19 October 2020
Sriprasert et al. have reported the findings of an unplanned post hoc analysis of serum estradiol levels in 275 women who were randomized to oral micronized estradiol 1mg/day, with/without vaginal micronized progesterone, in the ELITE trial . Although the initial treatment was with 1mg estradiol/day, dose reduction was permitted. Hence some women switched to either 0.5mg/0.25mg micronized estradiol daily during the study. The findings suggest that women with a higher BMI or women who consumed more than 2 standard alcoholic drinks/day had higher serum estradiol concentrations, whereas smoking was associated with lower serum estradiol. Although the authors point out that expert societies recommend against titrating estrogen therapy against serum estradiol concentrations, they also comment that serum estradiol is associated with treatment effects . Hence, the authors recommend that these lifestyle variables need to be taken into account by clinicians when prescribing the dose of menopausal estrogen therapy.