Health Checks to Prioritise During Perimenopause: A Practical Guide
Perimenopause is the right time to update your health screening routine. This guide covers the key checks, how often to have them, and why they matter.
Why Regular Screening Matters More in Your Forties and Fifties
Perimenopause is not just a reproductive transition. It is a whole-body hormonal shift that changes risk profiles across multiple organ systems. Blood pressure, cholesterol, blood glucose, bone density, and cardiovascular function all begin to shift during this window, often silently and without symptoms. The conditions that develop from these changes, including hypertension, type 2 diabetes, cardiovascular disease, and osteoporosis, are far easier to prevent or slow than to reverse. Regular health screening gives you a current picture of where you are, identifies trends before they become problems, and creates the data your GP needs to advise you appropriately. Many women in their forties fall into a gap in health services, too old for the frequent monitoring of pregnancy years but not yet flagged for age-related screening programmes. Being proactive about requesting the right checks closes that gap. This guide covers the core tests and screenings worth prioritising during perimenopause and how often to have them.
Cardiovascular Checks: Blood Pressure and Cholesterol
Blood pressure and cholesterol are the two most important cardiovascular markers to track during perimenopause. Blood pressure should ideally be checked annually if your readings are in the normal range (below 120/80 mmHg), and more frequently if you have had elevated readings or other risk factors. Home monitoring between GP visits gives a more accurate picture than clinic-only readings. For cholesterol, the NHS Health Check (available every five years from age 40-74) includes a full lipid panel and can calculate your cardiovascular risk score. If you have not had a cholesterol test since before perimenopause, request one now. LDL tends to rise and HDL can fall during the transition, often without any change in diet or weight. Ask your GP to explain your total-to-HDL ratio alongside the individual values, as this is a stronger predictor of cardiovascular risk than total cholesterol alone. If you have a family history of heart disease, earlier and more frequent testing is appropriate.
Metabolic Checks: Blood Glucose and HbA1c
Insulin resistance increases during perimenopause, and the risk of type 2 diabetes rises significantly. Fasting blood glucose and HbA1c (a three-month average of blood sugar control) should both be checked during the perimenopause years. In the UK, fasting glucose between 5.6-6.9 mmol/L and HbA1c between 42-47 mmol/mol indicates pre-diabetes. This is a reversible condition with the right intervention, and the NHS Diabetes Prevention Programme offers structured support for those who qualify. Waist circumference, measured at the midpoint between the lower rib and the top of the hip bone, should be recorded at the same time. A reading above 80 cm increases metabolic risk; above 88 cm significantly increases it. These three measures together (fasting glucose, HbA1c, and waist circumference) give a clear picture of metabolic health that blood pressure and cholesterol alone do not provide.
Bone Density and Thyroid Function
DEXA scanning to assess bone density is not routinely available before menopause in the NHS without specific risk factors, but it is worth asking about if you have: a family history of osteoporosis, a history of low body weight or eating disorder, long-term use of corticosteroids, a smoking history, or early menopause. A baseline DEXA provides a reference point against which future scans can be compared. Thyroid function is another check that is often overlooked but commonly abnormal in perimenopausal women. Hypothyroidism is particularly prevalent in women over 40 and shares many symptoms with perimenopause, including fatigue, weight gain, brain fog, low mood, and joint aches. A simple TSH (thyroid-stimulating hormone) blood test screens for thyroid dysfunction. If your TSH is borderline, free T4 and thyroid antibodies can help clarify whether Hashimoto's thyroiditis (autoimmune hypothyroidism) is developing. Request a thyroid check if you have not had one recently, particularly if perimenopause treatments have not improved your fatigue and weight.
Cancer Screening: What to Know and When
Perimenopause overlaps with several national cancer screening windows. In England, cervical screening (smear tests) is offered every three years for women aged 25-49 and every five years for women aged 50-64. Keep up to date with invitations and do not postpone. Breast screening (mammography) begins at age 50 in England, with invitations every three years via the NHS Breast Screening Programme. Some women with strong family histories or BRCA gene mutations may be eligible for earlier or more frequent screening through genetics services. Bowel cancer screening begins at 50 (with a home stool test) in England and Scotland, earlier in Wales and Northern Ireland. If you have abnormal vaginal bleeding, particularly postmenopausal bleeding or bleeding after intercourse during perimenopause, this should be investigated promptly and not attributed to hormonal change without proper assessment. Endometrial cancer, while uncommon, presents with abnormal bleeding and is highly treatable when caught early.
Mental Health, Eye Health, and Dental Checks
Health checks during perimenopause should extend beyond the purely physical. Mental health screening is increasingly included in routine GP reviews, and given that depression, anxiety, and burnout are all elevated during the menopause transition, it deserves explicit attention. If low mood, anxiety, or sleep disruption are significantly affecting your quality of life, discussing this with your GP opens the door to effective support, whether that is HRT, therapy, medication, or a combination. Eye health deserves a check every two years. The risk of conditions including glaucoma, macular degeneration, and diabetic eye disease increases with age. Annual dental checks prevent the gum disease that is associated with cardiovascular risk and can be worsened by the dry mouth that some women experience during perimenopause. Skin checks are worth adding if you have many moles, a history of sun damage, or a family history of melanoma. Building an annual health check appointment with your GP that covers blood pressure, blood glucose, cholesterol, thyroid, and weight gives you one consolidated appointment rather than chasing individual tests throughout the year.
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