Contraindications to all systemic MHT

Before starting systemic menopausal hormone therapy (MHT), including tibolone and conjugated estrogens+bazedoxifene, exclude the following contraindications to starting any form of systemic estrogen:

  • age 60 years or older1 
  • previous venous thromboembolism
  • previous transient ischaemic attack, stroke or acute myocardial infarction
  • uncontrolled hypertension
  • estrogen-dependent cancer (eg endometrial or breast cancer)
  • undiagnosed vaginal bleeding (may indicate estrogen-dependent cancer)
  • high risk of breast cancer
  • significant liver disease
  • porphyria or SLE (may be exacerbated by estrogen).

If any of these contraindications is present, systemic MHT must not be started without specialist referral for individual assessment of risks and benefits.

If there are no contraindications, check for contraindications specific to oral estrogen before starting systemic MHT.

A personal history of breast cancer is a contraindication to systemic MHT because of the potential to promote recurrence. Consider nonhormonal systemic therapies; if these are not effective, refer to a specialist. Intravaginal estrogen therapy can also be considered, in consultation with an oncologist. See also Cancer Australia’s Management of Menopausal Symptoms in Women with a history of breast cancer  for more information.

Note: Seek specialist advice for individuals with a personal history of breast cancer if symptoms are not controlled with nonhormonal therapies.

High familial breast cancer risk (greater than three times population risk) is a contraindication to MHT, without specialist advice. See Systemic MHT in individuals with increased familial breast cancer risk.

1 If systemic menopausal hormone therapy (MHT) is already being used at age 60 years, it may be continued to manage menopausal symptoms, after reassessing the benefits and harmsReturn