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

1. NICE. Menopause: identification and management. NICE guideline NG23. Published November 2015, last updated November 2024