<s>[INST] context: 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 [/INST] question: Major source of estrogen in postmenopausal women is: | options: A: Peripheral conversion of androstenedione B: Secretion from adrenals C: Testosterone from the ovary D: HRT | answer: A </s>