At your follow-up visit, expect to give another detailed medical history relating to any changes in your symptoms, side effects, or any other problems that have developed in relation to your therapy. Your blood pressure should be measured and a general examination including your breasts and abdomen should be done at each visit. Pelvic examinations should be performed annually and a Pap smear should be done every one to two years.
Often, the question arises of whether or not to take an endometrial sampling (endometrial biopsy) as a means of screening for uterine cancer or correcting hormone dose. I feel that if you are taking your progestin in an adequate dose, and your bleeding pattern is normal, there is no reason for doing an annual sampling. However, if you are one of those women who take estrogen only, who have their uterus intact, and who do not take progestin for some specific reason (some women with their uterus intact refuse progestin because of its side effects), I would recommend having an endometrial sample every year. You should also anticipate having a baseline mammogram taken when you first begin therapy and an annual mammogram thereafter.
It is my recommendation that once you start HRT, you visit your physician at least every six months. If the examinations listed above are done, and no problems occur in the interim, you need only those biannual visits. However, if you experience any side effects such as breakthrough bleeding, you should report them to your physician and anticipate that an endometrial sample may be taken.
It is also important that your doctor closely monitor the amount of estrogen you are taking and its effects on you. This monitoring may require testing your blood estrogen levels and measuring your calcium levels to assure that you are not losing calcium, which can lead to losing bone. One way of determining calcium levels is with the urine calcium creatinine test. Bone density testing is a method of determining bone loss that is very important for women at risk for osteoporosis. It shows whether bone mass has been maintained or improved with therapy. If bone density test results show that bone loss is continuing, then the method and/or type of HRT should be changed.