What information is necessary to obtain in a patient's medical history before prescribing Menopausal Hormone Therapy (MHT)?

From the Guidelines

Before prescribing Menopausal Hormone Therapy (MHT), it is essential to assess for contraindications, including history of breast cancer, liver disease, myocardial infarction, estrogen-dependent neoplasia, deep vein thrombosis, and thrombophilic disorders, as outlined in the 2024 guideline from the American Heart Association/American Stroke Association 1. To obtain a comprehensive patient history, consider the following key points:

• Personal or family history of breast cancer, endometrial cancer, venous thromboembolism, stroke, coronary heart disease, and liver disease
• Current medications to identify potential interactions
• Cardiovascular risk factors, including hypertension, diabetes, smoking, and hyperlipidemia
• Migraine history, especially with aura, which may increase stroke risk with estrogen therapy
• Bleeding patterns, particularly any abnormal uterine bleeding that would require investigation before starting MHT
• Bone health status and fracture risk
• Patient preferences, concerns, and understanding of MHT benefits and risks to ensure informed decision-making According to the 2024 guideline, ideal candidates for starting MHT are those under 60 years of age, within 10 years since menopause onset, with no elevated risk for cardiovascular disease, stroke, or breast cancer 1. When considering MHT, it is crucial to discuss the patient's options, including oral and transdermal formulations, and the potential risks and benefits associated with each, as outlined in the guideline 1. In patients with an intact uterus, it is necessary to determine if they can tolerate progestogen therapy to prevent endometrial hyperplasia, and to monitor for abnormal vaginal bleeding during MHT use 1.

From the FDA Drug Label

What should I tell my healthcare provider before taking medroxyprogesterone acetate tablets Before you take medroxyprogesterone acetate tablets, tell your healthcare provider if you: have any other medical problems Your healthcare provider may need to check you more carefully if you have certain conditions such as asthma (wheezing), epilepsy (seizures), diabetes, migraine, endometriosis (severe pelvic pain), lupus, or problems with your heart, liver, thyroid, kidneys, or have high calcium in your blood. are going to have surgery or will be on bed rest Your healthcare provider will let you know if you need to stop taking medroxyprogesterone acetate tablets. are breast feeding The hormone in medroxyprogesterone acetate can pass into your breast milk

The necessary information to obtain in a patient's medical history before prescribing Menopausal Hormone Therapy (MHT) includes:

• Medical problems: any other medical conditions, such as asthma, epilepsy, diabetes, migraine, endometriosis, lupus, or problems with the heart, liver, thyroid, kidneys, or high calcium in the blood 2
• Surgery or bed rest: if the patient is going to have surgery or will be on bed rest, as the healthcare provider may need to adjust the treatment plan 2
• Breastfeeding: if the patient is breastfeeding, as the hormone in medroxyprogesterone acetate can pass into breast milk 2
• Cancer history: history of certain cancers, as estrogen plus progestin may increase the chance of getting certain types of cancers, including cancer of the breast 2
• Blood clots: history of blood clots, as estrogen plus progestin may increase the chance of getting blood clots 2
• Liver problems: history of liver problems, as medroxyprogesterone acetate should not be used in patients with certain liver problems 2
• Pregnancy: if the patient thinks she may be pregnant, as medroxyprogesterone acetate should not be used during pregnancy 2

From the Research

Necessary Information for Prescribing Menopausal Hormone Therapy (MHT)

To prescribe MHT, the following information should be obtained from a patient's medical history:

• Severity of bothersome symptoms 3
• Treatment preferences 3
• Medical history, including presence of contraindications to MHT 3
• Personal risk of cardiovascular disease 3, 4, 5
• Personal risk of breast cancer 3, 4, 6, 7
• Family history of breast cancer, to assess the likelihood of carrying a BRCA mutation 7
• History of previous breast biopsies 7
• Presence of an intact uterus, to determine the need for progestogen therapy 7
• Risk factors for cardiovascular disease, such as lipid and glucose metabolism dysregulation, body fat redistribution, and abdominal obesity 4, 5

Considerations for MHT

When considering MHT, the following factors should be taken into account:

• Type of MHT, including estrogen-only or combined estrogen-progestogen therapy 3, 4, 6
• Dosing and route of administration, including oral or transdermal regimens 4, 6
• Duration of therapy, including the potential for extended use and associated risks 6
• Presence of contraindications, such as a history of breast cancer or cardiovascular disease 3, 4, 7, 5