What are the key contraindications and risks associated with prescribing HRT for menopausal symptoms?

Contraindications to prescribing hormone replacement therapy (HRT) include a history of breast cancer, endometrial cancer, ovarian cancer, or other hormone-sensitive cancers, as HRT is not routinely offered to women with a history of breast cancer. ¹

Women with contraindications such as hormone-sensitive cancers should be advised against HRT. ¹

Risks associated with HRT include a slight increase in endometrial cancer risk with sequential combined HRT, especially with longer duration of use, higher estrogen doses, or fewer days of progestogen per cycle. ¹

There is a very slight increase in ovarian cancer risk with combined HRT in women with ovaries. ¹

HRT does not increase the risk of coronary heart disease or mortality from cardiovascular disease in women without prior history. ²

Potential increased risks include a possible increase in dementia risk if HRT is started at age 65 or over. ²

Other risks include the potential for vaginal bleeding, especially within the first 3 months of systemic HRT, which should be monitored. ²

Women with certain conditions, such as a history of thromboembolic events or active liver disease, should also be considered contraindicated for HRT. ¹