madman
Super Moderator
Summary
In summary, it is easy to reach for a blood test when HRT is not perceived to be adequately managing symptoms of the menopause transition. Before an investigation is requested, clinicians should assess whether symptoms are truly caused by low levels of estradiol, highlighting the importance of also considering sociodemographic factors. Lack of data confirming a treatment threshold for serum estradiol should be considered, along with the variation of serum estradiol related to pharmacokinetic and pharmacodynamic processes. In the perimenopause it is not possible to differentiate between endogenous and exogenous estradiol, making serum levels impossible to interpret unless very low. Furthermore, the fluctuation of sex hormones may be responsible for symptoms – and this is not possible to capture by conventional means. Advice differs for younger women, where long-term health risks associated with low levels of estrogen are more significant.
If a patient has ongoing symptoms, listening to the patient, providing holistic care and changing HRT to alternative delivery routes may be more helpful strategies than measuring a serum estradiol level.
