication (take it after the blood draw, or note the time), and for anything cycle-dependent
- Stop biotin a few days beforehand if you take it
- Note that creatine supplementation raises measured creatinine without indicating kidney damage — say if you take it; see creatine in menopause
- Keep your results. A trend over years is far more informative than a single value
What to do with a result
- Get the number and the range, not just "normal"
- Ask whether it explains your symptoms — a borderline result plus matching symptoms is worth acting on
- Ask what would change your management
- Ask when to repeat it
- Keep a copy
A short, effective sentence: "Could you tell me the actual numbers? I'd like to keep track of them over time."
Our free printable visit prep sheet has space for the test list and results, and the free 30-day symptom tracker gives you the symptom side to set against them — which is what makes a borderline result interpretable.
The free 2-minute Menova self-check organizes your symptom picture — no account, not a diagnosis, and your answers never leave your device.
What not to do
Do not buy a direct-to-consumer panel hoping it will explain everything. Broad panels generate incidental findings, anxiety, and follow-up investigations without improving outcomes, and the hormone components are usually the ones guidance advises against.
Do not self-treat on a number — particularly iron, which is harmful in excess and should only be supplemented for a confirmed deficiency.
This article is general education, not medical advice or a diagnosis. Reference ranges differ between laboratories and results must be interpreted in clinical context by a licensed clinician. Do not start or stop treatment based on a result alone.
Sources: NHS — Blood Tests, NICE NG23 — Menopause, The Menopause Society, and NIDDK — Diagnostic Tests.