Contraindications and Precautions for Hormone Replacement Therapy with Femoston

Absolute Contraindications

• The American College of Obstetricians and Gynecologists recommends that Femoston is contraindicated in women with known or suspected breast cancer, except in appropriately selected patients being treated for metastatic disease 1
• The National Comprehensive Cancer Network recommends that Femoston is contraindicated in women with known or suspected estrogen-dependent neoplasia, including low-grade serous epithelial ovarian cancer, granulosa cell tumors, leiomyosarcoma, and stromal sarcoma, and advanced endometrioid uterine adenocarcinoma 2, 3, 4
• The American Heart Association recommends that Femoston is contraindicated in women with a history of venous thromboembolism or stroke 1
• The American College of Cardiology recommends that Femoston is contraindicated in women with antiphospholipid syndrome 1

Age and Timing Considerations for Risk Assessment

• The American College of Obstetricians and Gynecologists recommends that women ≥60 years of age or more than 10 years after natural menopause are at elevated risk for stroke with oral estrogen-containing HRT, and this excess risk must be weighed against clinical benefits 5
• The National Institute on Aging recommends that women at elevated baseline risk for cardiovascular disease or stroke face increased hazard with oral estrogen therapy 5

Critical Assessment Requirements Before Prescribing

• The American College of Obstetricians and Gynecologists recommends that before initiating Femoston, assess for a history of breast cancer, liver disease, myocardial infarction, known or suspected estrogen-dependent neoplasia, deep vein thrombosis, and thrombophilic disorders 5, 6

Important Clinical Pitfalls

• The American College of Obstetricians and Gynecologists recommends that using estrogen without progestin in women with an intact uterus increases endometrial cancer risk and is contraindicated 1
• The FDA recommends that initiating HRT solely for prevention of chronic conditions is not recommended, and the indication is limited to short-term treatment of menopausal symptoms and prevention of osteoporosis 1, 6

Special Populations with Relative Contraindications

• The National Comprehensive Cancer Network recommends that HRT, including Femoston, is contraindicated in survivors of low-grade serous epithelial ovarian cancer, granulosa cell tumors, leiomyosarcoma, and stromal sarcoma, and advanced endometrioid uterine adenocarcinoma 2, 3, 4