Major source of estrogen in postmenopausal women is:

All postmenopausal and symptomatic per menopausal women who do not have contraindication particularly­ Those with high risk factors osteoporosis. Those with premature menopause Evaluation before starting HRT: History-personal, medical, gynecological, family Examination -HT, wt., BMI, BP, breast, vaginal examination Pap smear Mammography Lipid profile Transvaginal sonography-endometrial thickness Work up relevant to symptoms, e.g. urinary continence, carbohydrate intolerance, psychoemotional states. Contraindications of HRT: Pregnancy CA breast CA endometrium Undiagnosed abnormal vaginal bleeding Active liver disease Present deep vein thrombosis, thromboembolic disorder Investigation not routinely needed before starting HRT Endometrial sampling-Only done if history of abnormal vaginal bleeding, TVS shows endometrial thickness> 5 mm. Serum FSH-Only done if diagnosis of menopause is not clear, e.g. vasomotor symptoms in absence of amenorrhoea Bone densitometry-Using DEXA (dual energy X-ray absorptiometry) oflumber vertebrae, hip bone for women with risk factors for osteoprosis, persistent backache, bone aches, history of recent fracture, for research purpose