From the Guidelines
Estrogen therapy during menopause is contraindicated in women with a history of breast cancer, liver disease, myocardial infarction, known or suspected estrogen-dependent neoplasia, deep vein thrombosis, or thrombophilic disorders. These conditions are identified as contraindications due to the increased risk of adverse outcomes associated with estrogen use, as outlined in the 2024 guideline for the primary prevention of stroke by the American Heart Association/American Stroke Association 1.
Key Contraindications
- History of breast cancer
- Liver disease
- History of myocardial infarction
- Known or suspected estrogen-dependent neoplasia
- History of deep vein thrombosis
- Thrombophilic disorders When considering hormone replacement therapy (HRT) for menopausal symptoms, it is crucial to assess for these contraindications and engage in shared decision-making to select the appropriate therapy, if any, as suggested by the guideline 1. For women without these contraindications, particularly those under 60 years of age and within 10 years of menopause onset without elevated cardiovascular or breast cancer risk, menopausal hormone therapy may be considered with careful monitoring and selection of the appropriate formulation (oral or transdermal) based on the presence of a uterus and other individual factors 1.
From the Research
Contraindications to Estrogen Replacement Therapy
The following are contraindications to estrogen replacement therapy during menopause:
- Breast or endometrial cancer 2
- Cardiovascular disease 2
- Thromboembolic disorders 2
- Active liver disease 2 Other potential contraindications may include:
- History of venous thromboembolism (VTE), as estrogen therapy may increase the risk of VTE 3
- Increased risk of breast cancer with extended use of estrogen therapy 2
- History of coronary heart disease, as estrogen therapy may increase the risk of coronary heart disease in older women and those a number of years beyond menopause 2
Important Considerations
When considering estrogen replacement therapy, it is essential to:
- Use the lowest effective estrogen dose for the shortest duration necessary, as risks increase with increasing age, time since menopause, and duration of use 2
- Carefully consider the contraindications of treatment and provide regular follow-up to ensure safe therapy 4
- Inform women of the potential benefits and risks of all therapeutic options and individualize care based on a woman's medical history, needs, and preferences 2