The checklist for everything you need to test in your midlife WOF

Stay on top of trouble with these health tests
Images: Getty

There’s a strong case to be made for a bit of a midlife warrant of fitness (WOF)! It’s a good old maintenance check of all the working parts so that as we get past menopause and our risk of health issues goes up naturally, we can keep on top of that stuff too. Here’s a guide to the basic health admin we’ll be doing – ideally annually, or every two to three years, as noted. And obviously, if you’re having symptoms that are not normal for you, have those checked out immediately.

A woman sitting at a desk reading about her midlife health


This blood test measures one of the important fats circulating in your bloodstream. The test measures LDL, HDL, total cholesterol and the total cholesterol to HDL ratio. It’s good to have this done every year.

What’s good

Your doctor will be looking for a low LDL number – less than two; a high HDL number – one or more; and a total cholesterol of below four. The total HDL ratio should be below four too.

Blood sugar/blood glucose

This is a test of how much glucose you have in your bloodstream. It’s checked via a test called HbA1c, which shows an average of your blood glucose levels over the previous three months. It’s good to have this blood test every year.

What’s good

Your doctor will be looking for an HbA1c well below 40. If it’s over 40, it’s a sign of prediabetes, and if it’s over 50, it’s type 2 diabetes. Both of these are serious and will need treatment.


This is a test of your red blood cell count and haemoglobin level, as well as ferritin, a protein that helps store iron in your body. A low level of ferritin usually indicates a low level of stored iron. If you’re experiencing fatigue, this is a go-to blood test. A total blood count and haemoglobin will be part of an annual general blood test.

What’s good

Haemoglobin between 115 and 155 g/L is considered normal. Lower than that could mean anaemia. Ferritin might be checked if your doctor suspects either low or higher-than-normal iron stores. Normal levels for a post-menopausal woman are 30-370 g/L. Your doctor will be able to interpret your result as it applies to you.

A woman sitting on a doctor's bed speaking to a doctor about her midlife health

Blood pressure

This is a test of how well your heart is pumping blood around your body. Do this at least annually.

What’s good

Blood pressure (BP) tends to rise with age, so it’s good to keep an eye on as it’s a marker for other conditions such as heart disease and stroke. BP is expressed as two numbers – the systolic pressure followed by the diastolic pressure. An “ideal” blood pressure is 120/80 or below. Your doctor will flag it with you if your blood pressure is higher – and may suggest treatment. High blood pressure, or hypertension, needs to be addressed for your long-term heart health.

Thyroid hormone

A blood test of TSH (thyroid-stimulating hormone) is a useful check of thyroid function. It can reveal an underactive or overactive thyroid. Your doctor may choose to also test triiodothyronine (T3)
and thyroxine (T4). It’s best to get this checked annually.

What’s good

A TSH level of 0.4 to 4.0 mIU/L is considered normal – but there’s a lot of nuance in thyroid hormones and symptoms will be taken into account as well. Tests of other thyroid hormones might be ordered if your doctor suspects something isn’t working as it should be.


Once you’re 45, you’ll start getting invitations for breast screening. Make time for these appointments to detect any early signs of breast cancer. They’re done every two years. It’s a free test.

Cervical screening

Your medical practice should send you alerts that it’s time to go for these appointments to check for signs of cervical cancer. Do it. It’s every three years. This doesn’t have to be the dreaded thing we’re all used to, every time. There’s now also a much simpler and less invasive test called an HPV swab, which you can do yourself, either in the doctor’s practice or at home. If this test (which you do every five years) shows abnormal cells, you’ll still have to have one of the old-fashioned smear tests.

Dental check-up

Our oral health is linked to our overall health – especially heart health – in ways that are not quite clearly understood. It’s possible that it’s because bacteria from gum disease can enter our bloodstream and cause inflammation in our blood vessels. Or it could be that inflammation in the gums causes a kind of cascade of inflammation throughout our body. Whatever the case, looking after our teeth is important. If you can afford it, try to have a general oral check-up with your dentist every year.

Bowel screening/colonoscopy

Talk to your doctor about whether you’re a candidate for colonoscopy – if you have a family history of bowel cancer or have had any unusual changes in bowel habits, make sure you flag this. If you’re over 60, you should expect a letter inviting you to take part in the National Bowel Screening Programme. Yes, it involves getting a bit up-close-and-personal with your poo – but it’s a really good test for detecting microscopic amounts of blood in there that could be very early signs of bowel cancer. Up to 90 percent of bowel cancer is curable if caught early, so this is a valuable test to do. It’s every two years and it’s free.

Skin check

This can take the form of a once-over from your doctor or dermatologist from head to toe (make sure they check your scalp and soles), or a more formal imaging of your moles and freckles, eg MoleMap. Many of us are probably going to have a skin cancer in our lifetimes – likely a non-melanoma skin cancer, which is easy to treat if picked up early. Around 90,000 of these are diagnosed every year, alongside more than 2000 of the more serious melanoma skin cancers. An annual check could be a lifesaver.

Symptoms not to ignore

There are symptoms that are crucial not to ignore. They might be signs of serious trouble – though probably not (we don’t want to spook you). Either way, it’s best to get these checked out sooner rather than later.

  • Irregular bleeding (especially post-menopause) This might be a sign of trouble in your uterus. Any bleeding after menopause or during HRT treatment that’s not when it’s supposed to be (bearing in mind that you’ll have a bleed if you’re on cyclical HRT) needs to be checked out.
  • Changes in bowel habits Sudden onset of new bowel symptoms – bloating, constipation, pain, diarrhoea – could be signs of trouble, including bowel or ovarian cancer. Don’t sit on these – take them to your doctor early. And if you have bowel symptoms that wake you up at night, or any bleeding, that goes double.
  • Sudden weight loss Losing weight quickly is not normal and it might not be healthy.
  • Extreme fatigue Feeling tired is one thing, but feeling overwhelming fatigue when there’s nothing else (like flu or no sleep) going on, is another and might be a sign of trouble.
  • Changes to an existing mole or freckle This can be a sign of melanoma.
  • Shortness of breath or irregular heartbeat These are frightening symptoms that need to be investigated as they might indicate heart issues.

The big six

How might I die and what can I do about it?

Some things are just completely random bad luck. Lots of illnesses and cancers fall into this category. While we can’t prevent death, some of the most common causes of death for women are things for which we can take a bit of action to lower our risk. These are the top six causes of death for women in New Zealand.

A green book cover with white lettering titled: 'The Everything Guide' about midlife health
Edited extract from The Everything Guide: Hormones, Health and Happiness in Menopause, Midlife and Beyond by Niki Bezzant (Penguin, $45)

1. Heart disease

More accurately, ischaemic heart disease, which is the term for heart failure caused by narrowed heart arteries. Heart disease kills 55 women every week in this country. We’re at higher risk the older we are and if we have a history of heart disease in our family. But there are lots of risk factors we can do something about – high blood pressure, high cholesterol, obesity, inactivity, smoking, alcohol consumption and stress.

2. Stroke

Again more accurately, cerebrovascular disease. The Stroke Foundation says that over 75 percent of strokes are preventable. This is all about hypertension (high blood pressure) – all the things we can do to look after our hearts are going to be useful here.

3. Lung cancer

A startlingly high number of women still die from lung cancer, which remains our most common cancer killer. More New Zealanders die from lung cancer than from breast cancer, prostate cancer and melanoma combined. Smoking is of course the big risk factor here, but it’s not the only one. See your doctor if you have an unexplained cough, shortness of breath, chest pains or noisy breathing.

4. Chronic lower respiratory diseases

More lung stuff – this encompasses chronic obstructive pulmonary disease (COPD), chronic bronchitis, emphysema and asthma. Again, smoking is a big contributor to these, including second-hand smoke. Whatever we can do to look after our lungs – including learning to breathe properly – can only be good.

5. Breast cancer

Breast cancer is diagnosed in nine women every day in Aotearoa, and it kills 650 women each year. Risk increases with age. Around 75 percent of women who are diagnosed with breast cancer and 80 percent of women who die from it are over 50. Family history is a risk factor, but there are others – inactivity, obesity, alcohol consumption. In some women, there is also a small risk associated with HRT use, however, the risk from HRT has long been over-hyped and for most women it’s low – much lower than from the things listed above.

6. Bowel cancer

While we tend to think of this as more of a male disease, women’s risk for bowel cancer goes up post-menopause, possibly from losing the protective effect of oestrogen. There’s nothing we can do about that, but we can decrease our risk by eating a good diet full of fibre, limiting saturated fat, red and processed meat, not smoking, keeping an eye on salt and sugar intake, and drinking little or no alcohol.

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