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Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Although there are no clear consensus about absolute contraindications to HRT, avoiding or discontinuing HRT is advisable in the following situations:

  • history of breast cancer
    • the risk of breast cancer recurrence and of new breast cancers may be increased in HRT (the risk of breast cancer recurrence is increased in Tibolone)
    • patients who are taking HRT should be counseled about the increased risk of breast cancer after four to five years of use
  • history or known high risk of venous or arterial thromboembolic disease, stroke and cardiovascular disease
    • stroke risk is increased in older women who use Tibolone
    • a transdermal preparation with minimal oestrogen is the preferred choice in this group (1).
  • uncontrolled hypertension (1)

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
  • abnormal liver function - since oral HRT products are metabolised in the liver
  • 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) (2)


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