Is there a point in running hormone labs on a postmenopausal (postmenopause) woman in her 70's?

Hormone Labs in Postmenopausal Women Over 70: Not Clinically Indicated

Hormone laboratory testing (FSH, estradiol, LH) serves no clinical purpose in a postmenopausal woman in her 70s, as menopause is a clinical diagnosis based on age and symptom history, and hormone levels do not guide treatment decisions or provide actionable information at this stage of life. 1, 2

Why Hormone Labs Are Not Useful

Menopause Is a Clinical Diagnosis

• The median age of menopause in the United States is 51 years (range 41-59 years), and by age 70, a woman is definitively postmenopausal based on age alone 1
• Hormone levels (FSH, estradiol) fluctuate widely in postmenopausal women and do not correlate with symptom severity or treatment response 1
• Management of menopausal symptoms is symptom-based, not laboratory-based—no routine monitoring tests are required once a woman is established as postmenopausal 1

Hormone Therapy Is Contraindicated for Initiation at Age 70

• The American College of Physicians explicitly contraindicates initiating hormone replacement therapy in women over 65 for chronic disease prevention, as it increases morbidity and mortality 1, 2, 3
• The U.S. Preventive Services Task Force gives a Grade D recommendation (recommends against) routine use of estrogen for prevention of chronic conditions in postmenopausal women 2, 4
• Women who initiate hormone therapy more than 10 years after menopause (which would include all women in their 70s) face substantially increased cardiovascular risks including stroke (8 additional strokes per 10,000 women-years) 2, 3

The Critical "10-Year Window" Has Closed

• The most favorable risk-benefit profile for hormone therapy exists only for women under 60 years of age or within 10 years of menopause onset 1, 2, 3
• In women ≥60 years of age or more than 10 years after natural menopause, oral estrogen-containing hormone therapy is associated with excess stroke risk that outweighs clinical benefits 1, 3
• The Women's Health Initiative Memory Study demonstrated that women aged 65-79 years had significantly increased dementia risk with combined estrogen-progestin (HR 2.05,95% CI 1.21-3.48) 4

When Labs Might Be Considered (Rare Exceptions)

Only If Considering Continuation of Existing Therapy

• For a woman already on hormone therapy who reaches age 70, the decision to continue is based on symptom burden and risk assessment, not hormone levels 3
• At age 65 (and certainly by 70), clinicians must reassess necessity and attempt discontinuation of hormone therapy, reducing to the lowest effective dose if continuation is deemed essential for persistent severe symptoms 3

Evaluation of Other Conditions

• If evaluating for other endocrine disorders (thyroid disease, adrenal insufficiency, pituitary pathology), specific targeted testing would be appropriate—but this is unrelated to routine menopausal management 1
• If investigating unexplained vaginal bleeding in a postmenopausal woman, endometrial biopsy (not hormone labs) is the appropriate diagnostic test 1

Common Clinical Pitfalls to Avoid

• Do not order FSH or estradiol levels to "confirm" menopause in a 70-year-old woman—the diagnosis is already established by age and clinical history 1, 2
• Do not use hormone levels to guide decisions about initiating hormone therapy—symptom severity, timing from menopause, and contraindications are what matter 1, 2
• Do not initiate systemic hormone therapy in women over 65 for chronic disease prevention (osteoporosis, cardiovascular disease), as this increases morbidity and mortality 2, 3
• Avoid the misconception that "bioidentical" or compounded hormones are safer—they carry the same risks and lack standardized dosing and safety data 1

What Should Be Done Instead

For Vasomotor Symptoms (If Present)

• Consider non-hormonal alternatives: selective serotonin reuptake inhibitors (SSRIs), gabapentin, or cognitive behavioral therapy 1
• If local genitourinary symptoms only (vaginal dryness, dyspareunia), low-dose vaginal estrogen preparations can be used with minimal systemic absorption and do not require progestin 1, 2

For Osteoporosis Prevention/Treatment

• Use bisphosphonates, denosumab, or other bone-specific therapies rather than systemic hormone therapy 1
• Ensure adequate calcium (1000-1300 mg/day) and vitamin D (800-1000 IU/day) intake 1
• Promote weight-bearing exercise 1

For Cardiovascular Risk Reduction

• Focus on evidence-based interventions: statin therapy if indicated, blood pressure control, smoking cessation, diabetes management 1
• Never initiate hormone therapy solely for cardiovascular disease prevention—this is explicitly contraindicated 2, 3