Brooke Davis, owner of Elysian Women’s Wellness, dives into the challenges women face during perimenopause, particularly regarding the importance of proper lab testing to understand hormonal changes and overall health. Brooke emphasizes the need for women to advocate for themselves in the healthcare system, providing insights into key hormones and blood markers that should be tested. The discussion also covers how to effectively communicate with healthcare providers to ensure that necessary tests are ordered, empowering women to take control of their health during this transitional phase.

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Today’s topic is one that I know so many of you have struggled with and that is getting the right labs ordered in perimenopause.

You’ve probably been there. You’ve explained your symptoms—fatigue, weight gain that won’t budge, brain fog, or mood swings—only to hear, “That’s just part of getting older” or, “Your labs are normal.” It’s frustrating, dismissive, and leaves you feeling stuck.

Here’s the reality: we know your hormones are inconsistent right now and causing some of the issues – but it’s not the whole picture and understanding what’s happening inside your body during perimenopause is essential to taking control of your health and symptoms. But for so many women navigating the healthcare system and advocating for the right tests can feel like an uphill battle. 

Which is one of the reasons I am so excited to officially announce that along with all of the functional labs we offer, we can now order blood labs!  Of course, we do not replace a licensed healthcare provider – but if for whatever reason, whether you don’t have insurance or you don’t have a doctor that you feel like is supporting your health and wellness the way you need, or you just want to bypass the conventional disease care model –  we can help fill that gap!  You are able to use HSA & FSA for payments as well for any of our services at this point which is such amazing progress in the field of true wellness! 

Regardless though of whether you’re going to work with us or go the route of your doctor we want to be here to help support you through that so today we’re breaking down:

• The most valuable blood labs to get done that if you have it, most insurances should cover as preventative care
• When to get them done
• And how to approach the conversation with your doctor.

This episode is all about empowering you to advocate for yourself and giving you the tools to take the next step toward better health—even if it means seeking alternatives outside of traditional healthcare, so without further adieu. 

Estradiol

Estradiol is the main form of estrogen, and it’s a key player in regulating your menstrual cycle, bone health, mood, and even skin elasticity. During perimenopause, estradiol levels can fluctuate wildly—some days high, other days low. These ups and downs can lead to symptoms like irregular periods, hot flashes, mood swings, and more. Testing estradiol helps us see where you are in the hormonal transition and create strategies to balance it for better overall well-being.

Progesterone

Progesterone is often called the “calming hormone” because it supports sleep, reduces anxiety, and balances the effects of estrogen. In perimenopause, progesterone is often the first hormone to decline, which can lead to symptoms like insomnia, irritability, and heavier periods. Testing progesterone levels gives insight into whether you might need support to restore balance, especially if you’re feeling overwhelmed or having trouble winding down.

The best times to test for estrogen and progesterone are going to be days 19-21 in a 28 day cycle, or 5-7 days after ovulation, adjusted for if you REGULARLY have a longer or shorter cycle.  If you don’t have a regular cycle you can do ovulation testing, basal body temperature tracking and test at the appropriate time based on that.  So make sure to plan your blood draw around that time if you plan to test for these.  Also keep in mind that a lot of times doctors will argue you don’t need to test for this etc.  This is not a diagnostic test, and your levels WILL fluctuate throughout the month, and over the months as you’re going through perimenopause – that being said, you can still potentially draw some clues about your health and ways to further support your body by knowing where these are when they’re supposed to be “at their peak”.

Testosterone

Yes, women have testosterone, too! It plays a role in libido, muscle maintenance, energy, and mood. In perimenopause, testosterone levels can dip, leading to symptoms like low sex drive, fatigue, and even difficulty building or maintaining muscle. Testing your testosterone levels is essential for understanding whether low levels are contributing to these challenges and if targeted interventions can help. 

Cortisol

Cortisol is your primary stress hormone, produced by the adrenal glands. It has a natural rhythm so it’s highest in the morning to help you wake up and lower in the evening to get ready for sleep. Of course, in perimenopause, stress and hormonal changes can throw this rhythm off, leading to fatigue, sleep issues, and even weight gain, especially around the midsection. Most doctors will only test cortisol with blood – which gives you honestly a very vague idea of what’s actually going on with your cortisol.  If you test with blood I’d suggest an AM reading between 8–10 AM when it should be the highest, and if that is off then you want to dig a little deeper.  Ideally, you’d want to test this with saliva throughout the day, to see the diurnal pattern and see WHERE your cortisol is off vs just the one blood point in the day.  Blood also shows us TOTAL cortisol vs saliva will show us usable vs total and if you use the DUTCH test will show metabolized cortisol as well giving us more insight into how your body is making it, using it and processing it. This will tell us if stress management or adrenal support might be needed to help you feel more balanced.

DHEA (Dehydroepiandrosterone)

DHEA is another hormone produced by your adrenal glands and this is a precursor to both testosterone and estrogen, so that means your body uses it to make these two main sex hormones – which is partly why stress management throughout perimenopause is SO important.. In perimenopause, DHEA levels can decline, which contributes to fatigue, low libido, and reduced ability to handle stress. Testing DHEA really can give a broader picture of adrenal health and a lot more of why your body is struggling to produce the hormones it needs and how you can support it.

These hormone markers are critical for understanding how your body is adapting to the hormonal shifts of perimenopause. Testing them provides insight into your symptoms and helps create a tailored plan to bring your body back into balance, so despite what your doctor says – in my opinion, along with a lot of other functional practitioners and even some conventional doctors it is important to have a picture of this even knowing that it will be fluctuating.

Next up we have more blood markers that are very commonly used for wellness checks and regular screening for disease, which again can just provide more insight into which areas of your body need a little extra support and possibly targeted supplementation.

Comprehensive Metabolic Panel (CMP)

The Comprehensive Metabolic Panel, or CMP, is basically a snapshot of how your body is functioning overall. It has markers for liver and kidney health, blood sugar, and electrolytes. In perimenopause, your liver is working hard to process and eliminate excess hormones, like estrogen, so understanding its function is critical. The kidney markers can give insight into hydration and overall metabolism. If something is off here, it could affect how well your body handles hormonal changes during perimenopause.

Metabolic and Liver Markers

1. Glucose (fasting): 75–85 mg/dL
   • Higher levels may indicate insulin resistance, while lower levels can signal hypoglycemia.
2. BUN (Blood Urea Nitrogen): 12–16 mg/dL
   • Optimal values reflect proper kidney function and protein metabolism.
3. Creatinine: 0.6–0.9 mg/dL
   • This reflects kidney filtration efficiency and muscle metabolism.
4. AST (Aspartate Aminotransferase): 10–25 U/L
   • Optimal levels indicate healthy liver function.
5. ALT (Alanine Aminotransferase): 10–25 U/L
   • Higher levels may suggest liver stress, even within normal lab ranges.

Complete Blood Count (CBC)

The CBC looks at your red and white blood cells, as well as platelets. It tells us if you might be dealing with anemia, infections, or even inflammation. For women in perimenopause, this is especially important because heavy or irregular periods are common, which can lead to low red blood cells or iron levels. If you’re feeling fatigued or weak, the CBC could possibly help uncover contributing factors outside of hormone imbalance.

6. Red Blood Cell (RBC) Count: 4.1–4.5 million/microliter
   • Too low can indicate anemia, while too high may signal dehydration or other issues.
7. White Blood Cell (WBC) Count: 5,000–8,000 cells/microliter
   • Lower or higher levels could indicate immune dysregulation.
8. Hematocrit: 37–42%
   • Reflects the percentage of blood composed of red blood cells; values outside this range may indicate anemia or dehydration.
9. Hemoglobin: 13–14.5 g/dL
   • Indicates oxygen-carrying capacity; lower levels may suggest iron or B12 deficiency.

Lipid Panel (Cholesterol and Triglycerides)

This test checks your cholesterol levels—both HDL (the “good” cholesterol that has protective properties) and LDL (the “bad” cholesterol)—as well as triglycerides, which are fats in your blood. During perimenopause, hormonal shifts can really impact your cholesterol levels, potentially increasing your risk of heart disease. Keeping an eye on these markers helps you take proactive steps to protect your cardiovascular health as you age. 

HDL (High-Density Lipoprotein): equal to or greater than 70 mg/dL

LDL (Low-Density Lipoprotein): less than 90 mg/dL (or <70 mg/dL for high-risk individuals)

Triglycerides: less than 70 mg/dL

This last one is a fairly uncommon and newer marker that health professionals are finding important when it comes to cardiovascular health and that is Apolipoprotein B (ApoB).  LDL is just one type of low density lipoprotein in the blood, the others are very low density lipoprotein, intermediate density lipoprotein, and lipoprotein(a) – but there is an apo b particle in each of those so it really gives a better overall indication of cardiovascular risk than just LDL alone. 

Optimal ApoB levels are typically below 90 mg/dL for low-risk individuals and below 70 mg/dL for women at higher risk of cardiovascular disease.

Hemoglobin A1C

There is glucose testing in the CMP, but this is just a single snapshot.  A1C This is your average blood sugar levels over the past 2-3 months. Hormonal changes through perimenopause can make you more insulin resistant, which means your body has a harder time processing sugar and keeping blood sugar levels stable. Elevated A1C levels can indicate prediabetes or diabetes, both of which can affect energy, weight, and even how your hormones are functioning. Optimally we want to see it between 4.8–5.3%.  Prediabetes: 5.7% and 6.4% Diabetes: A1C of 6.5% or higher

Full Thyroid Panel

This is an insanely common cause of fatigue in perimenopause that a lot of doctors are completely overlooking.  Often times, even if they do run a thyroid panel they will leave out reverse T3, which is actually a very important marker so personally I would be very specific and ask for a full thyroid panel which includes TSH (thyroid-stimulating hormone, this is a main marker that tell us the thyroid is being properly signaled by the pituitary gland to produce thyroid hormones.  This doesn’t mean that it is, but it means that that signal pathway is working well. We want to see this at 0.5–2.0 μIU/mL.

Free T3 or triiodothyronine (tri-aye-o-doh-thyronine) this is the active and usable form of thyroid hormone which we want to see between 3.4 – 4.4 pg/mL.  

Free T4 is the available but inactive thyroid hormone that needs to be converted to T3 and we ideally want that between 1.4 – 1.8 Nanograms per deciilitre. 

Next we have reverse T3 and is a byproduct of thyroid hormone metabolism.  It is inactive and it can actually act as kind of a brake to the thyroid which usually happens when someone is super sick but can also become an issue with chronic stress, or cortisol dysregulation, extreme dieting, low iron levels, or diabetes. Anything higher than 15 ng/dL and/or a ratio of T3 to RT3 greater than 10 could tell us that there is reduced thyroid hormone conversion taking place causing a slowed thyroid function.  This would also tell us that someone would actually need a replacement of T3, vs the most commonly prescribed T4 of levothyroxine or a combo.  

TPO (Thyroid Peroxidase Antibodies) and Anti Thyroglobulin antibodies are two markers that can help identify an autoimmune component to any thyroid issues. We want to see TPO less than <9 IU/mL and Anti-Thyroglobulin Antibodies less than 4 IU/mL.  Anything above this could suggest hashimotos. 

This test goes beyond the basic thyroid check and gives a deeper look at how your thyroid is functioning. The thyroid regulates your metabolism, energy, and even mood. In perimenopause, thyroid issues often arise or worsen, so knowing if your thyroid is underactive or overactive can be life-changing for your health.

Then we have an anemia panel Which checks for different types of anemia which is when the body doesn’t have enough healthy red blood cells. This will include iron, ferritin (which is your body’s iron storage), folate and b12.  Folate and B12 are needed for red blood cell production. Perimenopause often brings cycles of heavier periods or changes in your body’s ability to absorb nutrients, which can lead to deficiencies so testing for these markers is important. If you are constantly tired, lightheaded, or dealing with hair loss, this panel might give you a missing piece of the puzzle.

Iron: 85–130 mcg/dL

Ferritin: 50–100 ng/mL

Folate: ≥15 ng/mL

Vitamin B12: 800–900 pg/mL

Next we have some inflammatory markers.  Inflammation is the body’s natural response to injury or illness, but when it becomes chronic, it can contribute to various health issues, including heart disease, insulin resistance, and even hormone imbalances. Then in perimenopause, this chronic inflammation can worsen some of the symptoms like fatigue, joint pain, and weight gain, so this is definitely something we want to take a look at and address if needed.

High-Sensitivity C-Reactive Protein (HsCRP)

HsCRP is a blood marker that measures inflammation throughout the body. It is especially useful for detecting low-grade, chronic inflammation that might not cause noticeable symptoms.

High levels could indicate an inflammatory response tied to things like cardiovascular disease, metabolic syndrome, or even autoimmune issues, all of which are more common during perimenopause.

Typically we want to see C reactive protein below 1.0 mg/L, while levels above 3.0 mg/L might be a sign of increased risk for cardiovascular issues. 

Erythrocyte Sedimentation Rate (ESR)

This measures how quickly red blood cells settle at the bottom of a test tube. Faster rates can indicate inflammation in the body.

This marker is a little less specific with what’s happening in the body than HsCRP, so using it alongside c reactive protein can just help confirm the indication of chronic inflammation. It points more toward systemic inflammation linked to conditions like arthritis, even infections, or chronic diseases, all of which can overlap with the challenges of perimenopause.

Normal ESR values do vary by age but are typically under 20 millimeters per hour for women. Anything higher would need to be looked into a little deeper.

Next are just some individual micronutrient markers that are commonly low but really important for a lot of different functions in the body.

Vitamin D 25-hydroxy

While vitamin D is important for bone health, as it helps with calcium absorption it’s not JUST for bone health—it plays a huge role in regulation of estrogen and progesterone which impact your mood, and even immune support. About 50% of women are deficient in vitamin D so when you couple that with perimenopause or hormone dysregulation it can worsen fatigue, joint pain, and even symptoms of depression. Luckily, a really simple test can tell if you need to supplement to bring your levels back to optimal.  This is something I know a lot of people supplement with before testing, which again for MOST people should be fine – but keep in mind that because it is a fat soluble vitamin, and can actually even act as a hormone, there is danger for toxicity build up – best to just get tested.  50–80 ng/mL

Then we have Zinc

Zinc is a trace mineral that helps with immune function, wound healing, and even hormone production. It’s also essential for balancing cortisol levels, something that becomes so important during perimenopause. Low zinc levels might show up as slower healing, getting sick often, or even issues with taste and smell. 90–120 mcg/dL

Magnesium

Magnesium is a major mineral that supports over 300 processes in the body, including muscle function, stress response, and sleep. It also helps regulate blood sugar and hormone balance. Despite the importance of this mineral, over 50% of the population is low, and stress during perimenopause often makes this deficiency even worse.  Testing your levels can help determine if you need to supplement, but the best way to test is within the Red blood cells. Pure serum levels will tell you what’s in the blood – but not necessarily getting used by the cells.  We want to see this between 5.5–6.5 mg/dL

Now how can you approach this conversation with your doctor?

Advocating for your health starts with being prepared and proactive. If you want to request labs like these, it’s important to communicate your concerns effectively and navigate the conversation with confidence. 

So first off – I would suggest keeping a journal of your symptoms

Before scheduling your appointment, spend at least 1–2 weeks but over a month or two would be amazing –  tracking your symptoms. Include:

• Physical symptoms like fatigue, weight gain, hair loss, or joint pain.
• Emotional changes like mood swings, anxiety, or irritability.
• Timing and triggers of symptoms, such as whether they worsen after meals or during specific times of your menstrual cycle. You should also be keeping track of your menstrual cycle if you’re not already.

This is not only invaluable in terms of treatment and tracking progress with whatever intervention you use but also that you’re paying attention to your body and provides objective information to guide the conversation.

Number 2:

When talking with your doctor, be clear about why you want these specific labs. Frame your request in terms of identifying underlying causes and improving your overall health. For example:

• “I’ve noticed a lot of fatigue and trouble losing weight, and I’d like to check my thyroid and hormone levels to see if they’re contributing to these issues.”

You can mention how comprehensive lab testing aligns with the current guidelines for preventive care and hormonal health, specifically in women approaching menopause.

Number 3, be assertive – but also collaborative.  You don’t want to just walk in barking orders. 

Come to the conversation as a partnership with your doctor, because ultimately that’s what it should be. Using verbiage like

• “I really value your opinion and would like your guidance on exploring some of these labs to rule out underlying issues.”
• “I’ve done some research, and these labs seem relevant based on my symptoms. What do you think?”

This shows that you’re respecting their expertise and knowledge but also are advocating for yourself. 

Then, if your doctor says no for whatever reason, stay calm and explore alternatives:

1. You can Ask for an Explanation:
   • “Can you help me understand why these tests aren’t necessary at this time?”
     Maybe they have something else, or want to start somewhere else – which might also be fine to begin with.
2. Offer to Self-Pay:
   Sometimes doctors hesitate to order tests because of insurance so if you’re able to let them know you’re willing to pay out-of-pocket if necessary.
3. 
   If they won’t order the full panel, ask if they’d consider ordering a few key tests based on your symptoms, such as TSH and Free T3 for thyroid health or an iron panel for fatigue.
4. Go for a second opinion, get a new doctor, or work with someone like us along side your current care.
   If your doctor stands their ground, personally I would find a new doctor but obviously you have the right to seek another opinion or care elsewhere.  There are tons of telehealth options at this point, functional practitioners like us who are willing to support your health in the best ways without constraints of insurance.  

Remember, your health is a priority, and you deserve answers. Reiterate your goal of identifying the root cause of your symptoms, not just treating them superficially.

A final approach could be:

• “I want to be proactive about my health, especially as I approach menopause. These labs feel like an important step to understand what’s going on. If you’re unable to order them, could you recommend someone who can?”

Being informed and prepared will help you feel confident in navigating this conversation, even if it doesn’t go as planned.

As we wrap up today’s deep dive into the most impactful blood labs for perimenopausal women, I want to leave you with this: your health is in your hands. While navigating perimenopause can feel really overwhelming at times, understanding what’s happening in your body and using tools like these lab markers gives you the power to take back control. These tests don’t just provide answers—they actually open the door to solutions tailored to your unique needs.

This phase of life isn’t about just getting through; it’s about thriving in a way that honors your body and sets you up for long-term wellness. You deserve to feel vibrant, balanced, and strong—and the right testing is often the first step to making that a reality.

If you’re ready to dive deeper, we’ve compiled this entire list and so much more into the Midlife Mastery Guide, which we have designed to help you navigate this journey with clarity and confidence. You’ll find the link in the show notes.

Coach Brooke Davis Links:

Website: elysianwomen.org   

LinkedIn: Brooke Davis – Owner – Davis Fitness

Facebook: Brooke Davis, CPT 

Instagram: Brooke Davis  (@brooke_elysian)

Free Community: Women’s Fitness Simplified: Lean down, tone up, build confidence!

Take Our Free Hormone Analysis: https://brookedavis.typeform.com/to/quKUjmTI

Book a Discovery Call: https://scheduler.zoom.us/brooke-davis-mjzn71/discovery-call

Midlife Mastery Guide: https://www.canva.com/design/DAGXuYM0ixY/pgk1Th7jfh6fAlY5q-Xyjw/view?utm_content=DAGXuYM0ixY&utm_campaign=designshare&utm_medium=link&utm_source=editor