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
Peripheral conversion of androstenedione
Secretion from adrenals
Testosterone from the ovary
HRT