By Dr. Shawna Darou, ND In Functional Medicine / Blood Sugar / Insulin Resistance / Perimenopause

When women reach their 40s and 50s, the conversation around prevention needs to go far deeper than a Pap test and mammogram. These traditional screenings are important — but they only scratch the surface when it comes to long-term health.

This stage of life is when there are often shifts in metabolic health, hormones, cardiovascular health, and inflammation— sometimes with lots of symptoms, and other times more subtly. The key is that if we wait for disease to appear before taking action, we miss the window for prevention.

In functional medicine, we don’t wait. We look for the earliest signs of imbalance and intervene before things progress. These are the tests I recommend for women who want to stay strong, sharp, and vibrant for decades to come.

1. Fasting Insulin and HbA1c: Your Early Warning System for Metabolic Risk

Blood sugar issues often begin years before a diagnosis of prediabetes. Fasting insulin is one of the earliest markers of metabolic dysfunction— and yet it’s rarely checked in conventional care.

Even if your glucose or HbA1 care “normal,” elevated fasting insulin can signal that your body is working overtime to keep blood sugar balanced, especially as estrogen starts to fluctuate or decline. We can gather further information about metabolic health with changes in waist circumference, a drop in HDL cholesterol, and an increase in blood pressure.

Optimal

• Fasting insulin:< 50 pmol/L

• HbA1c:< 5.5%

• Waist circumference:< 35 inches

Learn more about assessing metabolic risk beyond lab tests - Are You Metabolically Healthy?

2. Lipid Panel: Because Cholesterol Shifts with Hormones

Estrogen is cardioprotective, which means when it begins to decline, cholesterol patterns can change quickly. I often see rising LDL, lower HDL, and higher triglycerides in women who previously had perfect cholesterol profiles.

That doesn’t always mean statins are needed — but it does mean we need to pay attention, adjust nutrition, and support cardiovascular health in general. A comprehensive lipid panel can help us assess cardiovascular risk and track how nutrition, lifestyle, and hormonesare influencing your numbers.

If cholesterol and LDL are high, I recommend following with an Apolipoprotein B test to further assess risk.

Learn practical diet strategies that support heart and metabolic health.

Key markers to track

• LDL and HDL cholesterol

• Triglycerides

• Total cholesterol to HDL ratio

• Triglyceride / HDL ratio

• Apolipoprotein B

3. Serum Hormone Testing: A Window Into Estrogen, Progesterone, and Cortisol

We can’t diagnose perimenopause with a blood test, but that doesn’t mean hormone testing isn’t helpful.

Measuring estradiol, progesterone, and morning cortisol gives us insight into how your body is adapting to hormonal shifts. For example:

• Low progesterone is common in the early 40s and can contribute to anxiety, poor sleep, and heavier cycles

• Estrogen fluctuations can impact mood, temperature regulation, and metabolism

• Cortisol gives us clues about your stress response, resilience, and energy regulation

Yes, I agree that hormones are fluctuating month by month, but it can still help to guide treatment. When paired with symptoms and cycle timing, hormone testing helps us design targeted, effective treatment strategies.

4. hs-CRP and Homocysteine: Clues to Inflammation and Cardiovascular Risk

High-sensitivity C-reactive protein (hs-CRP) is a marker of systemic inflammation— and a strong predictor of future cardiovascular events. Elevated homocysteine is linked to poor methylation, brain aging, and heart disease.

These tests go far beyond routine care but offer deep insight into how your body is aging, and how we can support it better.

Optimal ranges

• hs-CRP:< 1.0 mg/L

• Homocysteine:6–9 μmol/L

5. Thyroid Function — Full Panel, Not Just TSH

Thyroid dysfunction is often missed in women because most testing stops at TSH. But perimenopause and thyroid health are closely linked — and early signs of imbalance can be picked up with a full panel.

We look at

• TSH

• Free T3 and Free T4

• Reverse T3

• Anti-TPO and anti-thyroglobulin antibodies

Symptoms like fatigue, weight gain, hair loss, and brain fog shouldn’t be dismissed as “just aging.” A complete thyroid panel helps us dig deeper. (Why Brain Fog is a Metabolic Problem in Perimenopause)

6. DEXA Scan and Waist-to-Height Ratio: Rethinking Body Composition

The scale can’t tell you how much muscle you’re holding or where fat is accumulating. That’s why DEXA scans are so useful — they show us lean mass, visceral fat, and bone density all at once.

Even without access to a DEXA scan, waist-to-height ratio is one of the most powerful predictors of future metabolic risk.

Target ranges

• Waist-to-height ratio: < 0.5

• Bone density: watch for early signs of osteopenia, especially postmenopause

Prevention Starts With Looking Deeper

Your 40s and 50s are not the time to coast. This is the window where early changes in metabolic health, hormones, and inflammation can either take root or be reversed. But we can’t change what we don’t see.

What’s Next?

If you’re ready to take a more proactive approach to health screening, this is exactly the kind of work we do in practice. Looking deeper at blood sugar, cholesterol, hormones, thyroid, inflammation, and body composition can help us identify the earliest signs of imbalance and create a plan that is truly personalized to you.

If this article resonates with you, and you want to take a closer look at what’s going on beneath the surface, please ask at your next appointment. Let’s uncover the root causes and create a plan to help you feel your best now — and protect your health for the decades ahead.

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FAQs: Women’s Preventive Health Screening in Your 40s and 50s

What health tests should women over 40 consider beyond a Pap test and mammogram?

Beyond a Pap test and mammogram, women over 40 may benefit from screening fasting insulin, HbA1c, cholesterol, Apolipo protein B, hormones, thyroid markers, hs-CRP, homocysteine, and body composition markers like waist-to-height ratio or DEXA scan.

Why is fasting insulin important in perimenopause?

Fasting insulin is one of the earliest markers of metabolic dysfunction and can become elevated long before blood sugar or HbA1c show a problem. This is especially relevant during perimenopause, when changing estrogen levels can affect blood sugar regulation and weight gain.

What are the best blood tests for women in their 40s and 50s?

Some of the most helpful blood tests for women in midlife may include:

• Fasting insulin

• HbA1c

• Lipid panel

• Apolipoprotein B

• Estradiol and progesterone

• Cortisol

• Thyroid panel

• hs-CRP

• Homocysteine

• Vitamin and nutrient testing

These tests can help assess metabolic health, hormones, cardiovascular risk, and inflammation.

Should women in perimenopause have hormone testing?

Yes — while perimenopause is not diagnosed by blood work alone, hormone testing can still be helpful. Looking at estradiol , progesterone, and cortisol can offer useful information when interpreted alongside symptoms and cycle timing.

What is the best thyroid test for women over 40?

A more complete thyroid panel is often more helpful than TSH alone. This may include:

• TSH

• Free T3

• Free T4

• Reverse T3

• Anti-TPO antibodies

• Anti-thyroglobulin antibodies

This can help uncover early thyroid imbalance, especially when symptoms like fatigue, hair loss, brain fog, or weight gain are present.

Why are hs-CRP and homocysteine important for women’s health?

hs-CRP helps assess systemic inflammation, while homocysteine is linked to cardiovascular risk, methylation, and brain aging. These markers can provide valuable insight into long-term health and prevention.

What is the best way to assess body composition in midlife?

ADEXA scan is one of the most useful tools for assessing muscle mass, visceral fat, and bone density. If that’s not available, waist-to-height ratio is still a very helpful and practical marker for assessing metabolic risk.

References

1. Tabák AG, Herder C, Rathmann W, Brunner EJ, Kivimäki M.Prediabetes: a high-risk state for diabetes development.Lancet. 2012;379(9833):2279–2290.

2. Maas AHEM, Rosano GMC, Cifkova R, et al.Cardiovascular health after menopause: A position statement from the European Society of Cardiology.Eur Heart J. 2021;42(11):997–1008.

3. Taylor PN, Albrecht D, Scholz A, et al.Global epidemiology of hyperthyroidism and hypothyroidism.Nat Rev Endocrinol. 2018;14(5):301–316.

4. Ridker PM.C-reactive protein and the prediction of cardiovascular events among those at intermediate risk: moving an inflammatory hypothesis toward consensus.J Am Coll Cardiol. 2007;49(21):2129–2138.

5. Ashwell M, Gibson S.Waist-to-height ratio as an indicator of ‘early health risk’: simpler and more predictive than using a ‘matrix’ based on BMI and waist circumference.BMJ Open. 2016;6(3):e010159.

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