Women's Health Blood Tests Guide

Hormone tests important for women

Tests for iron and nutritional status (high risk in women)

Menopause blood tests

Menopause is clinically diagnosed after 12 consecutive months without a period in women over 45. Blood tests are not always needed for diagnosis but can be helpful in: women under 45 (premature ovarian insufficiency, POI), women with a uterus who have had irregular periods, and women on hormonal contraception masking periods.

Women's cancer screening blood tests

Recommended blood test schedule for women

Questions to ask your doctor

• Is my FSH result consistent with my reproductive status?
• Should I have an AMH test to check my egg reserve?
• Is my thyroid causing my irregular periods?
• Am I iron deficient despite a normal haemoglobin?
• When should I start bone density monitoring?

References

Sources cited on this page. PubMed links open the original abstract.

1. American College of Obstetricians and Gynecologists. Well-woman visit. Obstet Gynecol. 2018;132(4):e181–e186. PMID 30247356 · doi:10.1097/AOG.0000000000002897

Cervical screening – what the HPV test detects and why it changed

England switched from cytology-based cervical screening (looking at cells directly under the microscope) to primary HPV testing in 2019. The change reflects the biology of cervical cancer: virtually all cases (99.7%) are caused by persistent infection with high-risk strains of human papillomavirus (HPV), particularly HPV 16 and 18. HPV testing detects the cause, not the consequence. It is more sensitive than cytology – detecting pre-cancerous cell changes earlier – while maintaining specificity through the reflex cytology step (cells are only examined under the microscope if HPV is detected).

Current NHS schedule: HPV test every 5 years for women aged 25–64. The test is performed from a cervical sample collected during the same appointment as the previous smear test (the sample collection procedure is identical). A negative HPV result is highly reassuring – lifetime risk of developing cervical cancer with a consistently negative HPV test is near zero. A positive high-risk HPV result with normal cytology triggers repeat testing in 12 months; positive HPV with abnormal cytology triggers colposcopy referral.

BRCA testing – who should be tested and what to expect

BRCA1 and BRCA2 are tumour suppressor genes. Pathogenic variants (harmful mutations) are found in approximately 1 in 400–500 women in the general population, rising to 1 in 40 in the Ashkenazi Jewish population (three founder mutations account for most cases). Lifetime breast cancer risk with BRCA1 mutation: approximately 72%; with BRCA2: approximately 69% – compared with a population lifetime risk of approximately 12%. Ovarian cancer risk: BRCA1 approximately 44%; BRCA2 approximately 17%.

NICE (DG27) recommends genetic testing for women with a personal or family history suggesting high BRCA probability – calculated using the Manchester Scoring System or similar risk tools. A score suggesting more than 10% probability of a BRCA variant warrants referral to a cancer genetics service. Testing requires genetic counselling before and after the result. Women who test positive can choose between enhanced screening (annual breast MRI from age 30), risk-reducing surgery (bilateral mastectomy reducing risk by 95%; bilateral salpingo-oophorectomy reducing ovarian cancer risk by 85–90%), and chemoprevention (tamoxifen or anastrozole – reduces breast cancer risk by approximately 30% in high-risk women).

Bone density and the DXA scan

Women lose bone density rapidly in the first 3–5 years after menopause (approximately 1–3% per year during this phase, compared with 0.3–0.5% per year in premenopausal women). The WHO defines osteoporosis as a T-score below −2.5 standard deviations from the mean peak bone density of a young adult woman at the hip or spine on DXA (dual-energy X-ray absorptiometry). Osteopenia is a T-score between −1 and −2.5. NICE recommends DXA scanning for postmenopausal women with: fragility fracture (fracture from low-energy trauma), prolonged steroid use (above 7.5 mg prednisolone per day for more than 3 months), early menopause, other specific risk factors. The FRAX tool (fracture risk assessment) estimates 10-year fracture probability, guiding bisphosphonate prescribing decisions.