Contraindications for Menopausal Hormone Therapy

Absolute Contraindications to MHT

The American College of Obstetricians and Gynecologists recommends that a history of breast cancer is an absolute contraindication to menopausal hormone therapy (MHT) due to the risk of hormone-sensitive cancers 1, 2
The American Heart Association states that coronary heart disease or history of myocardial infarction is an absolute contraindication to MHT, regardless of symptom severity 1
The American College of Chest Physicians indicates that previous venous thromboembolism (DVT or pulmonary embolism) is an absolute contraindication to MHT 1
The American Stroke Association recommends that a history of stroke is an absolute contraindication to MHT due to the increased risk of recurrent stroke 1
The American Association for the Study of Liver Diseases states that active liver disease is an absolute contraindication to MHT due to the risk of worsening liver function 1
The Antiphospholipid Syndrome Foundation recommends that antiphospholipid syndrome (APS) or positive antiphospholipid antibodies is an absolute contraindication to MHT due to the increased risk of thrombosis 1
The National Blood Clot Alliance indicates that thrombophilic disorders are an absolute contraindication to MHT due to the increased risk of blood clots 1
The American Cancer Society recommends that known or suspected estrogen-dependent neoplasia is an absolute contraindication to MHT due to the risk of tumor growth 1

The North American Menopause Society states that a history of gallbladder disease is a relative contraindication to oral MHT, with an increased risk of gallbladder disease (RR 1.48-1.8), but transdermal routes may be safer 1
The American College of Cardiology recommends that current smoking is a relative contraindication to oral MHT, but not to transdermal formulations 3

The American Geriatrics Society indicates that women ≥60 years of age or more than 10 years past menopause should not use oral estrogen-containing MHT due to the increased risk of stroke 1
The National Institute on Aging recommends that initiating MHT after age 65 is contraindicated for chronic disease prevention due to the increased risk of morbidity and mortality 1
The US Preventive Services Task Force states that starting MHT solely for chronic disease prevention is contraindicated in asymptomatic women, regardless of age 1, 4

The American Society of Clinical Oncology recommends that premenopausal women with metastatic breast cancer should not use aromatase inhibitors unless combined with adequate ovarian suppression, due to the risk of compensatory rises in ovarian estrogens 5
The National Comprehensive Cancer Network indicates that women with non-hormone-sensitive cancers may consider MHT for vasomotor symptoms until approximately age 51, then reassess 2, 1

The American Medical Association recommends that clinicians should not confuse family history with personal history, as family history of breast cancer or uterine cancer (without confirmed BRCA mutation or personal diagnosis) is not an absolute contraindication to MHT 1, 3
The American College of Obstetricians and Gynecologists states that clinicians should not delay MHT in women with surgical menopause before age 45, without contraindications, due to the time-sensitive window for cardiovascular protection 1
The Endocrine Society recommends that clinicians should not use custom compounded bioidentical hormones or pellets due to the lack of safety and efficacy data 1
The American College of Clinical Endocrinologists indicates that clinicians should not prescribe esterified estrogens/methyltestosterone combinations due to unfavorable safety profiles 4