Contraindications for Femoston (Estradiol + Dydrogesterone) in Perimenopause
Femoston can be safely initiated during perimenopause for severe vasomotor symptoms in women without absolute contraindications, and does not need to be delayed until postmenopause. 1, 2
Absolute Contraindications
The following conditions completely prohibit the use of Femoston:
- History of breast cancer – any personal history of breast malignancy is an absolute contraindication to systemic hormone therapy 1, 2
- Coronary heart disease or myocardial infarction – active or prior CHD precludes HRT initiation 1, 2
- Previous venous thromboembolism or pulmonary embolism – any history of VTE/PE is an absolute contraindication 1, 2
- History of stroke – prior cerebrovascular accident prohibits HRT 1, 2
- Active liver disease – hepatic impairment contraindicates estrogen therapy 1, 2
- Antiphospholipid syndrome or positive antiphospholipid antibodies – APS or positive aPL antibodies are absolute contraindications 1, 2
- Thrombophilic disorders – known clotting disorders preclude HRT 1
- Known or suspected estrogen-dependent neoplasia – any hormone-sensitive cancer is a contraindication 1
- Unexplained vaginal bleeding – must be evaluated before initiating therapy 1
Relative Contraindications & High-Risk Situations
- Smoking in women over age 35 – significantly amplifies cardiovascular and thrombotic risks; smoking cessation is the single most important intervention before considering HRT 1
- History of gallbladder disease – oral estrogen increases cholecystitis risk (HR 1.61-1.79); transdermal formulations are preferred if HRT is necessary 1
- Hypertension – requires blood pressure monitoring and optimization before and during therapy 1
- Migraine headaches – may be exacerbated by oral estrogen 1
Favorable Timing Window
The benefit-risk profile for Femoston is most favorable for perimenopausal women under 60 years of age or within 10 years of menopause onset. 1, 2 Women in this window experience:
- 75% reduction in vasomotor symptom frequency 1
- Lower cardiovascular and thrombotic risks compared to older women 1
- No need to delay therapy until complete cessation of menses 2
Risk Context for Perimenopausal Women
For every 10,000 women taking combined estrogen-progestin (like Femoston) for 1 year, expect: 1, 2
- Risks: 7 additional CHD events, 8 more strokes, 8 more pulmonary emboli, 8 more invasive breast cancers
- Benefits: 6 fewer colorectal cancers, 5 fewer hip fractures, 75% reduction in hot flashes
Breast cancer risk does not appear until after 4-5 years of continuous use, while stroke and VTE risks emerge within 1-2 years. 1
Specific Femoston Safety Data
Low-dose Femoston (0.5 mg estradiol/2.5 mg dydrogesterone) demonstrates: 3, 4, 5
- Neutral effect on blood coagulation factors 6
- Very low incidence of breast-related adverse events 4
- No breast malignancy reported in clinical trials 4
- Only one case of simple endometrial hyperplasia observed (dydrogesterone provides ~90% reduction in endometrial cancer risk versus unopposed estrogen) 4, 5
- Effective across different BMI subgroups 7
Critical Pitfalls to Avoid
- Never initiate Femoston solely for osteoporosis or cardiovascular disease prevention – this is explicitly contraindicated (USPSTF Grade D recommendation) and increases morbidity and mortality 1, 2, 8
- Never prescribe to women with any absolute contraindication listed above – the risks far outweigh any symptom relief 1, 2
- Do not delay initiation in symptomatic perimenopausal women without contraindications – the window of opportunity for favorable benefit-risk is time-sensitive 1, 2
Mandatory Pre-Treatment Assessment
Before prescribing Femoston, verify: 1
- Absence of all absolute contraindications listed above
- Blood pressure measurement (hypertension amplifies stroke risk)
- Smoking status (cessation required if >35 years old)
- Personal and family history of breast cancer, VTE, stroke, CHD
- Liver function status
- Evaluation of any unexplained vaginal bleeding