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Contraindications

Authoring team

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

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The content herein is provided for informational purposes and does not replace the need to apply professional clinical judgement when diagnosing or treating any medical condition. A licensed medical practitioner should be consulted for diagnosis and treatment of any and all medical conditions.

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