What is included in the evaluation prior to administering menopausal hormone replacement therapy (HRT)?

Answer

All candidates for HT should be thoroughly evaluated with a detailed history and complete physical examination for a proper diagnosis and identification of any contraindications.

Baseline laboratory and imaging studies before administering HT include the following:

Hemography
Urinalysis
Fasting lipid profile
Blood sugar levels
Serum estradiol levels: In women who will be prescribed an implant and in those whose symptoms persist despite use of an adequate dose of a patch or gel
Serum follicle-stimulating hormone (FSH) levels: To monitor women taking oral preparations for symptomatic control, especially those with premature menopause
Ultrasonography: To measure endometrial thickness and ovarian volume
Electrocardiography
Papanicolaou test
Mammography: Performed once every 2-3 years and annually after the age of 50 years

Endometrial sampling is not required in routine practice. However, the presence of abnormal bleeding before or during HT should prompt consideration of ultrasonography to check endometrial thickness (cutoff, < 4 mm), followed by outpatient Pipelle sampling and hysteroscopy. In women with a tight cervix, formal hysteroscopy and dilation and curettage under general anesthesia are advised.

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Stages/nomenclature of normal reproductive aging in women.

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Nicole K Banks, MD Assistant Professor of Obstetrics and Gynecology, Virginia Commonwealth University School of Medicine; Clinician, VCU Health

Nicole K Banks, MD is a member of the following medical societies: American College of Medical Genetics and Genomics, American Congress of Obstetricians and Gynecologists, American Society for Reproductive Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Michel E Rivlin, MD Former Professor, Department of Obstetrics and Gynecology, University of Mississippi School of Medicine

Michel E Rivlin, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Medical Association, Mississippi State Medical Association, Royal College of Surgeons of Edinburgh, Royal College of Obstetricians and Gynaecologists

Disclosure: Nothing to disclose.

Chief Editor

Richard Scott Lucidi, MD, FACOG Associate Professor of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Virginia Commonwealth University School of Medicine

Richard Scott Lucidi, MD, FACOG is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Society for Reproductive Medicine

Disclosure: Nothing to disclose.

Additional Contributors

Suzanne R Trupin, MD, FACOG Clinical Professor, Department of Obstetrics and Gynecology, University of Illinois College of Medicine at Urbana-Champaign; CEO and Owner, Women's Health Practice; CEO and Owner, Hada Cosmetic Medicine and Midwest Surgical Center

Suzanne R Trupin, MD, FACOG is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Institute of Ultrasound in Medicine, International Society for Clinical Densitometry, AAGL, North American Menopause Society, American Medical Association, Association of Reproductive Health Professionals

Disclosure: Nothing to disclose.

Hemant Singhal, MD, MBBS, MBA, FRCS, FRCS(Edin), FRCSC Consultant Breast Surgeon, Clementine Churchill Hospital; Consultant Breast Surgeon, Harley Street Breast Clinic, UK

Hemant Singhal, MD, MBBS, MBA, FRCS, FRCS(Edin), FRCSC is a member of the following medical societies: Royal College of Physicians and Surgeons of Canada, Royal College of Surgeons of Edinburgh

Disclosure: Nothing to disclose.

Kanchan Kaur, MBBS, MS (GenSurg), MRCSEd Consulting Breast and Oncoplastic Surgeon, Medanta, The Medicity, India

Disclosure: Nothing to disclose.

Joan Pitkin, MBBS, FRCS, FRCOG Honorary Senior Clinical Lecturer, Faculty of Medicine, Imperial College; Consulting Staff, Northwick Park and St Mark's Hospitals, Northwest London Hospitals, NHS Trust; Director of Menopause Clinical and Research Unit, Director of Undergraduate Clinical Studies, Northwick Park and St Mark's Hospitals

Joan Pitkin, MBBS, FRCS, FRCOG is a member of the following medical societies: Royal Society of Medicine, International Continence Society, North American Menopause Society, British Menopause Society, International Menopause Society, International Urogynaecology Association, European Menopause and Andropause Society, United Kingdom Continence Society

Disclosure: Nothing to disclose.

What is included in the evaluation prior to administering menopausal hormone replacement therapy (HRT)?

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