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)
- (1) Current Problems in Pharmacovigiliance (2002), 28, 1-3.
- (2) Hickey M, Elliott J, Davison SL.Hormone replacement therapy. BMJ. 2012;344:e763.
Last reviewed 01/2018