Why Won't Anybody Tell Me the Optimal Estradiol Level In Menopause?

The Silence is Deafening

Your doctor won't tell you. The Menopause Society won't tell you. The British Medical Society won't tell you. Hell, even the International Menopause Society dances around this question like it's radioactive.

Why won't anybody tell you what serum (blood) estradiol level is optimal in menopause for a woman taking hormone therapy?

The silence is deafening.

Does this sound familiar?

Doctor: "We don't really monitor levels. Just take your hormone and see how you feel."

You: "But what should my blood level be?"

Doctor: "Well, everyone's different. There's no one-size-fits-all ."

You: "But surely there's research on this?"

Doctor: "It's complicated. We focus on symptoms, not numbers."

This isn't malicious gaslighting. Your doctor may not know the answer because:

Nobody taught them. Medical schools don't teach hormone optimization. They learn "lowest dose, shortest time" and call it education.

They're traumatized by 2002. The Women's Health Initiative scared an entire generation of doctors away from anything beyond minimal dosing.

It's easier to avoid labs. Monitoring levels means more work, more follow-ups, more thinking. Much simpler to hand you a prescription and hope for the best.

They treat hormones like Tylenol. Administer a standard dose, assume it works for everyone, and proceed to the next patient.

Let me be crystal clear: The research exists. The optimal ranges are established. The silence is a choice born of ignorance, not malice.

The WHI Hangover: How One Flawed Study Broke Medicine

The 2002 Women's Health Initiative didn't just scare women away from hormone therapy; it lobotomized an entire medical specialty.

Despite being thoroughly debunked (wrong hormones, wrong timing, wrong population), doctors still reflexively prescribe based on WHI's "lowest dose, shortest time" mantra. They're practicing 2002 medicine in 2025.

The result? Millions of women are chronically undermedicated because their doctors are still fighting ghosts from a 23-year-old study that used horse urine hormones in 70-year-old women.

Meanwhile, the research showing optimal estradiol targets has been published for decades. But reading new research requires effort, and changing practice patterns (especially when none of the “expert” oversight organizations have come on board) requires courage.

The Evidence-Based Answer You Should Know

After meticulously reviewing three decades of pharmacokinetic studies, randomized controlled trials, and observational data, the optimal serum estradiol range for most menopausal women on hormone replacement therapy is 65-150 pg/mL.

This isn't Amy Killen's opinion. This isn't "functional medicine woo." This is hard science published in the most prestigious medical journals in the world.