Should hormone levels be monitored during menopause?

From the Guidelines

Monitoring hormone levels during menopause is generally not necessary for most women. Menopause diagnosis and treatment decisions are typically based on symptoms rather than hormone measurements. Blood tests for follicle-stimulating hormone (FSH) and estradiol may occasionally be used to confirm menopause status in uncertain cases, but they aren't routinely recommended for symptom management or hormone therapy adjustments. Hormone levels naturally fluctuate significantly during perimenopause, making single measurements unreliable indicators. For women using hormone therapy (HT) such as estradiol patches, pills, or gels combined with progesterone (for those with a uterus), dosing is based on symptom relief rather than achieving specific hormone levels. The goal is to use the lowest effective dose for the shortest time needed to manage symptoms. Regular clinical follow-ups with your healthcare provider are more valuable than hormone testing, focusing on symptom control, side effects, and overall health assessment. This approach is more practical and cost-effective while still ensuring appropriate management of menopausal symptoms. The U.S. Preventive Services Task Force recommends against the use of combined estrogen and progestin for the prevention of chronic conditions in postmenopausal women 1.

Some key points to consider:

• The use of hormone therapy for the primary prevention of chronic conditions is not recommended due to the associated risks, including an increased risk of stroke, dementia, and breast cancer 1.
• The decision to use hormone therapy should be individualized, taking into account the woman's health and quality-of-life priorities, as well as her personal risk factors 1.
• The goal of hormone therapy is to use the lowest effective dose for the shortest time needed to manage symptoms, rather than achieving specific hormone levels 1.
• Regular clinical follow-ups are essential to monitor symptom control, side effects, and overall health assessment 1.

Overall, the focus should be on managing menopausal symptoms and monitoring overall health, rather than relying on hormone level testing.

From the Research

Monitoring Hormones in Menopause

• The decision to monitor hormones in menopause should be based on individual symptoms and health status, as menopausal symptoms can vary widely among women 2, 3.
• Hormone therapy (HT) is an effective treatment for menopausal symptoms, including vasomotor symptoms and genitourinary syndrome of menopause, but its use should be individualized based on clinical factors and patient preference 4, 5.
• The benefits and risks of HT differ by age, time since menopause, and comorbidity status, with younger women (close to menopause) generally having a more favorable risk-benefit ratio 4.
• Non-hormonal treatment options are also available for women who are not candidates for HT or who prefer not to use it, including low-dose vaginal estrogen, ospemifene, and vaginal moisturizers and lubricants 3, 5.
• Regular health check-ups and screenings can help identify potential health risks and guide treatment decisions, but there is no clear evidence to support routine monitoring of hormone levels in all menopausal women 6.

Considerations for Hormone Monitoring

• Women with moderate or severe menopausal symptoms may benefit from hormone monitoring to guide treatment decisions 2, 4.
• Hormone monitoring may also be useful for women with a history of hormone-sensitive cancers or other health conditions that may be affected by hormone therapy 5.
• However, routine hormone monitoring is not recommended for all menopausal women, as it may not provide significant benefits and may lead to unnecessary testing and treatment 6.

Treatment Options

• HT is the most effective treatment for vasomotor symptoms and other symptoms of the climacteric, but its use should be individualized based on clinical factors and patient preference 4, 5.
• Non-hormonal treatment options, such as low-dose vaginal estrogen, ospemifene, and vaginal moisturizers and lubricants, are available for women who are not candidates for HT or who prefer not to use it 3, 5.
• Lifestyle measures, such as regular exercise, a healthy diet, and stress management, can also help alleviate menopausal symptoms and improve overall health 6.