From the Guidelines
Laboratory tests indicated in a postmenopausal woman after hysterectomy with symptoms of menopause include estradiol, follicle-stimulating hormone (FSH), luteinizing hormone (LH), and prolactin, as clinically indicated.
Relevant Laboratory Tests
- Estradiol: to assess menopausal status and symptoms
- Follicle-stimulating hormone (FSH): to confirm menopausal status, although its reliability may be affected by prior chemotherapy or pelvic radiation exposure
- Luteinizing hormone (LH): to assess menopausal status
- Prolactin: to rule out other medical causes of symptoms, such as thyroid disease or diabetes 1
Clinical Considerations
In postmenopausal women with symptoms of menopause, it is essential to assess and treat medical causes of symptoms, such as thyroid disease and diabetes 1. The USPSTF recommends against the use of hormone therapy for the primary prevention of chronic conditions in postmenopausal women, but this does not apply to the treatment of menopausal symptoms 1. A pelvic evaluation should be performed to assess for vaginal atrophy in women with complaints of vaginal dryness, and can be accomplished by referral to an appropriate specialist 1.
From the Research
Laboratory Tests for Postmenopausal Women after Hysterectomy
The following laboratory tests may be indicated in a postmenopausal woman after hysterectomy if symptoms of menopause are present:
- Follicle stimulating hormone (FSH) levels to confirm menopause 2
- Estradiol levels to evaluate hormonal status, although caution is advised due to potential pitfalls in laboratory analysis 3
- Anti-mullerian hormone (AMH), inhibin B, and DHEA-S levels to assess ovarian function 3
- Estrone levels to evaluate hormonal status 3
Considerations for Hormone Replacement Therapy
When considering hormone replacement therapy (HRT) for postmenopausal women after hysterectomy, the following factors should be taken into account:
- Estrogen-only therapy may be sufficient for women without a uterus, as the risk of endometrial cancer is eliminated 4
- The addition of progestogen to estrogen-only therapy may increase the risk of breast cancer without providing additional benefits for hot flashes or vaginal symptoms 4
- Individualized risk/benefit analysis is necessary to determine the appropriateness of HRT for each patient 4
Potential Effects of Hysterectomy on Menopause
Hysterectomy may be associated with an earlier onset of menopause, particularly in women with unilateral oophorectomy 2
- Women who undergo hysterectomy with unilateral oophorectomy may experience menopause 4.4 years earlier than those with both ovaries intact 2