Contraindications

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)

Reference:

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