What it measures

The pressure in your arteries, given as two figures. The first is the pressure when your heart pumps, and the second is the pressure when it rests between beats.

Why it is in the check-up

High blood pressure does not usually cause symptoms, so the only way to find it is to measure it. Untreated, it raises the risk of heart attack, stroke, heart failure and kidney disease.

The American Heart Association calls it the most prominent modifiable risk factor for cardiovascular disease that increases with age among women. It puts the rise down mainly to age; the British Heart Foundation adds that blood pressure may go up after the menopause.

What the result can and cannot show

A reading of 140/90 mmHg or higher, taken by a healthcare professional, counts as high.

One raised reading is not a diagnosis. NICE asks for it to be confirmed with a monitor worn through the day or with readings taken at home, where an average of 135/85 mmHg or higher confirms it.

What it measures

Your weight in kilograms divided by the square of your height in metres. The result is your body mass index, or BMI.

Why it is in the check-up

Through the menopause women tend to gain fat around the middle and to lose muscle, the American Heart Association reports. Height and weight are also measured in the NHS Health Check, which looks for a higher risk of heart disease, stroke, diabetes and kidney disease.

What the result can and cannot show

For most adults the NHS counts a BMI of 25 to 29.9 as overweight and 30 or more as obese. The thresholds are lower, at 23 and 27.5, for people of South Asian, Chinese, other Asian, Middle Eastern, Black African or African-Caribbean background.

BMI cannot tell muscle from fat, and it does not show where fat is carried, which is why your waist is measured too.

What it measures

Your resting heart rate, counted while your blood pressure is taken.

Why it is in the check-up

A resting pulse is the simplest measure of the heart at rest, and it is taken at the same time as your blood pressure. An irregular pulse can be the first sign of an irregular rhythm, which may cause no symptoms at all.

What the result can and cannot show

A single reading is a snapshot: a pulse rises with anxiety, caffeine and exertion. An irregular pulse is for a doctor to interpret, and the an ECG, which you can add records the rhythm properly.

What it measures

Follicle-stimulating hormone is made by the pituitary gland. It helps to control the menstrual cycle and prompts eggs to grow in the ovaries.

Why it is in the check-up

FSH rises in the years before the menopause, as the ovaries become less active. In the Study of Women’s Health Across the Nation, among 1,215 women followed through a natural menopause, it began to rise about six years before the final period and levelled off about two years after it.

The check-up records your level as a dated measurement, to set beside your symptoms and your other results. The menopause assessments of The London Clinic and London Doctors Clinic include it.

What the result can and cannot show

A raised level is consistent with the perimenopause or the menopause, but one result cannot say where you are. FSH changes through the menstrual cycle, and around the start of the menopause results can contradict one another. If you still have periods, your summary records the day of your cycle.

Hormonal contraception and HRT change the result. It is a record, not a diagnosis.

What it measures

Luteinising hormone is also made by the pituitary gland. It triggers the release of an egg from the ovary.

Why it is in the check-up

LH works alongside FSH. From the age of 45, a level that stays high may mean that the menopause is approaching. The menopause assessments of The London Clinic and London Doctors Clinic measure it together with FSH and oestradiol.

What the result can and cannot show

LH changes through the menstrual cycle, so it is read together with FSH and oestradiol and never on its own. It is a record, not a diagnosis.

What it measures

Oestradiol is the main form of oestrogen before the menopause. It is made mostly in the ovaries.

Why it is in the check-up

In the Study of Women’s Health Across the Nation, oestradiol began to fall about two years before the final period, changed fastest at the final period and levelled off about two years after it.

Oestrogen is essential for healthy bones, and its fall after the menopause can lead to a rapid decrease in bone density, says the NHS. In women taking HRT, the level is sometimes used to monitor treatment.

What the result can and cannot show

Oestrogen levels change often, so one result is a snapshot, and a trend needs more than one test. It does not show whether you have reached the menopause.

What it measures

Progesterone, made by the ovary after an egg is released. One blood test.

Why it is in the check-up

Progesterone rises only after ovulation, so its level says whether an egg was released in this cycle. In the perimenopause, cycles without ovulation become common, and that is one reason periods become irregular.

It also matters if treatment is being considered: a woman with a womb who takes oestrogen needs progesterone with it, and the level is part of the picture a doctor reads.

What the result can and cannot show

The result depends entirely on when in the cycle the sample was taken. Measured in the first half of a cycle, a low level is expected and means nothing. If you still have periods, your summary records the day of your cycle.

After the menopause the level is low in everyone, so the test adds little once periods have stopped. It cannot say whether you have reached the menopause.

What it measures

Prolactin, made by the pituitary gland. One blood test.

Why it is in the check-up

A raised prolactin level can stop periods, cause hot flushes and lower sex drive — the very things a woman of 45 would put down to the menopause. The cause is usually a small benign pituitary tumour or a medicine, and both are treatable.

It is the test that catches the mimic. That is why it sits beside FSH and oestradiol rather than instead of them.

What the result can and cannot show

Prolactin rises with stress, with sleep, after a meal, after exercise and in pregnancy, so a mildly raised single result is often nothing. It is repeated before anything is concluded.

Many common medicines raise it, among them some antidepressants and anti-sickness drugs. Tell your coordinator what you take, so that your summary records it.

What it measures

Anti-Müllerian hormone, made by the small follicles in the ovaries. The level falls as their number falls, and it is steady through the cycle, unlike FSH and oestradiol.

Why it is in the check-up

It is the steadiest of the ovarian measurements: it does not swing with the cycle, so a single sample means more than a single FSH does.

It falls years before the final period, which is why it is used in research as a marker of how far the transition has gone, and why a woman who wants a number rather than a guess asks for it.

What the result can and cannot show

It cannot tell you when your last period will be. It is a population-level marker with wide individual variation, and no level defines the menopause.

It is not a fertility test in the sense most people mean: it says something about how many eggs remain, nothing about their quality or about any particular month. Hormonal contraception lowers it.

What it measures

Four results from one sample: thyroid-stimulating hormone, made by the pituitary gland, which tells the thyroid how much hormone to make; free thyroxine (free T4) and free triiodothyronine (free T3), the active hormones in the blood; and antibodies to thyroid peroxidase (anti-TPO), the sign that the immune system is attacking the gland.

Why it is in the check-up

Thyroid disease is common and its symptoms are vague: tiredness, weight change, feeling cold or hot, low mood, a fast or slow pulse.

Thyroid disorders may cause symptoms similar to those of the menopause, says the British Thyroid Foundation, and NICE warns doctors that in menopausal women the symptoms of a thyroid disorder may be mistaken for the menopause. Women are ten times more likely than men to have thyroid disease, and around 3% of women over 50 are treated with thyroxine.

What the result can and cannot show

TSH outside its range, read with free T4 and free T3, shows an underactive or an overactive thyroid. The tests do not show the cause; the antibodies help, because they point to autoimmune thyroid disease.

Antibodies can be present in people whose thyroid works normally, and they are not in themselves a disease. Severe illness, pregnancy, biotin supplements and some medicines, including the contraceptive pill and steroids, change the readings.

What it measures

The number and size of the cells in your blood, including your haemoglobin, and the erythrocyte sedimentation rate: the time your red blood cells take to settle at the bottom of a tube.

Why it is in the check-up

A full blood count is the test that shows anaemia, and it is the broadest single look at the blood: the red cells that carry oxygen, the white cells that fight infection and the platelets that help blood to clot.

Heavy periods are a very common cause of iron deficiency anaemia, says the NHS, and in the perimenopause periods may become heavier. Its symptoms include tiredness, shortness of breath and palpitations.

What the result can and cannot show

A low haemoglobin or red cell count may be a sign of anaemia; the count does not show its cause.

A raised sedimentation rate means inflammation somewhere, not where or why. It rises with age, in women, in pregnancy and with anaemia, so it is read with everything else and never alone.

What it measures

Creatinine and urea, the waste products the kidneys clear, with the estimated glomerular filtration rate (eGFR) worked out from them; and the liver panel: the enzymes ALT and AST, with bilirubin.

Why it is in the check-up

Kidney disease does not usually cause symptoms in its early stages, and it is often found only when a blood test is done for another reason. People with kidney disease, even when it is mild, are at higher risk of heart attack and stroke, says the NHS.

The liver matters if treatment is being considered: the NHS says HRT may not be suitable for women with liver disease, and NICE asks for a liver enzyme level before a statin is started.

What the result can and cannot show

Healthy kidneys filter more than 90 ml a minute. A figure between 60 and 89 counts as kidney disease only when other tests also show signs of damage.

The panel shows whether each level sits inside the laboratory’s reference range, not why one does not. Meat eaten in the 12 hours before the test can affect the kidney result, which is why we ask you to avoid it.

What it measures

HbA1c is glycated haemoglobin: glucose that has attached itself to your red blood cells. It reflects your average blood sugar over the last two to three months. No preparation is needed.

Why it is in the check-up

Diabetes UK estimates that almost 1.3 million people in the UK have type 2 diabetes that has not been diagnosed. Prediabetes does not usually cause symptoms.

The American Heart Association reports that the metabolic syndrome, of which raised blood sugar is one part, becomes more common through the menopause, although it puts the rise in blood sugar itself down mainly to age.

What the result can and cannot show

Below 42 mmol/mol is normal, 42 to 47 is the range known as prediabetes, and 48 or above is the level used to diagnose diabetes.

In a person without symptoms, one result of 48 or more is not a diagnosis: the test is repeated first. A result below 48 does not by itself rule diabetes out.

What it measures

Total cholesterol, HDL cholesterol and triglycerides are measured, and non-HDL and LDL cholesterol are worked out from them. LDL is the main source of blockages in the arteries. HDL is often called “good” cholesterol, because it helps to clear LDL.

Why it is in the check-up

In the Study of Women’s Health Across the Nation, total cholesterol, LDL cholesterol and apolipoprotein B rose substantially within the year before and the year after the final period. The authors describe it as a rise in lipids unique to that time, and attribute it to the menopause and not to age.

High cholesterol does not usually cause symptoms, so it is found only by a test.

What the result can and cannot show

The NHS gives healthy levels for adults as a total cholesterol below 5 mmol/L and a non-HDL cholesterol below 4 mmol/L.

The figures are not a verdict on their own. A doctor reads them with your age, your blood pressure and your other results to estimate your risk over the next ten years. NICE asks for that estimate to be made with the QRISK3 tool, and for a statin to be offered when the risk is 10% or more.

The American Heart Association notes that around the menopause a higher HDL does not always mean a healthier heart.

What it measures

C-reactive protein is made by the liver in response to inflammation. The test measures how much of it is in your blood.

Why it is in the check-up

A raised level is a sign of inflammation somewhere. It is the broadest inflammatory marker in common use, and it is measured alongside the sedimentation rate because the two rise and fall at different speeds.

What the result can and cannot show

A normal level makes significant inflammation unlikely. A raised level shows inflammation without showing where or why: an infection, an injury or a flare of an inflammatory condition all raise it.

A single result is a snapshot, and a mildly raised level in a woman who feels well often means nothing at all.

What it measures

A prothrombin time, which measures the seconds a clot takes to form, reported with the international normalised ratio (INR), together with the activated partial thromboplastin time and, in most panels, fibrinogen.

Why it is in the check-up

A coagulation screen measures how long your blood takes to clot. It is the baseline a doctor wants before any question of clotting arises.

It matters if treatment is being considered. The NHS says HRT may not be suitable for women with a history of blood clots, and tablets carry a small added risk of clots that patches and gels do not.

What the result can and cannot show

The screen shows whether clotting is slower or faster than the reference range. It does not explain why, and it is not a test for an inherited clotting disorder: that needs its own tests, which we do not arrange.

The numbers move with illness, with vitamin K and with any anticoagulant you take, so tell your coordinator about every medicine.

What it measures

Human chorionic gonadotrophin in the blood, the hormone of pregnancy. A blood test is more sensitive than a urine test and detects a pregnancy earlier.

Why it is in the check-up

The mammogram and the bone density scan use X-rays, and before either is justified for you the clinic must establish that you are not pregnant. The blood test answers that with a number rather than a question.

It matters more than it sounds in these years. Fertility falls through the perimenopause but does not stop, and irregular periods make a late pregnancy easy to miss.

What the result can and cannot show

A negative result means no pregnancy was detectable when the sample was taken. A positive result is a reason to stop and talk to a doctor, and both X-ray scans are postponed.

The result is read on the day, before your scans, which is why your blood is taken first.

What it measures

An ultrasound scan of the womb and the ovaries. It measures the thickness of the lining of the womb and looks for fibroids, polyps and cysts. About 20 minutes, no radiation.

Why it is in the check-up

The lining of the womb is the thing to look at in these years. After the menopause it thins, and a lining that is thicker than expected is the finding that matters, above all in a woman who has had any bleeding.

Fibroids and polyps are common and are a frequent cause of the heavy or irregular bleeding of the perimenopause. A scan shows whether they are there.

What the result can and cannot show

It is not a test for ovarian cancer, and no screening body recommends scanning the ovaries of women without symptoms: the UK National Screening Committee does not recommend ovarian cancer screening, and the US Preventive Services Task Force recommends against it (grade D).

Cysts and fibroids are common and usually harmless, and finding one often leads to a repeat scan. That is the cost of looking. Any bleeding a year or more after your last period needs a doctor, not a check-up: see your GP.

What it measures

An ultrasound scan of both breasts and the armpits. About 20 minutes, no radiation.

Why it is in the check-up

Ultrasound and X-rays see different things. In dense breast tissue, which is more common before and around the menopause, a mammogram is harder to read, and ultrasound adds what the mammogram cannot resolve.

The two together are what a one-stop breast clinic does, and the check-up does both in the same visit.

What the result can and cannot show

Ultrasound alone is not breast screening: the NHS programme is built on mammograms, and the evidence for ultrasound as a screening test on its own is not there.

Adding ultrasound finds more cysts and more benign lumps, and each of those has to be explained — sometimes with a needle test that turns out to have been unnecessary. More looking means more finding, and not all of it matters.

What it measures

A bone density scan uses low-dose X-rays to measure how dense your bones are, usually at the hip and the lower spine. You lie on your back on an open table while a scanning arm passes over you. The scan takes 10 to 20 minutes.

Why it is in the check-up

In the Study of Women’s Health Across the Nation, bone density began to fall one year before the final period, and the loss slowed but did not stop two years after it. Over the ten years studied, the women lost on average 10.6% of their bone density at the spine and 9.1% at the neck of the thigh bone, most of it in the three years around the final period.

Osteoporosis often gives no sign until a bone breaks. The Royal Osteoporosis Society estimates that half of women over 50 will break a bone because of it.

What the result can and cannot show

The result is a T-score, which compares your bones with those of a healthy young adult: −1 or above is normal, between −1 and −2.5 is low bone density, also called the osteopenia range, and −2.5 or below is the osteoporosis range.

The score is one part of assessing bone strength, not the whole of it: doctors read it with your age and your other risk factors. The radiation is about what you receive in three days of normal life.

What it measures

A mammogram is an X-ray of each breast, usually taken from above and from the side. It can find a cancer before there are any symptoms. Each X-ray takes a few seconds; some women find them uncomfortable.

Why it is in the check-up

About one woman in seven born in the UK in 1961 will be diagnosed with breast cancer in her lifetime, Cancer Research UK estimates. Screening is estimated to prevent about 1,300 deaths from breast cancer a year in the UK.

The NHS invites women every three years from 50 until their 71st birthday. The US Preventive Services Task Force recommends a mammogram every two years from 40 to 74.

What the result can and cannot show

Of every 100 women screened, four are asked back for further tests, and one of those four is found to have cancer.

Screening can also find a cancer that would never have caused harm: an independent UK review estimated about three such cases for every death prevented. Very rarely a cancer is missed, and a cancer can develop between screens. A mammogram uses a small amount of radiation.

What it measures

Four things at one appointment with a female clinician: a cervical sample taken into liquid for cytology; a test of that sample for human papillomavirus; a swab for the vaginal flora; and the pH of the vaginal secretions, read at once on a strip.

Why it is in the check-up

Cervical screening checks the health of the cervix and helps prevent cervical cancer, says the NHS. Here the sample is both tested for human papillomavirus and examined for changes in the cells: that pairing is what the London provider whose published price we used offers as a smear with HPV testing.

The swab and the pH belong to the menopause rather than to cancer. After the menopause falling oestrogen thins the vaginal tissue and raises the pH, and the two together distinguish that change from an infection — which matters, because the symptoms overlap and the treatments do not.

What the result can and cannot show

These are the three results in the check-up that cannot be read in hours, because a swab has to be grown and a cervical sample has to be looked at by a cytologist. Counted from the moment the sample reaches the laboratory, the published times are 48 hours for the swab culture, three days for the HPV test and six days for the cytology report. You are sent each one on the day it is ready rather than all of them when the slowest arrives, and your summary is reissued each time.

A normal smear does not rule out cervical cancer, and screening works by repetition rather than by any single test. The pH is a crude measurement, easily disturbed by blood, semen, lubricant or a recent bath.

If you are in an NHS screening programme, this does not replace it; tell your own GP what was done and when, so that your NHS recall is not duplicated.

What it measures

An ECG records the electrical activity of your heart, including its rate and rhythm. Small sticky patches are placed on your arms, legs and chest, and you lie still for a few minutes. It is quick and painless.

Why you might add it

Palpitations are a common complaint around the menopause, and a resting trace is the simplest way to see the rhythm. It also gives your doctor a baseline to compare with in later years.

What the result can and cannot show

A resting ECG records only a few minutes, so a rhythm problem that comes and goes may not appear. The US Preventive Services Task Force recommends against ECG screening in adults without symptoms who are at low risk (grade D), because of the harm that can follow from findings of no consequence.

What it measures

A small monitor worn on a belt, with a cuff on the arm, which takes a reading every 20 to 30 minutes through the day and less often at night. You return it the next day.

Why you might add it

It is what NICE asks for to confirm high blood pressure, because one reading in a clinic is not enough, and blood pressure may rise after the menopause.

What the result can and cannot show

An average of 135/85 mmHg or higher during the day confirms high blood pressure. The monitor is mildly uncomfortable and interrupts sleep. If your reading on the day is normal, you probably do not need it.

What it measures

An ultrasound scan of the lymph nodes in one or two areas — for the breast, the armpit and above the collarbone.

Why you might add it

The nodes in the armpit are the first place breast cancer spreads, and they are scanned as part of assessing a breast lump.

What the result can and cannot show

In a woman with a normal mammogram and a normal breast ultrasound, scanning the nodes separately adds little. Enlarged nodes are usually reactive, and finding one often leads to a needle test that was not needed.

What it measures

A Doppler ultrasound scan of the arteries and veins of one or both legs.

Why you might add it

Aching, swelling and visible veins are common complaints, and a scan distinguishes varicose veins from a problem in the deeper veins or the arteries.

What the result can and cannot show

In a woman with no symptoms the scan rarely changes anything. Varicose veins found incidentally are a cosmetic matter unless they are causing trouble.

What it measures

Iron tests measure the iron in your blood and, depending on the laboratory’s panel, how it is carried and stored.

Why you might add it

Heavy periods are a very common cause of iron deficiency anaemia, says the NHS, and in the perimenopause periods may become heavier. The symptoms of iron deficiency anaemia include tiredness, shortness of breath and palpitations.

What the result can and cannot show

A low result may mean iron deficiency. Not everyone with low iron has anaemia: that is shown by the full blood count. A high result can be a sign of other conditions, such as haemochromatosis.

The test is usually done in the morning, and the laboratory may ask for a fasting sample, which is why your nurse comes before breakfast.

What it measures

Vitamin D, which regulates the calcium and phosphate that keep bones, teeth and muscles healthy; vitamin B12; and folate. Three results from the same blood sample.

Why you might add it

A low vitamin D level is common in the UK: in the National Diet and Nutrition Survey, 18% of adults aged 19 to 64 had a level below 25 nmol/L, the level below which the risk of poor bone and muscle health is considered to rise.

Bone density falls around the menopause, and vitamin D is one of the things bones depend on. B12 and folate are measured with it because a shortage of either causes anaemia, and because tiredness at this age has several possible explanations.

What the result can and cannot show

Each shows your level on the day of the test and no more. Vitamin D is lowest from January to March, so a low result in February says less than the same result in August.

A low B12 or folate is a finding to act on; a normal one does not rule out every cause of tiredness. Whatever your vitamin D result, UK government advice is that everyone should consider a daily supplement in autumn and winter.

What it measures

An MRI scan of both breasts, usually with an injection of contrast dye. It takes about 40 minutes and uses no radiation.

Why you might add it

It is the most sensitive breast imaging there is, and in the NHS it is offered for screening to women at high risk because of a strong family history or a known gene change.

What the result can and cannot show

For a woman at ordinary risk it is the clearest example in this check-up of more looking producing more doubt: it finds many things that turn out to be nothing, and each one leads to another test.

It needs an injection of dye, and it may not be possible if you have a pacemaker or other metal in your body. If you have a strong family history, this is a conversation for a doctor, not an addition to a check-up.

What it measures

An MRI scan covering, in most packages, the brain, the chest, the abdomen, the pelvis and the spine. It takes about an hour, and it uses no radiation.

Why you might add it

It is the broadest look at the body that can be had without X-rays, and it is on the list of additions our doctors drew up. People choose it to see everything at once.

What the result can and cannot show

It is not a screening test for cancer, and no screening body recommends one for people without symptoms. Its weakness is the mirror of its breadth: in a well person most of what it finds is of no consequence, and each finding has to be chased down.

Expect findings. A scan of this kind commonly shows cysts, small nodules and wear in the spine, and sorting the harmless from the important takes more tests, more time and more money.

What it measures

Women make testosterone too, in smaller amounts than men. It helps to control sex drive and plays a part in muscle and bone growth. The test measures the total amount in your blood, which is the measure the British Menopause Society advises, with sex hormone binding globulin so that the free fraction can be worked out.

Why you might add it

Testosterone levels decline through a woman’s reproductive years, according to the 2019 Global Consensus Position Statement on testosterone for women.

NICE advises considering testosterone for low sexual desire at the menopause when HRT alone has not helped. The British Menopause Society recommends a baseline level before any such treatment, so that later results can be compared with it. This records that baseline.

What the result can and cannot show

The Global Consensus statement is clear that no blood level separates women with low sexual desire from women without, and that the test should not be used to diagnose it. The figure is a baseline for your doctor. Your sample is taken in the morning, when the level is highest.

What it measures

Lipoprotein(a) is a large particle, made by the liver, that carries cholesterol. Its level is set mainly by your genes, and diet and exercise change it very little.

Why you might add it

A high level is a risk factor for diseases of the heart and blood vessels. It does not usually cause symptoms, and it is not part of an ordinary cholesterol test, so only this test shows it. About one adult in five has a raised level, the US National Lipid Association estimates.

American guidelines now recommend measuring it at least once in every adult: the National Lipid Association in 2024, and the American College of Cardiology and American Heart Association in 2026.

The level is stable through most of life, but it can rise at the menopause. The check-up therefore measures it for every woman, whether or not it has been measured before.

What the result can and cannot show

The National Lipid Association counts a level below 75 nmol/L as low risk, 75 to 125 as intermediate and 125 or more as high risk. UK laboratories and doctors may use the different bands published by the charity HEART UK.

The figure is a measure of inherited risk, for your doctor to weigh with everything else. It is not a diagnosis.