From the Guidelines
Before initiating Hormone Replacement Therapy (HRT) in a 56-year-old postmenopausal woman, it is essential to assess for contraindications to menopausal hormone therapy use, including history of breast cancer, liver disease, history of myocardial infarction, known or suspected estrogen-dependent neoplasia, history of deep vein thrombosis, and thrombophilic disorders, as recommended by the 2024 guideline from the American Heart Association/American Stroke Association 1. To evaluate these contraindications, the following laboratory tests are recommended:
- Complete blood count (CBC) to rule out any underlying blood disorders
- Comprehensive metabolic panel (CMP) to assess liver function and electrolyte balance
- Lipid profile to evaluate cardiovascular risk
- Thyroid function tests (TSH, free T4) to assess thyroid function
- Fasting blood glucose to evaluate glucose metabolism
- Follicle-stimulating hormone (FSH) and estradiol levels to confirm menopausal status
- Coagulation studies (PT/INR, PTT) if there's any history of clotting disorders Additionally, a mammogram within the past year and a Pap smear if not current are essential to rule out any estrogen-dependent neoplasia or cervical cancer. It is also important to consider the patient's overall health status, including any history of cardiovascular disease, stroke, or breast cancer, as these factors may influence the decision to initiate HRT, as suggested by the 2024 guideline from the American Heart Association/American Stroke Association 1. The selection of menopausal hormone therapy preparation should be made with shared decision-making, taking into account the patient's individual risk factors and medical history, and considering alternative nonhormonal therapy if contraindications are present, as recommended by the 2024 guideline from the American Heart Association/American Stroke Association 1.
From the Research
Laboratory Tests Prior to Initiating HRT
The following laboratory tests are recommended prior to initiating Hormone Replacement Therapy (HRT) in a 56-year-old postmenopausal woman:
- Confirmation of menopause by follicle-stimulation hormone (FSH) and E2 levels 2
- Mammography to exclude malignancy 2
- Assessment of lipid metabolism 2, 3
- Measurement of total cholesterol (TC), high density cholesterol (HDL-C), low density cholesterol (LDL-C), triglycerides, and calculation of TC/HDL-C and LDL-C/HDL-C ratios 3
- Pap smear, although it is not as important since cervical cancer is a rare event in some populations 2
- Pelvic sonography, although it cannot be a decisive diagnostic tool for ruling out malignancy 2
Additional Considerations
Other factors that may be considered prior to initiating HRT include: