From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
When using estradiol in postmenopausal hormone replacement therapy (HRT), there is no need to monitor or target specific FSH levels. FSH levels naturally rise during menopause (typically >30 mIU/mL) and will decrease with estrogen therapy, but this reduction doesn't need to be monitored routinely or used to guide treatment decisions. Instead, HRT dosing should be based on symptom relief and tolerability rather than laboratory values. The typical starting dose for oral estradiol is 0.5-1 mg daily, transdermal estradiol 0.025-0.05 mg/day patch, or estradiol gel 0.5-1.0 g daily. For women with an intact uterus, progesterone must be added (such as micronized progesterone 100-200 mg daily for 12-14 days per month or continuously) to prevent endometrial hyperplasia. The mechanism behind this approach is that estrogen therapy works by alleviating symptoms through direct action on target tissues, not by normalizing FSH. While FSH levels will decrease with adequate estrogen replacement, this is a consequence of negative feedback on the hypothalamic-pituitary axis rather than the therapeutic goal itself, as suggested by recent studies 1. Some studies have suggested that the degree of reduction of FSH (39.1-52.2%) and LH (48.0-64.3%) from the baseline may possibly be used as a guide to the therapeutic hormone levels during HRT 2, but this is not a recommended practice in current clinical guidelines. Current recommendations for HRT use in menopausal women focus on the benefits of HRT in improving the symptoms of menopause, as well as the potential role of HRT in managing long-term sequelae, and evidence pertaining to the potential risks associated with HRT 3. In terms of the choice of estrogen and progestin, recent physiology-based clinical evidence suggests that estradiol and progesterone may have a better safety profile compared to other estrogens and progestins 1, 4. However, the primary goal of HRT is to alleviate symptoms, and treatment decisions should be based on individual patient needs and responses to therapy. Key points to consider when using estradiol in postmenopausal HRT include:
- Starting with a low dose and titrating as needed to achieve symptom relief
- Adding progesterone to prevent endometrial hyperplasia in women with an intact uterus
- Monitoring for potential side effects and adjusting the treatment regimen as needed
- Considering the use of estradiol and progesterone due to their potentially better safety profile.