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Women's Metabolic Clarity · Topic 9 of 15

Bloodwork: What to Ask For

'Normal labs' do not always mean you feel normal. Let's understand why.

Educational disclaimer: This content is for education only. It is not medical advice, diagnosis or treatment. Pinnacle Coordinated Wellness is an education-first coordination layer, not a medical office, and Dr. Pat Pachciarz® is not a clinician. Nothing here is a protocol, dose or promise of results. Always talk with your own licensed clinician before making any health change. If you have chest pain, trouble breathing, thoughts of self-harm, or another emergency, call 911 (or call or text 988 for mental health crisis support).
On this page
  1. Why do I feel awful when my labs are 'normal'?
  2. Should I get my hormones tested?
  3. What labs might I ask about in midlife?
Question 25 of 45

Why do I feel awful when my labs are 'normal'?

Short answer

  • Lab 'normal' ranges cover most healthy people. They do not show how you feel.
  • Many menopause symptoms do not show up in blood tests at all.
  • Menopause is mostly diagnosed by age and symptoms, not one blood test.
  • Your symptoms are real data. Write them down.

What to look out for

  • Being dismissed because labs are normal.
  • Only one test taken, with no trend.
  • Symptoms that are getting worse.

Top 3 things to act on or ask your clinician

  1. Bring a symptom log: sleep, hot flashes, mood, periods, energy.
  2. Ask: 'What else could explain how I feel?'
  3. Ask: 'Can we look at my trends over time?'
Sources for this answer
  1. Peer-reviewed Harlow SD et al. Executive summary of the Stages of Reproductive Aging Workshop + 10: addressing the unfinished agenda of staging reproductive aging. Menopause. 2012;19:387-95. PMID: 22343510. DOI: 10.1097/gme.0b013e31824d8f40
  2. Peer-reviewed Stuenkel CA et al. Treatment of Symptoms of the Menopause: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2015;100:3975-4011. PMID: 26444994. DOI: 10.1210/jc.2015-2236
  3. Peer-reviewed The North American Menopause Society (now The Menopause Society). The 2022 hormone therapy position statement of The North American Menopause Society. Menopause. 2022;29:767-794. PMID: 35797481. DOI: 10.1097/GME.0000000000002028
  4. Expert commentary, not research Dr. Mary Claire Haver (OB/GYN): The New Menopause (book, Rodale, 2024)
Question 26 of 45

Should I get my hormones tested?

Short answer

  • During perimenopause, hormone levels swing day to day. One test may not mean much.
  • Guidelines say FSH and estrogen tests are usually not needed to diagnose menopause in women over 45 with typical symptoms.
  • Testing can help in some cases, like early menopause or unclear symptoms.
  • Saliva and at-home panels are not supported by society guidance for diagnosis or treatment.

What to look out for

  • Expensive panels that promise answers.
  • Treatment based only on a hormone number.
  • Symptoms before age 40 (ask about early menopause).

Top 3 things to act on or ask your clinician

  1. Ask: 'Would hormone testing change my care?'
  2. Ask: 'Which tests do you recommend for me, and why?'
  3. If under 40-45 with symptoms, ask about early menopause checks.
Expert vs. evidence: Gary Brecka promotes detailed hormone panels (non-clinical opinion). Society guidance favors diagnosis by age and symptoms. We go with society guidance.
Sources for this answer
  1. Peer-reviewed Harlow SD et al. Executive summary of the Stages of Reproductive Aging Workshop + 10: addressing the unfinished agenda of staging reproductive aging. Menopause. 2012;19:387-95. PMID: 22343510. DOI: 10.1097/gme.0b013e31824d8f40
  2. Peer-reviewed Stuenkel CA et al. Treatment of Symptoms of the Menopause: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2015;100:3975-4011. PMID: 26444994. DOI: 10.1210/jc.2015-2236
  3. Peer-reviewed The North American Menopause Society (now The Menopause Society). The 2022 hormone therapy position statement of The North American Menopause Society. Menopause. 2022;29:767-794. PMID: 35797481. DOI: 10.1097/GME.0000000000002028
  4. Expert commentary, not research Dr. Mary Claire Haver on Huberman Lab: How to Navigate Menopause & Perimenopause for Maximum Health & Vitality (podcast episode, June 2024)
  5. Expert commentary, not research Dr. Sara Gottfried on Huberman Lab: How to Optimize Female Hormone Health for Vitality & Longevity (podcast episode, Jan 2023)
  6. Non-clinical wellness opinion, not research Gary Brecka, The Ultimate Human, Ep. 227: Menopause: Symptoms, Hormones, Tests & Solutions (podcast episode, Dec 2025)
Question 27 of 45

What labs might I ask about in midlife?

Short answer

  • Every woman is different. Your clinician decides what fits you.
  • Common midlife labs include a lipid panel, fasting glucose or A1C, TSH, and a blood count.
  • Some women also ask about iron, vitamin D or B12, depending on symptoms.
  • Bone density scans are advised at 65, or sooner with risk factors.

What to look out for

  • No lipid or sugar check in several years.
  • Heavy periods (ask about iron and blood count).
  • Family history of early heart disease.

Top 3 things to act on or ask your clinician

  1. Ask: 'Which labs are right for me this year?'
  2. Ask: 'Do I need a bone density scan?'
  3. Ask: 'What are my numbers and trends?'
Sources for this answer
  1. Peer-reviewed El Khoudary SR et al. Menopause Transition and Cardiovascular Disease Risk: Implications for Timing of Early Prevention: A Scientific Statement From the American Heart Association. Circulation. 2020;142:e506-e532. PMID: 33251828. DOI: 10.1161/CIR.0000000000000912
  2. Peer-reviewed American Diabetes Association Professional Practice Committee. 2. Diagnosis and Classification of Diabetes: Standards of Care in Diabetes-2024. Diabetes Care. 2024;47:S20-S42. PMID: 38078589. DOI: 10.2337/dc24-S002
  3. Peer-reviewed US Preventive Services Task Force. Screening for Osteoporosis to Prevent Fractures: US Preventive Services Task Force Recommendation Statement. JAMA. 2018;319:2521-2531. PMID: 29946735. DOI: 10.1001/jama.2018.7498
  4. Peer-reviewed Garber JR et al. Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. Endocr Pract. 2012;18:988-1028. PMID: 23246686. DOI: 10.4158/EP12280.GL
  5. Expert commentary, not research Dr. Sara Gottfried on Huberman Lab: How to Optimize Female Hormone Health for Vitality & Longevity (podcast episode, Jan 2023)
  6. Expert commentary, not research Dr. Peter Attia: Outlive: The Science and Art of Longevity (book, 2023)
Sources

Every source on this page

Peer-reviewed research comes first, then society guidance, then expert commentary. Dr. Mary Claire Haver and Dr. Stacy Sims are listed first among the experts. Expert voices are commentary, not research. When an expert claim differs from the evidence, we follow the evidence and say so.

  1. Peer-reviewed Harlow SD et al. Executive summary of the Stages of Reproductive Aging Workshop + 10: addressing the unfinished agenda of staging reproductive aging. Menopause. 2012;19:387-95. PMID: 22343510. DOI: 10.1097/gme.0b013e31824d8f40
  2. Peer-reviewed Stuenkel CA et al. Treatment of Symptoms of the Menopause: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2015;100:3975-4011. PMID: 26444994. DOI: 10.1210/jc.2015-2236
  3. Peer-reviewed The North American Menopause Society (now The Menopause Society). The 2022 hormone therapy position statement of The North American Menopause Society. Menopause. 2022;29:767-794. PMID: 35797481. DOI: 10.1097/GME.0000000000002028
  4. Peer-reviewed El Khoudary SR et al. Menopause Transition and Cardiovascular Disease Risk: Implications for Timing of Early Prevention: A Scientific Statement From the American Heart Association. Circulation. 2020;142:e506-e532. PMID: 33251828. DOI: 10.1161/CIR.0000000000000912
  5. Peer-reviewed American Diabetes Association Professional Practice Committee. 2. Diagnosis and Classification of Diabetes: Standards of Care in Diabetes-2024. Diabetes Care. 2024;47:S20-S42. PMID: 38078589. DOI: 10.2337/dc24-S002
  6. Peer-reviewed US Preventive Services Task Force. Screening for Osteoporosis to Prevent Fractures: US Preventive Services Task Force Recommendation Statement. JAMA. 2018;319:2521-2531. PMID: 29946735. DOI: 10.1001/jama.2018.7498
  7. Peer-reviewed Garber JR et al. Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. Endocr Pract. 2012;18:988-1028. PMID: 23246686. DOI: 10.4158/EP12280.GL
  8. Expert commentary, not research Dr. Mary Claire Haver (OB/GYN): The New Menopause (book, Rodale, 2024)
  9. Expert commentary, not research Dr. Mary Claire Haver on Huberman Lab: How to Navigate Menopause & Perimenopause for Maximum Health & Vitality (podcast episode, June 2024)
  10. Expert commentary, not research Dr. Sara Gottfried on Huberman Lab: How to Optimize Female Hormone Health for Vitality & Longevity (podcast episode, Jan 2023)
  11. Expert commentary, not research Dr. Peter Attia: Outlive: The Science and Art of Longevity (book, 2023)
  12. Non-clinical wellness opinion, not research Gary Brecka, The Ultimate Human, Ep. 227: Menopause: Symptoms, Hormones, Tests & Solutions (podcast episode, Dec 2025)
Your next step

Take this to your clinician.

  • Bring your questions and a short symptom log to your next appointment.
  • Want help organizing your questions and care team? Pinnacle Coordinated Wellness is here to listen and connect.
  • Practitioners: share this page with the women you serve.
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All 15 topics · Other topics: Weight and Body Changes · Muscle and Strength · Why HIIT or Cardio-Only Can Backfire · Insulin Resistance and Blood Sugar · Sleep and Night Sweats · Cortisol and Stress · Brain Fog, Mood and Anxiety · Thyroid · Heart and Bone Risk After Menopause · Hormone Therapy Basics · Gut Health · Nutrition and Protein · Alcohol · The Shame and Guilt Cycle, and Identity