||(i) Treated breast cancer. Refer to specialist clinic for appropriate counselling and risk-benefit assessment. As per NICE, HRT may be considered for quality of life reasons.
(ii) HRT does not add significantly to the risk of breast cancer in patients with a family history of breast cancer. Patients with a significant family history should be referred to a geneticist (see NICE guidelines for information). Treatment of urogenital symptoms with topical estrogens is not contraindicated. Advise referral to specialist menopause clinic.
|Endometrial Carcinoma||(i) Complete Surgical Resection with no evidence of recurrence – Refer for gynaecological opinion. Estrogen therapy may be used with caution.
(ii) Incomplete Resection or evidence of recurrence – Estrogen therapy completely contraindicated. Consider use of high dose progestogen therapy. Advise referral to specialist menopause clinic.
|Stroke||Risk of fatal recurrent CVA (ie. risk of recurrence does not go up, but risk of fatal recurrence does. Advise referral to specialist menopause clinic.|
|Thromboembolic Disease||A family history of spontaneous thromboembolism – request thrombophilia screen where available, confirmed venous thromboembolism has now been established as a contraindication to HRT in the data sheets. If normal, advise of possible increased risk of further DVT on HRT and avoid the oral route. If abnormal, refer for specialist haematological advice. Advise referral to specialist menopause clinic.|
|Undiagnosed Vaginal Bleeding||Do not initiate HRT until fully investigated and significant pathology excluded.|