Standard blood work doesn't always account for the ways women's health needs differ from men's. Iron depletion from menstruation, higher rates of thyroid dysfunction, hormonal shifts across life stages. These aren't edge cases. They affect a large proportion of women, and they're often underscreened.
If you're proactive about your health, here are the areas worth paying attention to and the tests that give you useful data.
Bespoke Labs does not diagnose, treat, interpret results, or provide medical advice. Use your results with your physician, specialist, or practitioner.
Iron and Ferritin
Iron deficiency is the most common nutritional deficiency worldwide, and women of reproductive age are disproportionately affected. Menstruation is the primary driver. Regular monthly blood loss depletes iron stores over time.
Ferritin, which measures stored iron, drops long before hemoglobin does. This means you can be iron depleted, experiencing fatigue, poor recovery, brain fog, hair thinning, and declining performance, while your standard blood count still looks "normal."
Standard reference ranges flag ferritin as low only below 12 to 15 µg/L. But many practitioners consider levels below 30 to 50 µg/L suboptimal, especially for active women.
If you're testing iron status, consider ferritin alongside a CBC and iron studies (serum iron, TIBC, transferrin saturation). The combination tells a much more complete story than ferritin alone.
Thyroid Health
Women are 5 to 8 times more likely than men to develop thyroid dysfunction. Both underactive (hypothyroidism) and overactive (hyperthyroidism) thyroid conditions are far more common in women, and symptoms can be subtle and easy to dismiss.
Fatigue, unexplained weight changes, hair thinning, mood shifts, feeling cold, dry skin, and irregular periods can all be connected to thyroid function. These symptoms are frequently attributed to stress, aging, or "just how things are" without anyone checking the numbers.
The key markers:
- TSH: the standard screening marker. An elevated TSH suggests underactive thyroid; a suppressed TSH suggests overactive.
- Free T4: the active thyroid hormone that TSH is trying to regulate. TSH alone doesn't always tell the full story.
- Free T3: the most metabolically active form of thyroid hormone. Some practitioners want to see this alongside TSH and free T4.
If you've been told your thyroid is "fine" based on TSH alone, adding free T4 and free T3 gives a more complete picture.
Hormonal Testing and Cycle Timing
Women's hormones fluctuate throughout the menstrual cycle, which means when you test matters as much as what you test.
The key hormones:
- Estradiol (E2): the primary estrogen. Fluctuates significantly across the cycle.
- Progesterone: rises after ovulation. Testing it in the follicular phase will always show a low number, which doesn't mean there's a problem.
- LH and FSH: regulate ovulation and cycle function. The ratio between them can be informative.
- Testosterone: women produce it too, and it plays a role in energy, libido, mood, and muscle function. Both low and elevated levels can be relevant.
- DHEA-S: an adrenal androgen that feeds into both testosterone and estrogen production.
When to test
General guidance on timing (your practitioner can advise based on your specific situation):
- Day 2 to 5 of your cycle (early follicular phase): this is when estradiol, LH, and FSH are at their baseline levels. Most hormone panels are designed to be drawn during this window.
- Approximately 7 days after ovulation (mid-luteal phase): this is when progesterone peaks. If you're testing progesterone specifically, this is the relevant window.
Testing hormones at the wrong point in your cycle can produce results that look abnormal but are actually just a reflection of normal fluctuation. Timing gives your results context.
Perimenopause and Menopause
The transition into menopause, perimenopause, can begin years before periods stop entirely. During this time, hormone levels become increasingly variable, and symptoms like irregular cycles, sleep disruption, mood changes, hot flashes, and changes in energy are common.
Many women in this stage want data but are told there's no point in testing because "hormones fluctuate." And they do. But having a snapshot of FSH, estradiol, and other markers can still provide useful context, especially when tracked over time or discussed with a practitioner who specialises in menopause care.
The markers most relevant during this stage:
- FSH: tends to rise as ovarian function declines. Persistently elevated FSH is one indicator of the menopausal transition.
- Estradiol: tends to decline, though it can fluctuate widely during perimenopause.
- TSH and thyroid markers: thyroid dysfunction often emerges or worsens around menopause, and symptoms can overlap (fatigue, weight changes, mood shifts).
Vitamin D and B12
These aren't exclusive to women, but women are disproportionately affected by deficiencies in both.
Vitamin D: deficiency is extremely common in Canada, especially from October to April. Women who are pregnant, breastfeeding, or have darker skin are at higher risk. Vitamin D affects bone health, immune function, mood, and muscle function.
Vitamin B12: deficiency is more common in women who follow plant-based diets, take certain medications (including hormonal contraceptives and metformin), or have absorption issues. Symptoms include fatigue, cognitive changes, and nerve-related issues.
If you're supplementing either one, testing tells you whether your current dose is actually getting your levels where they need to be.
Building a Testing Plan
There's no single panel that fits every woman. What to test depends on your age, life stage, symptoms (if any), goals, and what you're tracking. But a practical starting point might include:
- Ferritin + CBC + iron studies: especially if you menstruate, are active, or experience fatigue
- TSH + free T4: a thyroid baseline
- Vitamin D + B12: nutritional status
- Hormonal panel (timed to your cycle): if you want a picture of your hormonal health
From there, retest the markers that matter most on a schedule that makes sense. Every 3 to 6 months for things like ferritin and vitamin D, less frequently for thyroid and hormones unless something is changing.
Your Data, Your Health
Women's health needs are specific, and the standard system doesn't always screen for the right things at the right time. If you want to see where your numbers stand, you can order the tests yourself.
Bespoke Labs provides access to lab testing and results delivery. We do not diagnose, treat, interpret results, or provide medical advice. Discuss your results with a qualified healthcare provider.