How will I be monitored if I start HRT?
Initially you are likely to be seen every three or four months. When all are happy with the treatment regimen, less frequent checks will be required. Opinion varies as to the Frequency that physical examination should be undertaken. Some suggest that pelvic examinations should only be performed when taking routine cervical smears, usually at 3 5 year intervals. Others recommend pelvic examinations once or twice each year. My own opinion is that those looking after women's health should consider undertaking a clinical examination at least every 12 18 months to exclude the development of obvious disease. Examination should include a blood pressure reading, breast and pelvic examination. These examinations are not performed because of any increased risk, but purely as it is good clinical practice for doctors looking after to provide appropriate reassurance.
There is usually no indication to check oestrogen levels routinely for patients having oestrogen replacement therapy. Occasionally, a blood hormone test may assist adjustment of hormone replacement therapy if symptoms persist.
A 48-year-old lady with depression seemed to benefit for a while with transdermal patches but then her depression increased again. Her plasma oestradiol test was found to be low on two occasions. An oestradiol implant was introduced and this resulted in symptomatic relief.
Regular testosterone estimations should be considered for women receiving testosterone treatment (18).
Routine breast screening is recommended in most developed countries (Q32.36). Hormone replacement therapy may be associated with increased glandular tissue making breast x-rays (mammograms) appear denser it is essential that the radiologist reading the pictures is aware that you are on HRT. Sometimes supplementary tests such as ultrasound may be recommended. We advocate regular mammography for postmenopausal women. If you have been taking HRT for more than ten years, mammography once every year or eighteen months would seem appropriate beyond the age of fifty.
At one time, regular sampling of the endometrium (lining of the uterus) was advocated when HRT involved oestrogen without progestogen. We now know that if you are taking oestrogen replacement together with progestogen supplements your are even less likely to develop endometrial cancer than a woman who have never taken HRT. There is, therefore, no longer a reason to recommend sampling unless there is inappropriate bleeding.
Please click on the required question.
Thank you for choosing to visit us.
This is the personal website of David A Viniker MD FRCOG, Consultant Obstetrician and Gynaecologist at Whipps Cross University Hospital, London - Specialist Interests - Reproductive Medicine including Infertility, PCOS, PMS, Menopause and HRT.
I do hope that you find the answers to your women's health questions in the patient information and medical advice provided.
