What labs are required for female patients considering Hormone Replacement Therapy (HRT)?

Laboratory Tests Required for Female Hormone Replacement Therapy

For women considering Hormone Replacement Therapy (HRT), a comprehensive baseline laboratory assessment is essential to ensure safety and appropriateness of treatment, with specific tests required to evaluate hormone levels, metabolic function, and rule out contraindications.

Essential Laboratory Tests

Baseline Hormone Levels

• Follicle-stimulating hormone (FSH) and luteinizing hormone (LH) - To confirm menopausal status, particularly important in women under 40 with suspected premature ovarian insufficiency 1
• Estradiol - To assess baseline estrogen levels and confirm menopausal status
• Thyroid-stimulating hormone (TSH) - To rule out thyroid dysfunction which can mimic menopausal symptoms

Metabolic and Cardiovascular Assessment

• Lipid profile - Total cholesterol, LDL, HDL, and triglycerides to assess cardiovascular risk
• Fasting blood glucose - To evaluate for diabetes or insulin resistance
• Liver function tests - To rule out active liver disease which is a contraindication to HRT 2

Cancer Screening

• Mammogram - To establish baseline breast health before initiating therapy
• Endometrial assessment - For women with unexplained vaginal bleeding to rule out endometrial pathology 3

Additional Tests Based on Specific Circumstances

For Women with Intact Uterus

• Pelvic ultrasound - To evaluate endometrial thickness and rule out pathology
• Endometrial biopsy - If abnormal bleeding is present 4

For Women with Hypertension

• Blood pressure measurement - Hypertension is not a contraindication but may influence route of administration 1
• Transdermal estradiol is preferred in hypertensive women 1

For Women with Risk Factors for Osteoporosis

• Bone mineral density (BMD) - To establish baseline bone health, especially important as HRT can provide bone protection 1

For Women with History of Venous Thromboembolism

• Thrombophilia screening - Consider in women with personal or strong family history of VTE
• D-dimer - If clinically indicated for suspected VTE

Monitoring Tests During HRT

• Annual clinical assessment - To evaluate treatment effectiveness and side effects 2
• Mammogram - Regular screening as per age-appropriate guidelines
• Endometrial assessment - For women with abnormal bleeding while on HRT 4
• Lipid profile and liver function tests - Periodic monitoring to assess metabolic effects

Important Considerations

• No routine monitoring tests are required once established on therapy, but specific tests may be prompted by symptoms or concerns 1
• For premenopausal women transitioning to postmenopausal status while on tamoxifen, serial assessment of LH, FSH, and estradiol is mandatory when considering AI therapy 1
• Women with premature ovarian insufficiency (POI) should be monitored annually with particular attention to compliance with HRT 1
• For women with an intact uterus, progestogen must be given in combination with estrogen therapy to protect the endometrium 1, 4

Route-Specific Considerations

• Transdermal estradiol is preferred for women with hypertension or risk factors for venous thromboembolism 1, 5
• 17-β estradiol is preferred to ethinylestradiol or conjugated equine estrogens for estrogen replacement 1

HRT is a valuable treatment option for menopausal symptoms when appropriately prescribed based on comprehensive laboratory assessment and individual risk factors. The laboratory evaluation ensures that benefits outweigh risks and helps guide the selection of optimal HRT regimen and route of administration.