Contraindications
Do not prescribe hormone replacement therapy (HRT) in women with:
- Current, past, or suspected breast cancer.
- Known or suspected oestrogen-dependent cancer.
- Undiagnosed vaginal bleeding.
- Untreated endometrial hyperplasia.
- Previous idiopathic or current venous thromboembolism (deep vein thrombosis or pulmonary embolism), unless the woman is already on anticoagulant treatment.
- Active or recent arterial thromboembolic disease (for example, angina or myocardial infarction).
- Active liver disease with abnormal liver function tests.
- Pregnancy.
- Thrombophilic disorder.
The following conditions require caution when using HRT
- abnormal vaginal bleeding
- HRT should not be commenced in women with undiagnosed abnormal vaginal bleeding
- combined HRT itself may cause unscheduled bleeding in the first six months of use but if it is persistent or new onset (after six month), pelvic disease should be excluded
- migraine - although not a contraindication for HRT, low dose transdermal preparations are favoured
- history of endometrial or ovarian cancer - specialist advice should be sought before HRT use
- high risk of gall bladder disease - the risk may be increased further with HRT (the risk may be lower with transdermal therapy)
Reference
- NICE. Menopause: identification and management. NICE guideline NG23. Published November 2015, last updated November 2024
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