Replacing estrogen, usually with progesterone, at menopause is the most effective relief for hot flashes and night sweats, prevents bone loss and fractures, and restores vaginal and urinary comfort. Beginning near menopause is linked to better sleep, lower diabetes risk, healthier arteries, and possibly longer life. Skin-delivered forms started early carry far less clot and stroke risk. (Full Review)
| Marker | Target | Why |
|---|---|---|
| Estradiol (E2) | ~50–120 pg/mL on transdermal therapy | Confirms absorption and adequate dosing |
| Follicle-stimulating hormone (FSH) | >25–30 IU/L at baseline | Confirms menopausal status at baseline |
| Lipid panel (LDL, HDL, triglycerides) | LDL <100, HDL >50, triglycerides <100 mg/dL | Tracks cardiovascular effect; flags oral-estrogen triglyceride rise |
| Blood pressure | <120/80 mmHg | Screens for hypertension that raises stroke risk |
| Fasting glucose / HbA1c | Glucose <90 mg/dL; HbA1c <5.4% | Monitors metabolic benefit and diabetes risk |
| Bone mineral density (DEXA T-score) | T-score above −1.0 | Documents the skeletal benefit over time |
| Liver enzymes (ALT, AST) | Within normal limits | Screens hepatic tolerance of oral therapy |
Cadence: Reassess at ~6–12 weeks after initiation or dose change, then at 6–12 months, and at least annually thereafter