Health Check Over 40 UK: The Blood Tests You Need

Turning 40 is when your body quietly starts rewriting the rules. Cardiovascular risk climbs. Hormones shift. Metabolic changes that were invisible in your 30s begin to show up — in your energy levels, your weight, your sleep, and eventually your bloodwork. The problem is that most of these changes are silent. You will not feel your cholesterol rising or your thyroid slowing down until the damage is already done.

The NHS offers a free Health Check for adults aged 40 to 74, repeated every five years. It is a good starting point — but it was designed as a population-level screening tool, not a comprehensive personal health assessment. If you are serious about catching problems early and optimising how you feel, you need to go further.

This guide breaks down exactly what the NHS Health Check covers, what it misses, and which blood tests matter most once you pass 40 — covering heart health, diabetes, thyroid function, hormones, inflammation, and cancer screening.

What Does the NHS Health Check Actually Cover?

The NHS Health Check is offered to every adult in England aged 40 to 74 who does not already have a diagnosed condition such as heart disease, diabetes, or kidney disease. You are invited once every five years, either by your GP surgery or local council.

During the appointment, a healthcare professional will:

• Measure your blood pressure
• Check your cholesterol — total cholesterol and HDL (“good” cholesterol), usually via a finger-prick test
• Test your blood sugar (glucose or HbA1c) to assess diabetes risk
• Measure your height, weight, and BMI
• Ask about lifestyle factors — smoking, alcohol, diet, exercise
• Calculate your cardiovascular risk score (QRISK) — your percentage chance of having a heart attack or stroke within the next 10 years
• Discuss dementia awareness (for those aged 65–74)
• From 2025, include questions about menopause symptoms for women

If your risk factors are elevated, the healthcare professional may recommend lifestyle changes, refer you for further testing, or suggest medication such as statins. In some cases, kidney function (eGFR and creatinine) is also checked.

The programme is well-intentioned and it is free. But it was designed as a population-level cardiovascular risk screen, not a thorough health assessment. And for anyone over 40 who wants to be proactive rather than reactive, the gaps are significant.

What the NHS Health Check Misses

The NHS Health Check was created to identify people at high risk of cardiovascular disease. It does that job reasonably well. But the human body at 40 has far more going on than heart risk alone. Here is what the standard check does not cover:

• Thyroid function: TSH, Free T4, and Free T3 are not part of the NHS Health Check. Hypothyroidism affects 5–10% of the UK population and prevalence increases with age — yet it is only tested when you present with symptoms severe enough for a GP to investigate. Read more: Thyroid Blood Test UK.
• Advanced cardiovascular markers: The NHS checks total cholesterol and HDL. It does not test ApoB (the number of atherogenic particles in your blood) or Lp(a) (a genetically determined cardiovascular risk factor that affects 1 in 5 people). As Peter Attia has argued extensively, ApoB is a far better predictor of cardiovascular events than LDL alone.
• Liver health: ALT and GGT are not tested. Non-alcoholic fatty liver disease (NAFLD) now affects roughly 25% of UK adults, and it is almost entirely asymptomatic until advanced stages. Liver enzymes are the earliest warning sign.
• Hormones: Testosterone, oestradiol, and FSH are only tested in very specific clinical situations. For men experiencing gradual testosterone decline, and for women entering perimenopause, these markers provide essential context. The 2025 update adds menopause symptom questions to the NHS Health Check — but not the blood tests to go with them.
• Vitamin and mineral status: Vitamin D, B12, and ferritin are not included. Vitamin D deficiency affects an estimated 1 in 5 UK adults, B12 deficiency is common in over-50s, and low ferritin is one of the most frequent causes of unexplained fatigue.
• Inflammation: CRP (C-reactive protein) is a marker of systemic inflammation linked to cardiovascular disease, autoimmune conditions, and chronic illness. It is not part of the standard check.
• Full iron studies: Ferritin alone may be checked if anaemia is suspected, but a full iron panel (ferritin, serum iron, TIBC, transferrin saturation) gives a far clearer picture. Iron overload — not just deficiency — becomes a relevant risk after 40.

NHS Health Check vs Comprehensive Private Panel

The comparison between a standard NHS Health Check and a comprehensive private blood test illustrates the difference between population screening and personalised health assessment:

The NHS Health Check is not wrong — it is just incomplete. It was designed for a health system under extreme resource pressure, not for individuals who want to take ownership of their health. Think of it as the free MOT that checks your brakes and lights. A comprehensive panel is the full diagnostic that checks every system under the bonnet.

Cardiovascular Disease: The Biggest Risk After 40

Cardiovascular disease (CVD) is the leading cause of death in the UK, responsible for around 160,000 deaths per year. The British Heart Foundation estimates that 7.6 million people in the UK are living with heart and circulatory diseases, and more than half of all UK adults have cholesterol levels above national guidelines.

The risk escalates sharply from your 40s. For adults aged 40 to 69, each 20 mmHg rise in systolic blood pressure doubles the risk of death from coronary heart disease. And the process of atherosclerosis — arterial plaque build-up — is typically well underway by the time you reach 40, even if you feel perfectly healthy.

The NHS Health Check covers total cholesterol and HDL, which gives you a basic ratio. But the science has moved on. The blood tests that matter most for assessing cardiovascular risk in your 40s include:

• ApoB (Apolipoprotein B): Measures the actual number of atherogenic lipoprotein particles in your blood. ApoB is now considered a superior predictor of cardiovascular events compared with LDL cholesterol alone, because it counts every particle that can embed in your arterial wall — including VLDL and Lp(a). If your ApoB is elevated, your cardiovascular risk is elevated, regardless of what your LDL says.
• Lp(a) (Lipoprotein-a): A genetically determined cardiovascular risk factor that affects approximately 1 in 5 people. Unlike cholesterol, Lp(a) levels are largely set by your genes and do not change significantly with diet or exercise. You only need to test it once in your life to know your risk — but the NHS does not test it at all. Elevated Lp(a) roughly doubles your risk of heart disease.
• Triglycerides: Elevated triglycerides, particularly combined with low HDL, are a strong marker for metabolic dysfunction and insulin resistance. They are also an independent risk factor for cardiovascular disease.
• hs-CRP (high-sensitivity C-reactive protein): Measures low-grade systemic inflammation. Chronic inflammation is now understood to be a driving force behind atherosclerosis, not just a consequence of it. Elevated hs-CRP combined with elevated ApoB significantly increases your risk profile.

Diabetes and Metabolic Health

More than 4.1 million adults in England have been diagnosed with type 2 diabetes, and an estimated further 850,000 have it without knowing. If you are over 40, your risk increases substantially — and the window for reversing prediabetes through lifestyle intervention is finite.

The NHS Health Check includes a basic blood glucose or HbA1c measurement, which is helpful. HbA1c gives you a 2–3 month average of blood sugar levels, and it can identify prediabetes (42–47 mmol/mol) before full diabetes develops (48+ mmol/mol).

But the most useful addition for anyone over 40 is fasting insulin. Insulin resistance — where your body produces more and more insulin to keep blood sugar in range — develops years before HbA1c rises. Your blood sugar can look perfectly normal while your insulin levels are already elevated, silently driving weight gain, inflammation, and arterial damage. Testing fasting insulin alongside HbA1c gives you a much earlier warning.

Thyroid Function in Your 40s

Thyroid disorders affect 5–10% of the UK population and become significantly more common after 40, particularly in women. Hypothyroidism (an underactive thyroid) can cause fatigue, weight gain, brain fog, depression, dry skin, and sensitivity to cold. The symptoms overlap heavily with general ageing, stress, and perimenopause — which means it is frequently missed.

The NHS typically tests only TSH (thyroid-stimulating hormone) if thyroid problems are suspected. If TSH is within range, you are told your thyroid is “fine.” But TSH alone can miss subclinical thyroid dysfunction. A comprehensive thyroid panel adds Free T4, Free T3, and thyroid antibodies (TPO and TgAb) — which can detect autoimmune thyroiditis (Hashimoto’s) years before TSH becomes abnormal.

For anyone over 40, particularly women, including a full thyroid panel in your annual blood test is one of the highest-value additions you can make.

Hormonal Changes After 40: Women and Men

Women: Perimenopause and Beyond

The average age of menopause in the UK is 51, but perimenopause — the transitional phase when hormone levels begin to fluctuate — typically starts in the early-to-mid 40s and can last 2 to 8 years. During perimenopause, oestrogen does not simply decline in a straight line. It fluctuates dramatically, sometimes spiking higher than pre-menopausal levels before dropping again. Progesterone tends to fall earlier and more consistently. This imbalance drives symptoms including hot flushes, night sweats, mood changes, irregular periods, brain fog, and anxiety.

The 2025 NHS Health Check update adds menopause symptom questions, which is a positive step. But it does not include blood tests for FSH, oestradiol, or testosterone (which also declines in women and affects libido, energy, and muscle mass). If you are considering HRT or want to understand where you are in the menopausal transition, hormone blood testing provides the objective data to guide those conversations with your doctor. Read our full guide: Menopause Blood Tests.

Men: The Gradual Testosterone Decline

In most men, testosterone levels begin to decline from around age 30, dropping by roughly 1% per year. The decline is gradual — unlike the hormonal cliff of menopause, it is often imperceptible year to year. But by age 50, many men have testosterone levels 20% or more below their peak, and about a third of men over 45 have levels below the normal range for their age.

Low testosterone can contribute to fatigue, reduced muscle mass, increased body fat, low mood, reduced libido, and poor concentration. The NHS does not routinely test testosterone unless a man presents with specific symptoms and his GP deems it clinically necessary — which means many men experience a slow decline in quality of life without understanding the cause.

A comprehensive panel that includes testosterone, SHBG (sex hormone-binding globulin), and free testosterone gives a clear picture of hormonal status and provides a baseline for future comparison.

Cancer Screening: What the NHS Does and Does Not Offer

The NHS runs three national cancer screening programmes in England:

• Bowel cancer screening: Offered every 2 years from age 50 (previously 54, being rolled out to 50 from 2025). A home faecal immunochemical test (FIT) kit is posted to you.
• Breast cancer screening: Mammography every 3 years for women aged 50–70.
• Cervical cancer screening: Every 3 years for women aged 25–49, every 5 years for women aged 50–64.

These programmes are evidence-based and save lives. But they are distinct from the NHS Health Check — they run on separate schedules, and not everyone takes up the invitation. There is no routine blood test for cancer in the NHS Health Check.

While blood tests cannot diagnose cancer, certain markers can flag the need for further investigation. Elevated liver enzymes (ALT, GGT) can indicate liver problems that warrant imaging. A persistently elevated CRP may prompt investigation for underlying causes. Changes in full blood count parameters can point towards blood cancers or chronic conditions. None of these are diagnostic on their own, but as part of a regular comprehensive panel, they add another layer of early detection.

Preventive vs Reactive: Why Annual Testing Matters

The fundamental limitation of the NHS approach is frequency. A health check every 5 years is better than nothing, but a great deal can change in half a decade. You could develop insulin resistance, thyroid dysfunction, vitamin deficiency, or elevated inflammatory markers — all of which progress quietly for years before causing symptoms.

Annual blood testing changes the dynamic entirely. Instead of isolated snapshots, you build a longitudinal record of your health. You can see your HbA1c creeping up from 38 to 41 to 43 over three years — still within the “normal” range, but trending towards prediabetes. You can catch ferritin dropping year on year before it reaches a level that makes you feel exhausted. You can track your cholesterol ratio and ApoB response to dietary changes.

This is the difference between reactive medicine (waiting for disease to arrive) and preventive medicine (intervening before it does). It is also the approach advocated by longevity physicians including Peter Attia, who argues that the diseases that kill most people — heart disease, cancer, metabolic disease, neurodegenerative disease — develop over decades and are far easier to prevent than to treat.

Your Annual Testing Schedule After 40

Here is a practical framework for how often to test, combining NHS screening programmes with private blood testing:

The goal is not to replace the NHS — it is to fill the gaps. Take every NHS screening invitation you receive. Accept the free Health Check. And then supplement it with comprehensive blood testing that covers the markers the NHS does not.

Frequently Asked Questions

What does an NHS Health Check include?

The NHS Health Check includes blood pressure measurement, total cholesterol and HDL cholesterol (usually via finger-prick test), blood glucose or HbA1c, height, weight, BMI, and a cardiovascular risk score (QRISK). From 2025, it also includes menopause symptom questions for women. It does not include thyroid function, liver enzymes, hormones, vitamins, iron studies, or advanced cardiovascular markers like ApoB.

How often should I get a health check after 40?

The NHS offers a free Health Check every 5 years between ages 40 and 74. For more proactive health monitoring, an annual comprehensive blood test (covering 45–70 biomarkers) provides far better trend data and earlier detection of changes. If you are managing a condition, on medication, or making significant lifestyle changes, testing every 3–6 months is more appropriate.

What blood tests should a 40-year-old get?

At minimum: a full lipid panel (including triglycerides and ideally ApoB), HbA1c for diabetes risk, TSH and Free T4 for thyroid function, liver enzymes (ALT, GGT), kidney function (eGFR, creatinine), vitamin D, B12, ferritin, CRP for inflammation, and hormones (testosterone, oestradiol, FSH). Testing Lp(a) once is also strongly recommended as it is genetically determined and never tested on the NHS.

Is the NHS Health Check worth it?

Yes — it is free and it provides a baseline cardiovascular risk assessment that many people would not otherwise get. A 2023 BMJ study found that NHS Health Check attendance was associated with reduced multiorgan disease risk. The limitation is scope: it only covers cardiovascular risk factors and misses thyroid, liver, hormonal, vitamin, and inflammatory markers. The best approach is to accept the NHS Health Check when invited and supplement it with a comprehensive private blood test annually.

Can I get a private health check to complement the NHS?

Absolutely. A private blood test requires no GP referral and covers 45–70 biomarkers compared with the NHS Health Check’s 3–4. You choose when and how often to test, a professional phlebotomist visits your home, and results are returned in 2 working days with a GP review. It fills every gap the NHS Health Check leaves — thyroid, liver, hormones, vitamins, iron, inflammation, and advanced lipids.

What are the early warning signs of heart disease after 40?

The early stages of cardiovascular disease are typically silent — which is precisely why blood testing matters. Elevated ApoB, high triglycerides, raised hs-CRP, and elevated HbA1c are all markers that can flag risk years before symptoms appear. By the time you experience chest pain, shortness of breath, or other physical symptoms, arterial damage is often well advanced. Regular blood testing is the most effective way to catch these risks early.

Should women over 40 get hormone blood tests?

Yes, particularly if you are experiencing symptoms that could indicate perimenopause — irregular periods, hot flushes, mood changes, sleep disruption, brain fog, or changes in libido. Testing FSH, oestradiol, and testosterone provides objective data to discuss with your doctor, particularly if you are considering HRT. Even without symptoms, establishing a baseline in your early 40s allows you to track changes over time. Read more: Menopause Blood Tests.

Should men over 40 get testosterone tested?

It is strongly recommended. Testosterone declines by roughly 1% per year from age 30, and about a third of men over 45 have levels below normal for their age. Symptoms of low testosterone — fatigue, reduced muscle mass, weight gain, low mood, poor concentration — overlap with stress, poor sleep, and general ageing, so many men do not connect the dots. Testing testosterone, SHBG, and free testosterone establishes a baseline and gives you data to act on.