Bloodwork & baseline

TestWhy FSHRising FSH confirms ovarian function decline. Single reading is less useful than trend — expect fluctuation in peri. Estradiol (E2)Should be tested day 3 of cycle if still menstruating. Swings wildly in peri — context matters. TSH + Free T4Rule out thyroid dysfunction. Most important differential diagnosis. Hashimoto's is common in women this age. FerritinNot just hemoglobin — ferritin below 30 causes fatigue and brain fog even if "not anemic." Below 50 is suboptimal. Vitamin D (25-OH)Target 50–70 ng/mL. Deficiency is epidemic and mimics mood/joint symptoms. Fasting insulin + glucosePerimenopause increases insulin resistance. Catches metabolic changes early. DHEA-SAdrenal androgen marker. Low levels correlate with fatigue and low libido. ProgesteroneTest day 19–21 if cycling. Dropping progesterone is often the first hormonal change. hs-CRPSystemic inflammation marker. Baseline for tracking protocol effectiveness. Lipid panelCardiovascular risk rises sharply as estrogen declines. Establish baseline now.

A menopause-specialist OB/GYN or reproductive endocrinologist is worth finding. Many general practitioners are undertrained on HRT, and the biggest mistake is finding a provider who dismisses hormone therapy based on the outdated 2002 WHI study. The Menopause Society practitioner directory (formerly NAMS) lists certified specialists.