Testing & Tracking
You can't manage what you don't measure. Here's exactly what to test, when, and how to use the results to advocate for yourself.
2+ yrs
Average Time to Diagnosis
For menopause symptoms
3+
Doctors Before Answers
Many women report seeing
12
Key Tests to Know
Your baseline panel
1
Best Advocate: You
Come prepared
Knowledge is power — especially when doctors dismiss you. Many women are told their symptoms are "just stress" or "normal aging." Having data — tracked symptoms, test results, patterns — gives you the ammunition to push back and get proper care.
Essential Blood Tests
These tests create your baseline and help identify issues that can mimic or worsen menopause symptoms.
🔴 Thyroid Panel
Rule out first
TSHThyroid Stimulating Hormone
Optimal
0.5–2.5 mIU/L
Annually, or if symptoms present
Thyroid issues mimic menopause: fatigue, weight gain, brain fog, mood changes. Rule this out first.
Free T4 & Free T3Active thyroid hormones
Optimal
Mid-range of lab values
If TSH abnormal
TSH alone can miss issues. Full panel gives complete picture.
💉 Metabolic & Nutrient Panel
Energy & Function
Vitamin D (25-OH)Critical for bones, mood, immunity
Optimal
40–60 ng/mL
Annually
Deficiency is extremely common. Affects bone health, mood, energy, immunity. Supplement if low.
Vitamin B12Energy, nerve function
Optimal
>500 pg/mL
Annually
Low B12 causes fatigue, brain fog, tingling — all overlap with menopause. Common in women 40+.
FerritinIron stores
Optimal
50–150 ng/mL
Annually
Heavy perimenopausal bleeding can deplete iron. Low ferritin = fatigue, hair loss, cold intolerance.
Fasting GlucoseBlood sugar
Optimal
<100 mg/dL
Annually
Insulin sensitivity drops in menopause. Catch prediabetes early.
HbA1c3-month blood sugar average
Optimal
<5.7%
Every 1–3 years
Better than single glucose reading. Prediabetes: 5.7–6.4%. Diabetes: ≥6.5%.
❤️ Cardiovascular Panel
Heart Protection
Lipid PanelCholesterol breakdown
Key targets
LDL <100, HDL >60
Annually
LDL rises, HDL falls after menopause. Track changes. See Heart Health dashboard.
Lp(a)Lipoprotein(a) — genetic risk
Optimal
<30 mg/dL
Once (genetic, doesn't change)
Elevated Lp(a) = higher heart risk regardless of other factors. 20% of people have high levels. Test once.
hs-CRPHigh-sensitivity C-reactive protein
Optimal
<1.0 mg/L
If risk factors present
Inflammation marker. Elevated levels add to cardiovascular risk assessment.
💡 A Note on Hormone Testing
FSH, estradiol, and progesterone tests are often NOT necessary for diagnosis. In perimenopause, hormones fluctuate so wildly that a single blood draw may catch a "normal" moment. Menopause is typically diagnosed by symptoms + age + cycle history — not blood tests. However, hormone testing can be useful for: ruling out other conditions, monitoring HRT dosing, or evaluating early menopause (before 45). Don't let a "normal" FSH result dismiss your symptoms.
Imaging & Scans
Beyond blood work, these imaging studies provide critical information for this life stage.
🦴 Bone & Heart Imaging
Baseline & Monitoring
DEXA ScanBone density measurement
T-score target
> -1.0
Baseline at menopause, then per results
Bone loss accelerates dramatically in first 5–7 years post-menopause. Get baseline. T-score -1 to -2.5 = osteopenia. Below -2.5 = osteoporosis.
Coronary Calcium Score (CAC)CT scan of heart arteries
Optimal
0 (no calcium)
Consider at 50+ or if risk factors
Detects calcified plaque in coronary arteries. Excellent predictor of heart attack risk. Score of 0 is very reassuring. Higher scores guide prevention intensity.
MammogramBreast cancer screening
Result
BIRADS 1 or 2
Annually starting at 40 (or per doctor)
Breast cancer risk increases with age. Annual screening catches cancers early when most treatable.
Get Baseline Now
- DEXA scan (bone density)
- Full lipid panel
- Fasting glucose / HbA1c
- Thyroid panel
- Vitamin D, B12, Ferritin
Annual Monitoring
- Lipid panel
- Fasting glucose
- Blood pressure
- Vitamin D (if supplementing)
- Mammogram
If Symptoms Worsen
- Thyroid panel (fatigue, weight)
- Ferritin (heavy bleeding)
- B12 (neurological symptoms)
- Cardiac workup (palpitations)
Symptom Tracking
Data beats memory. Tracking symptoms reveals patterns, proves severity, and arms you for doctor visits.
What to Track Daily or Weekly
Rate severity 1-10, note triggers, track patterns over time
Hot flashes (number/severity)
Night sweats
Sleep quality
Energy level
Mood (anxiety, irritability)
Brain fog
Joint pain
Headaches
Period dates/flow
Weight
Exercise
Alcohol/caffeine
Recommended Tracking Apps
Balance
Menopause-Specific
Comprehensive symptom tracking, personalized insights, created by menopause experts. Free tier available.
Caria
Menopause-Specific
Tracks symptoms, provides CBT-based support for mood and sleep. Evidence-based content.
Midday
Menopause-Specific
AI-powered tracking and personalized recommendations. Integrates with health coaches.
Apple Health
General Health
Cycle tracking includes menopause features. Integrates with other health data. Free.
Clue
Cycle Tracking
Excellent for tracking cycle changes in perimenopause. Predicts patterns.
Simple Spreadsheet
DIY Option
A Google Sheet works fine. Columns for date, symptoms, severity. Print for doctor visits.
Pro tip: Before your appointment, summarize 2–4 weeks of tracking into a one-page brief: "I had 8 hot flashes/day averaging severity 7/10, sleep quality 4/10, brain fog daily." Data is hard to dismiss.
Preparing for Your Appointment
Come prepared. You often have 15 minutes. Make them count.
Appointment Checklist
Bring With You
- Symptom tracking summary (2–4 weeks minimum)
- List of all current medications and supplements
- Date of last period and recent cycle patterns
- Family history: menopause age (mother/sisters), heart disease, osteoporosis, breast cancer
- Previous test results if switching doctors
- Written list of your top 3 concerns
Questions to Ask
- "Could these symptoms be related to perimenopause/menopause?"
- "What tests would you recommend to rule out other causes?"
- "What are my treatment options — hormonal and non-hormonal?"
- "Am I a candidate for HRT? What are my specific risks?"
- "When should I get a DEXA scan?"
- "What's my cardiovascular risk and what should I monitor?"
- "Can you refer me to a menopause specialist if needed?"
🔎 Finding the Right Doctor
- NAMS-certified practitioners: Use the directory
- Gynecologists with menopause focus
- Endocrinologists for complex hormone issues
- Functional medicine doctors (often more thorough testing)
- Telehealth menopause clinics: Midi, Evernow, Alloy
If your doctor dismisses your symptoms, find another doctor. You deserve to be heard.
🚩 Red Flags in a Provider
- "Your labs are normal, you're fine" (without addressing symptoms)
- "It's just stress / aging / in your head"
- "HRT is too dangerous" (outdated thinking)
- Unwilling to discuss treatment options
- Rushes through appointment without listening
- Prescribes antidepressants without exploring hormone connection
Self-Advocacy Scripts
What to say when you're not being heard. Use these phrases.
Phrases That Work
I've been tracking my symptoms for X weeks. Here's the data. I'd like to discuss what's causing this.
I understand my labs may be 'normal,' but my symptoms are significantly impacting my quality of life. What else can we explore?
I'd like to discuss hormone therapy. Can you walk me through my individual risks and benefits?
If you're not comfortable treating menopause, can you refer me to someone who specializes in it?
I've read that [X test/treatment] is recommended for women my age. What's your perspective on that for me?
I don't feel my concerns are being addressed. I'd like to understand why you're not recommending further testing/treatment.
Reading Your Own Results
Get Copies
Always request copies of all test results. Patient portals make this easy. Build your own health file.
Optimal ≠ Normal
"Normal" lab ranges are wide. You may feel better with levels in the optimal range. Compare your results to optimal targets, not just reference ranges.
Track Trends
A single result matters less than trends over time. Is your LDL rising? Is your Vitamin D improving with supplementation? Track year-over-year.
Ask Questions
"What does this result mean for me specifically? What should I do about it? When should we retest?" Don't leave confused.
You are the expert on your body. Doctors have medical training. But you know what you're experiencing. A good doctor partners with you; they don't dismiss you. If something feels wrong, keep advocating until you get answers.
✓ Your Testing Action Plan
✓ Get baseline blood work: thyroid, D, B12, ferritin, lipids, glucose
✓ Request Lp(a) test — one-time genetic screen
✓ Schedule DEXA scan at menopause for bone baseline
✓ Download a tracking app and use it for 2+ weeks
✓ Create a one-page symptom summary before your next appointment
✓ Prepare questions and bring them written down
✓ Request copies of all your test results
✓ If dismissed, find a menopause-informed provider