Test May Allow Individualized HRT Regimens.

JANCIN, BRUCE

VAIL, COLO. -- Basal estrogen measurement in menopause may eventually provide a practical tool for individualizing hormone replacement therapy regimens, Dr. Kenneth Faber said at a conference on obstetrics and gynecology sponsored by the University of Colorado.

"We think of menopause as a time when women are hypogonadal. And clinically they are. However, that's not to say they're without estrogen. It turns out that two-thirds of women who have ovaries still have measurable levels of estradiol, although probably not by the test you're using," explained Dr. Faber, a reproductive endocrinologist at Kaiser Permanente of Colorado, Denver.

Most commercial assays classify a serum estradiol level of 20 pg/mL or below as "undetectable." But more sensitive tests used in research laboratories tell a very different story.

For example, in the Study of Osteoporotic Fractures, the largest U.S. prospective fracture database, two-thirds of menopausal women had a serum estradiol level above 5 pg/mL. Menopausal women with an estradiol level in this range had a lower risk of vertebral and hip fractures and a decreased bone mineral density loss rate than women having less or no serum estradiol. But they also appeared to have a higher risk of breast cancer.

Interestingly, serum estradiol in postmenopausal women turns out not to correlate with age.

"You'd think that recently menopausal women would have higher levels of estrogen than those who were menopausal in the Eisenhower administration, but it turns out there's no ...