Perimenopause Lab Tests

Integrative lab testing helps identify early metabolic, cardiovascular, nutrient, and hormonal changes in perimenopause. Using optimal ranges and personalized analysis, TārāMD uses labs to guide prevention, support symptoms, and shape long-term health.

By Suzanne Fenske, MD, FACOG, ABOIM, MSCP

Perimenopause Lab Tests

Perimenopause is an incredible opportunity to shape your future health, and integrative lab testing can help.

Lab tests help us identify early signs of dysfunction (such as insulin resistance, inflammation, and nutrient deficiencies) so we can prevent chronic disease down the road. Additionally, lab work helps us capture a baseline so we can observe changes over time. Baseline labs, including hormone tests, are invaluable during transitions such as perimenopause.

Keep reading as we discuss our integrative approach to perimenopause and why lab testing is so important, along with recommended labs for perimenopausal women.

Integrative Perimenopause Lab Testing

Integrative medicine uses tools from both Western and holistic medicine. TārāMD

offers standard lab testing such as an annual CBC (complete blood count) and CMP (comprehensive metabolic panel), as well as additional evidence-based, advanced, and functional tests.

There isn’t a single lab test to diagnose perimenopause. Still, labs discussed in this article (along with any additional personalized recommendations from your TārāMD provider) help us fully assess your health.

From an integrative perspective, we always work to put lab data in the context of your health history, symptoms, and goals. We don’t treat the lab number; we treat the whole person. We strive to have long relationships with our patients, and labs help us monitor your health and progress over time.

We don’t just look at labs when something is wrong, searching for a diagnosis; our integrative approach focuses on health optimization and prevention. When we evaluate lab results, we often use a tighter, more optimal range (also called the functional range) rather than the wide standard lab range provided by the lab. Viewing labs through this lens supports health optimization.

Let’s look at specific lab tests we order at TārāMD. Many of these labs are helpful at any life stage, but we’ll highlight why they are important in perimenopause.

Metabolic Health

In perimenopause, declining hormones decrease insulin sensitivity. It’s during this life phase when insulin resistance may begin, affecting fat storage, body composition, blood sugar balance, inflammation, and cardiovascular health.

Recommended tests:

Fasting glucose – Fasting glucose is included in a standard CMP panel and tells us your baseline blood sugar value for the day before eating. An increasing value over time may point to insulin resistance, metabolic syndrome, or prediabetes.

Hemoglobin A1C – Provides a 3-month average blood sugar estimate. An elevated value signals prediabetes or diabetes.

Fasting insulin – Rising insulin levels may be the first sign of insulin resistance, even when blood sugar looks normal. Rates of insulin resistance in perimenopausal women in the US have increased over the last 20 years.

Learn more and discover action steps in these articles:

Cardiovascular Health

Heart disease is the number one cause of death for women in US. Risk increases post-menopause without the protective benefits of estrogen and other hormones.

Lipid panel – This standard screening Measures total cholesterol, LDL (low-density lipoprotein), HDL, and triglycerides to provide important clues about lipid metabolism and cardiovascular risk. Advanced lipid panels also measure particle size and density to provide more information.

Apolipoprotein B (Apo B) – This molecule is found in LDL and other lipoproteins. It provides a direct measure of circulating lipids and risk of atherosclerosis. Atherosclerosis is an inflammatory process in which plaque builds up in the arteries, which may lead to blockages.

Lipoprotein (a) – Is another lipoprotein molecule where higher levels correlate with atherosclerosis and cardiovascular risk.

High sensitivity C-reactive protein (Hs-CRP) – Is a biomarker of inflammation and suggests widespread chronic inflammation in the body, which can affect the cardiovascular system.

Homocysteine – Is part of the biochemical cycle, called the methylation cycle, which generates methyl groups so the body can make glutathione, creatine, and other molecules. High levels are associated with cardiovascular risk and may also suggest a vitamin B12 or folate deficiency.

Learn more and discover action steps in these articles:

Nutrients

Nutrient deficiencies in perimenopause may reduce metabolic function and exacerbate hormonal symptoms. Blood tests are an effective way to measure specific nutrients of interests. Nutrients that we frequently check include:

Vitamin D (25-hydroxy)
Vitamin B12
Folate
Iron (total iron, iron binding capacity, ferritin)
Magnesium
Zinc
Omega 3s

Learn more and discover action steps in these articles:

Hormones

Measuring hormone levels in the blood helps us evaluate hormonal changes during perimenopause and provide supportive tools. In women using bioidentical hormone replacement therapy (BHRT), testing allows us to optimize and monitor levels.

Follicle Stimulating Hormone (FSH) – Is a brain hormone that signals the ovaries to produce follicles and estrogen for ovulation and reproduction. In perimenopause, FSH levels rise, predicting menopause and correlating with symptoms and chronic disease risk.

Estradiol – Estradiol is the primary estrogen during the reproductive years and what we use in estrogen replacement therapy with our patients. During perimenopause, estrogen levels can wildly fluctuate at first and then decrease as menopause approaches.

Progesterone – Progesterone is produced by the ovaries after ovulation, so we measure it during the luteal phase of the menstrual cycle. Progesterone is typically one of the first hormones to decline in perimenopause.

Testosterone – Testosterone doesn’t necessarily decline with perimenopause like estrogen and progesterone, but it does decrease with age and contribute to hormonal symptoms. Evaluating testosterone and other androgens, including DHEA, is an essential piece of comprehensive women’s care.

Thyroid panel – Perimenopausal hormone changes can affect thyroid hormone levels and even trigger autoimmune thyroid issues. We recommend a full thyroid panel, including at least TSH, free T4, free T3, and thyroid antibodies.

Learn more and discover action steps in these articles:

Functional Tests

All the blood tests we’ve mentioned so far are available through standard labs such as Labcorp or Quest, are widely available, and often covered by insurance. Specialty labs offer functional tests and help us gather information to identify underlying root causes of symptoms and diseases. These tests are a hallmark tool of integrative and functional medicine, allowing us to personalize care. A couple tests that we may order for patients in our clinic include:

Comprehensive stool analysis – Provides markers of digestive health, microbiome balance, gut infections, and more.

Comprehensive hormone testing – Typically urine or saliva tests that look at hormones (stress and sex hormones) and their metabolites for a full picture of hormonal levels, daily or monthly patterns, and hormone detoxification.

Learn more and discover action steps in these articles:

Imaging

Perimenopausal women need to begin thinking about imaging as part of their preventative care plans. At TārāMD, we follow clinical guidelines and may also suggest additional, earlier, or more frequent imaging for an individual patient.

Breast Imaging – In addition to annual mammograms, some women may benefit from screening breast ultrasounds or breast MRIs.

DEXA Bone Density Scan – Is the gold standard for assessing bone mineral density, osteopenia, and osteoporosis. Some DEXA scans also provide body composition data. Your insurance may not cover DEXA until age 65, but we recommend it earlier when there is more time to counter age-related bone loss.

Learn more and discover action steps in these articles:

Personalized Care

Lab tests don’t mean much without the thoughtful analysis of an integrative MD. At TārāMD, labs are one tool in our toolkit, and we always put the results in the context of the patient in front of us to provide genuine, integrative, personalized care.

It’s January, a new year. Have you scheduled your annual wellness exam yet? If not, now is the time.

References

Hulteen, R. M., Marlatt, K. L., Allerton, T. D., & Lovre, D. (2023). Detrimental Changes in Health during Menopause: The Role of Physical Activity.International journal of sports medicine, 44(6), 389–396.
Chedraui, P., & Pérez-López, F. R. (2019). Metabolic syndrome during female midlife: what are the risks?.Climacteric : the journal of the International Menopause Society, 22(2), 127–132.
Xi, X., Pei, C., & Song, N. (2025). Prevalence of and trends in obesity and insulin resistance among US perimenopausal women, 2003-2023.Menopause (New York, N.Y.), 10.1097/GME.0000000000002612. Advance online publication.
Singh, K., & Prabhakaran, D. (2024). Apolipoprotein B - An ideal biomarker for atherosclerosis?.Indian heart journal, 76 Suppl 1(Suppl 1), S121–S129.
MacDougall, D. E., Tybjærg-Hansen, A., Knowles, J. W., Stern, T. P., Hartsuff, B. K., McGowan, M. P., Baum, S. J., Wilemon, K. A., & Nordestgaard, B. G. (2025). Lipoprotein(a) and recurrent atherosclerotic cardiovascular events: the US Family Heart Database.European heart journal, 46(44), 4762–4775.
Doumatey, A. P., Zhou, J., Adeyemo, A., & Rotimi, C. (2014). High sensitivity C-reactive protein (Hs-CRP) remains highly stable in long-term archived human serum.Clinical biochemistry, 47(4-5), 315–318.
Ganguly, P., & Alam, S. F. (2015). Role of homocysteine in the development of cardiovascular disease.Nutrition journal, 14, 6.
Spicer, J., Malaspina, D., Blank, S. V., & Goosens, K. A. (2025). Follicle-stimulating hormone: More than a marker for menopause: FSH as a frontier for women's mental health.Psychiatry research, 345, 116239.