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

Updated: Sep 13, 2021
  • Author: Nicole K Banks, MD; Chief Editor: Richard Scott Lucidi, MD, FACOG  more...
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Answer

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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