Last reviewed 01/2018

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)