After menopause: the health check that looks at bones, heart and metabolism.
A postmenopause health check is less about hormones and more about the things that change once oestrogen falls: cardiovascular risk, blood sugar and lipids, thyroid function, and bone. Most of it is blood work; bone density itself is measured by a DEXA scan, not a bone health blood test. Here is what a sensible check includes, and why each part is there.
Why the focus shifts after menopause
During reproductive life oestrogen has a broadly protective effect on blood vessels, cholesterol handling, insulin sensitivity and bone turnover. When it falls at menopause, those systems change. Cardiovascular risk rises steadily from this point and heart disease becomes one of the leading causes of death in women, bone loss accelerates in the first years after the final period, and abdominal fat, blood pressure and blood sugar tend to drift upward even in women whose habits have not changed.
None of this is inevitable for any individual, and much of it can be measured early and acted on. That is the purpose of the check: to see where you stand now, so you and your doctor can decide what, if anything, needs attention.
Heart and blood vessels
- Fasting lipid profile. Total cholesterol, LDL, HDL and triglycerides. LDL tends to rise after menopause and is one of the main modifiable risk factors for heart disease. Some doctors add lipoprotein(a), a largely inherited marker, once in a lifetime.
- Blood pressure. Not a blood test, but essential. It is not part of a blood collection, so have it measured at your GP or a pharmacy, or with a validated home monitor, and bring the reading to the consult; it is part of any cardiovascular risk estimate.
- Cardiovascular risk calculation. Australian guidelines use age, sex, blood pressure, cholesterol, smoking, diabetes status and a few other factors to estimate risk over the next five years. The blood tests feed that calculation; the number is what guides decisions.
Metabolism and blood sugar
- HbA1c or fasting glucose. Screens for prediabetes and type 2 diabetes, both more common after menopause. HbA1c reflects the average over about three months and does not require fasting.
- Waist measurement and weight. Fat distribution shifts toward the abdomen after menopause, and waist size tracks metabolic risk better than weight alone.
- Liver function. Fatty liver is increasingly common at midlife and often silent. A liver panel is a simple way to check.
Where weight change is the main concern, the metabolic side is covered in more depth in menopause weight gain: the metabolic tests that explain what changed.
Thyroid
Thyroid disorders become more common with age and are more frequent in women. An under-active thyroid causes fatigue, weight gain, low mood, dry skin and raised cholesterol, all of which can be mistaken for the after-effects of menopause. An over-active thyroid can accelerate bone loss. A TSH test is a quick way to make sure the thyroid is not the explanation for symptoms attributed to something else.
Bones: what a blood test can and cannot do
This is the part most often misunderstood. There is no bone health blood test that measures bone density. Bone density is measured by a DEXA scan, a low-dose X-ray of the hip and spine, and that is the test that diagnoses osteopenia and osteoporosis. Your doctor decides whether and when a DEXA is warranted based on your age, risk factors, and any fracture history; Medicare rebates it in defined circumstances.
What blood tests can do is check the things bone depends on, and exclude other causes of bone loss:
- Vitamin D. Needed to absorb calcium. Low levels are common in Australia despite the climate, particularly in women who cover up, work indoors or have darker skin.
- Calcium and phosphate. Usually normal, but abnormal results point to parathyroid or kidney causes that need separate attention.
- Kidney function. The kidneys handle vitamin D and calcium, and reduced function affects both bone and the safety of some treatments.
- Thyroid. As above, an over-active thyroid drives bone loss.
A normal set of bone-related blood results with a DEXA showing low density is a common combination; the blood tests are there to make sure nothing else is going on, not to replace the scan.
Iron and general health
Iron deficiency is less common once periods stop, but it does not disappear, and low iron in a postmenopausal woman is something doctors take seriously because the usual explanation (heavy periods) no longer applies. A full blood count and ferritin are often included for that reason, and to complete the picture on fatigue.
What is not usually in the check
FSH and oestradiol are not needed to confirm menopause in a woman over 45 whose periods have stopped for a year, and they add little to a postmenopause health check. If you are on menopausal hormone therapy, monitoring is a separate conversation with the doctor who prescribes it, covered in blood tests while on menopausal hormone therapy. Cancer screening (breast, cervical, bowel) sits alongside all of this through the national screening programmes and your GP, not through blood tests.
How often
There is no single rule. Many doctors suggest a baseline around the time of menopause and then a review every one to a few years, more often if a result was abnormal or if you have other risk factors. Reference ranges differ between laboratories, so keeping to the same lab where you can makes results easier to compare over time.
Common questions
Can a blood test tell me if I have osteoporosis?
No. Osteoporosis is diagnosed by DEXA bone density scan. Blood tests check vitamin D, calcium, kidney and thyroid function, which influence bone and can reveal secondary causes, but they do not measure density.
Do I need to fast?
For a fasting lipid profile and fasting glucose, yes, usually 8 to 12 hours with water allowed. If your panel uses HbA1c and non-fasting lipids, fasting may not be required. The request form or collection centre will confirm.
I feel fine. Is the check still worth doing?
Raised cholesterol, prediabetes, low vitamin D and an under-active thyroid are all usually silent at first. The point of a check in a woman who feels well is to find these early, when they are easiest to address. Your GP can advise how often is sensible for you.
Is it rebated by Medicare?
When a GP orders these tests as part of a health assessment or to investigate symptoms, most are rebated. A check you initiate yourself is self-pay and not rebated. KnowLuna offers a test-only price if you bring your own doctor's request, or a bundled price with a KnowLuna doctor consult.
General information only, not medical advice. If your symptoms are severe or sudden, see a doctor promptly.