What are the contraindications for Menopausal Hormone Therapy (MHT) and Dovient?

Contraindications for Menopausal Hormone Therapy (MHT)

MHT has absolute contraindications including history of breast cancer, coronary heart disease, previous venous thromboembolism or stroke, active liver disease, and antiphospholipid syndrome. 1

Absolute Contraindications to MHT

• History of breast cancer - Hormone-sensitive cancers are a strong contraindication to systemic hormone therapy 2, 1

• Coronary heart disease or history of myocardial infarction - This is an absolute contraindication regardless of symptom severity 1

• Previous venous thromboembolism (DVT or pulmonary embolism) - Any history of VTE contraindicates MHT 1

• History of stroke - Prior cerebrovascular events preclude MHT use 1

• Active liver disease - Current hepatic dysfunction is an absolute contraindication 1

• Antiphospholipid syndrome (APS) or positive antiphospholipid antibodies - This includes both clinical APS and positive aPL antibodies 1

• Thrombophilic disorders - Known clotting disorders contraindicate MHT 1

• Known or suspected estrogen-dependent neoplasia - Any hormone-sensitive malignancy is contraindicated 1

Relative Contraindications to MHT

• History of gallbladder disease - Increased risk with oral HRT (RR 1.48-1.8), though transdermal routes may be safer 1

• Current smoking - This is a relative contraindication to oral HRT but not to transdermal formulations 3

Age and Timing Considerations as Practical Contraindications

• Women ≥60 years of age or more than 10 years past menopause - Oral estrogen-containing HRT is associated with excess stroke risk in this population 1

• Initiating HRT after age 65 - This is explicitly contraindicated for chronic disease prevention as it increases morbidity and mortality 1

• Starting HRT solely for chronic disease prevention - This is contraindicated in asymptomatic women regardless of age 1, 4

Special Population: Cancer Patients

• Premenopausal women with metastatic breast cancer - Aromatase inhibitors are contraindicated in premenopausal women unless combined with adequate ovarian suppression, as reduction in tissue estrogen can lead to compensatory rises in ovarian estrogens 2

• Women with non-hormone-sensitive cancers - These patients may consider HRT for vasomotor symptoms until approximately age 51, then reassess 2, 1

Critical Clinical Pitfalls to Avoid

• Do not confuse family history with personal history - Family history of breast cancer or uterine cancer (without confirmed BRCA mutation or personal diagnosis) is NOT an absolute contraindication to MHT 1, 3

• Do not delay HRT in women with surgical menopause before age 45 - Without contraindications, the window for cardiovascular protection is time-sensitive 1

• Do not use custom compounded bioidentical hormones or pellets - These lack safety and efficacy data 1

• Do not prescribe esterified estrogens/methyltestosterone combinations - These are not recommended for primary prevention and have unfavorable safety profiles 4

Regarding "Dovient"

I cannot identify "Dovient" as a recognized medication name in the provided evidence or standard medical references. If you are referring to a specific hormone therapy product, please clarify the generic name or provide additional context so I can address contraindications specific to that formulation.