From the Guidelines
Before starting hormone replacement therapy (HRT) in a menopausal woman, it is crucial to check follicle-stimulating hormone (FSH), estradiol, thyroid-stimulating hormone (TSH), and sometimes luteinizing hormone (LH) levels to confirm menopause and rule out other conditions. The decision to check these hormones is based on the understanding that menopause is characterized by decreased ovarian production of estrogen and progestin, which can lead to various symptoms and increased risk of chronic diseases 1.
Key Hormones to Check
- FSH: Levels above 30 IU/L, combined with low estradiol levels, help confirm menopause.
- Estradiol: Low levels (typically below 50 pg/mL) are indicative of menopause.
- TSH: Testing is important to rule out thyroid disorders that can mimic menopausal symptoms.
- LH: May be checked to further confirm menopause, especially in cases where FSH levels are not conclusive.
- Progesterone: Checking progesterone levels may be relevant for women who still have a uterus, to inform whether combined estrogen-progesterone therapy is needed.
Additional Tests
A comprehensive metabolic panel and lipid profile are often included to assess overall health status and cardiovascular risk factors before initiating HRT. These baseline measurements help clinicians select appropriate HRT formulations and dosages and provide reference points for monitoring treatment effectiveness 1.
Clinical Considerations
It is essential to approach HRT with caution, using the lowest effective dose for the shortest possible time, as the quality of evidence on the benefits and harms of HRT varies for different hormone regimens 1. By checking these key hormones and considering the individual's overall health status, clinicians can make informed decisions about HRT, balancing the potential benefits against the risks to optimize outcomes for menopausal women.
From the Research
Hormones to Check Before Starting HRT in Menopausal Women
- The decision to start Hormone Replacement Therapy (HRT) in menopausal women should be based on individual patient characteristics, including age, time since menopause, and comorbidity status 2, 3.
- There is no specific list of hormones to check before starting HRT, but rather a comprehensive evaluation of the patient's symptoms, medical history, and risk factors 4.
- The following factors should be considered when evaluating a menopausal woman for HRT:
- Age and time since menopause
- Severity of menopausal symptoms
- Medical history, including cardiovascular disease risk
- Presence of contraindications or comorbidities
- The Women's Health Initiative (WHI) trials and other studies have provided valuable insights into the benefits and risks of HRT, including the importance of timing, type, and route of administration 2, 3.
- Guideline groups recommend HRT for the treatment of menopausal women with bothersome symptoms, and practical recommendations are available to guide first-line management 3, 4.