By:  Andreia Monteiro | Medical Doctor (Medical Association No. 45778), specialist in Immuno-hemotherapy, dedicated to preventive, functional, and aesthetic medicine. She is the founder and clinical director of Clínica Pilares da Saúde, and the Imunocare supplement store in  Amadora.

After 40, the body changes its tune: the tests that should be on your agenda

There is a phrase I hear almost every week in the office: “I feel like something is wrong, but all my tests came back normal.” It’s not your imagination. Many times, we simply haven’t asked the body the right questions yet. After 40, a woman’s body enters a transitional phase—hormonal, metabolic, and skeletal—that calls for closer and more frequent attention. The good news is that most things that can go wrong can be detected early, treated early, and, in many cases, prevented. And that starts with knowing which tests to ask for, and how often.

Here is a practical guide, organized by the areas that really matter from this decade onward.

1. Blood tests: the foundation of everything

An annual “general” check-up is no longer enough. From 40 onward, there are specific markers that deserve extra attention:

•       Complete blood count: detects anemia, which is common at this stage due to ongoing menstrual blood loss or nutritional deficiencies.

•       Lipid profile (total cholesterol, LDL, HDL, triglycerides): a woman’s cardiovascular risk rises significantly after menopause, so it is worth starting to monitor it before that phase begins.

•       Fasting glucose, glycated hemoglobin (HbA1c), and insulin: these screen for prediabetes, which often remains silent for years.

•       Thyroid function (TSH, T4, total and free T4, and antibodies): thyroid disorders are much more common in women, and symptoms such as fatigue, weight changes, or hair loss are easily mistaken for “stress” or “age.”

•       Vitamin D, vitamin B12, and iron studies with ferritin: common deficiencies that directly impact energy, mood, immunity, and bone health.

•       Kidney and liver function: an important starting point for evaluating any supplementation or treatment adjustments.

The ideal frequency depends on your medical history, symptoms, and previous results. This is where your attending physician comes in: to interpret the numbers in context, never in isolation.

2. Hormonal health: recognizing perimenopause before it screams

Many women reach perimenopause without realizing they are already there. Irregular cycles, insomnia, mood swings, mild hot flashes, or even difficulty concentrating can begin years before menopause itself. A hormonal assessment—which should include FSH, LH, estradiol, estriol, progesterone, testosterone, and many other hormones and, depending on the clinical picture, other markers—helps clarify this transition and determine, together with your doctor, whether some form of hormone modulation makes sense. There is no fixed age for requesting this assessment: the signal to act is the symptoms, not chronological age.

3. The non-negotiable cancer screenings

This is perhaps the area where personal responsibility saves the most lives, because these screenings detect diseases that, when caught early, have very high cure rates.

•       Mammography: in Portugal, organized screening now covers women between the ages of 45 and 74, repeated every two years. If there is a family history of breast cancer or other risk factors, your doctor may recommend starting earlier.

•       Cervical screening: with cervical cytology (Pap smear) and, from age 30 onward, often associated with an HPV test. It should be kept up to date even after menopause and even in women vaccinated against HPV.

•       Colorectal cancer screening: generally from age 50 (or earlier if there is a family history), through fecal occult blood testing or colonoscopy, depending on medical guidance.

•       Skin examination: an annual dermatological assessment, especially if you have many moles, fair skin, or a history of intense sun exposure, helps identify suspicious lesions early.

An abnormal screening result is not, in itself, a diagnosis—it is an invitation to investigate more closely, often with simple tests and without any emergency. It is this timely investigation, done calmly and with medical supervision, that makes all the difference in the outcome.

4. Bones and heart: what doesn’t hurt until it hurts a lot

Bone mass loss accelerates in the years around menopause, and cardiovascular disease remains the leading cause of death in women—more than any cancer. Yet it is often undervalued, because the symptoms, when they appear, are often different from those classically described in men.

•       Bone densitometry: generally recommended from age 65 in the general population, but it can and should be done earlier in the presence of risk factors—early menopause, prolonged corticosteroid use, a family history of osteoporosis or fractures, and low body weight.

•       Blood pressure: it should be measured at least once a year, even without symptoms.

•       Overall cardiovascular risk assessment: lipid profile (cholesterol), blood pressure, glucose, weight, and habits such as smoking and poor or insufficient sleep should be part of routine check-ups from age 40 onward.

5. What else counts: vision, hearing, and emotional health

Presbyopia (difficulty seeing up close) usually sets in from age 40–45, so regular ophthalmology check-ups are no longer just about aesthetics. Hearing also deserves attention in this decade, especially with frequent noise exposure. And emotional health—often the great oversight in check-ups—deserves the same space as any blood test: emotional instability, anxiety, or recurring insomnia are not “things of age” that we should simply resign ourselves to. They are signs that can, and should, be assessed.

It is also worth remembering that no test can replace daily habits. The way you eat, sleep, move, and manage stress directly influences the values that appear in these tests—and it is often there, in your routine, that lies the fastest lever for improving them.

The power is in your hands

None of these tests, taken alone, guarantees perfect health. But together, and done regularly, they become a powerful tool: the tool of deciding with information, instead of waiting for the body to scream before it is heard. You do not need to memorize this list—build a monitoring plan tailored to your history and risk factors with your doctor.

Health after 40 is not a destination you suffer through. It is a daily construction, built from small and consistent decisions. And that construction often begins with a simple request for blood tests.