What blood tests should women ask for?

The standard annual panel.

If you walk into a U.S. primary care office for a routine annual physical, the bloodwork ordered is usually some version of the following. Specifics vary by provider, plan and reason for the visit.

This is a perfectly reasonable starting frame for a healthy adult. It is also notably thin on biomarkers that disproportionately affect U.S. women — particularly those who menstruate, those who are pregnant or postpartum, and those navigating the years before menopause.

"A standard annual panel is built for the median patient. Women are not statistically the median patient."

The women's-extended panel.

The biomarkers below are not "extra" in any luxury sense. Many are inexpensive, well-validated, and routinely ordered by clinicians who pay attention to women's health. They are simply not part of the default U.S. annual physical, and so often need to be requested.

Ferritin (iron stores).

The single most-discussed missing marker in women's health writing — for reason. Ferritin sits outside CBC and only shows up on iron-specific orders. Approximately 1 in 5 menstruating women in the U.S. has clinically heavy periods, and iron stores can run low for years before haemoglobin drops enough to register as anaemia on CBC. The ferritin guide walks through what the number means in context, and the ferritin-and-heavy-periods guide covers the menstrual connection specifically.

Vitamin D (25-OH).

Often included now in U.S. primary care — but not universally. Worth asking about if you spend most of your time indoors, live above the 35th parallel, have darker skin (which alters skin synthesis), are postpartum, or are managing autoimmune or bone-health concerns. Read more on the vitamin D page.

Vitamin B12 (and folate).

B12 deficiency is more common than most people realise, particularly in vegetarians, vegans, those on long-term acid-suppression medication, and adults over 50. Symptoms — fatigue, brain fog, tingling — overlap heavily with iron deficiency and thyroid dysfunction, which is part of why a clean differential matters. Folate is often added in the same blood draw. See the B12 guide.

Free T4 and free T3 (full thyroid).

TSH alone catches most overt thyroid disease but misses some patterns of subclinical or symptomatic dysfunction. A full panel — TSH plus free T4, free T3, and optionally TPO antibodies — is increasingly considered the standard of care for women with thyroid symptoms. The thyroid panel guide covers what each marker adds.

Fasting insulin and HbA1c.

HbA1c is now standard. Fasting insulin is not — but it often moves first when metabolic health is drifting, sometimes years before glucose or HbA1c flag. Particularly worth a conversation if you have PCOS, gestational diabetes history, a family history of type 2 diabetes, or perimenopausal symptoms.

ApoB.

An emerging standard in U.S. preventive cardiology. ApoB counts the cholesterol-carrying particles that actually drive atherosclerosis — a more direct measure of cardiovascular risk than total cholesterol or LDL alone. Increasingly emphasised in women's heart health, where the standard lipid panel can underestimate risk.

hsCRP.

High-sensitivity C-reactive protein. A general marker of low-grade inflammation, useful as cardiovascular context and as a sanity check when interpreting other inflammation-sensitive markers (ferritin, for example, can rise with inflammation independent of iron status).

Hormones, and the importance of cycle context.

Hormones are the most context-dependent biomarkers on the page. A single estradiol number means very different things depending on the day of the cycle, the time of day, the use of hormonal contraception, and where you sit in the reproductive lifespan.

• Estradiol (E2): typically lowest in the early follicular phase, peaks around ovulation, plateaus in the luteal phase, drops with menstruation. Always note the cycle day on the order. See the estradiol page for full reference ranges by phase.
• Progesterone: only meaningful in the luteal phase, ideally drawn around day 21 of a 28-day cycle (or roughly 7 days post-ovulation). Read the progesterone page.
• FSH and LH: elevated baseline FSH in the early follicular phase is one of the markers used in evaluating perimenopause, ovarian reserve and ovulation patterns.
• AMH: anti-Müllerian hormone. A marker of ovarian reserve. Generally cycle-independent — but interpretation is nuanced and depends on the clinical question.
• Testosterone (total and free): worth discussing if there are symptoms of androgen excess (acne, hirsutism, irregular cycles) or, conversely, low libido and energy concerns.

If you are on hormonal contraception, many of these results are difficult to interpret — your provider may want you off contraception for a cycle or two before drawing, depending on the question.

Cardiometabolic markers, by life stage.

Cardiovascular disease is the leading cause of death in U.S. women — and the standard "lipid panel" alone often misses the early signal in women, particularly through the perimenopause transition when ApoB and hsCRP tend to drift before LDL or total cholesterol flag. The cardiometabolic page walks through this in depth.

Markers worth discussing.

• ApoB: the particle count behind atherosclerotic risk.
• Lp(a): a one-time genetic marker. Worth drawing once in a lifetime, particularly with a family history of early cardiovascular disease.
• hsCRP: low-grade inflammation as risk context.
• Fasting insulin and HbA1c: metabolic drift indicators.
• Triglyceride/HDL ratio: a useful insulin-sensitivity proxy already inside the standard lipid panel.

Insurance, coverage and the "they won't cover that" conversation.

This is the conversation that derails more good bloodwork than any clinical question. A few framing notes that may be useful when talking to your provider's office.

The practical conversation.

If your provider is willing in principle but unsure about coverage, the useful sentence is: "Can we order it, and can the office help me find out the out-of-pocket cost if it isn't covered?" Many practices have a billing person who can give you a real number before the draw.

If a test is meaningful to you but the practice can't run it, the compare-tests hub covers at-home options (Function Health, LetsGetChecked and others) that include many of these markers without an insurance loop.

How to ask.

The way a request is framed often shapes whether it's heard as a reasonable clinical question or a googled wish-list. A few moves that tend to land well.

If the answer is no.

It often won't be — but if it is, asking why is part of the learning. Sometimes there's a clinical reason you don't have visibility into. Sometimes it's coverage. Sometimes the provider would prefer to retest something else first. All of those are useful.