Contraindications to Hormone Replacement Therapy - By Dr. Meghan van Drimmelen, ND
As a naturopathic doctor who regularly prescribes hormone replacement therapy (HRT) to women going through perimenopause and menopause, I understand the importance of individualizing treatment plans to maximize benefits and minimize risks. While HRT remains the most effective treatment for vasomotor symptoms (VMS) and the genitourinary syndrome of menopause, it is important to be aware of the contraindications for this therapy. Women who have contraindications for HRT may still benefit from other therapies, such as non-hormonal treatments for VMS or low-dose vaginal estrogen therapy for genitourinary syndrome of menopause.
Contraindications to HRT
Based on the North American Menopause Society’s (NAMS) guidelines, HRT (which includes Health Canada approved bioidentical hormone therapy) is contraindicated in the following situations:
1. History of breast cancer
Women who have a history of breast cancer should not use HRT. This is because estrogen can stimulate the growth of breast cancer cells.
2. History of endometrial cancer
Women who have a history of endometrial cancer should not use HRT. This is because estrogen can increase the risk of endometrial cancer. However, women who have had a hysterectomy (removal of the uterus) can use HRT without an increased risk of endometrial cancer.
3. History of blood clots
Women who have a history of blood clots (deep vein thrombosis or pulmonary embolism) or who have a personal history of a high risk blood clotting disorder should not use HRT. This is because estrogen can increase the risk of blood clots. Women who have a history of stroke or heart attack should also avoid HRT.
4. Liver disease
Women who have liver disease should not use HRT. This is because the liver plays a key role in metabolizing estrogen, and liver disease can affect the way the body processes estrogen.
5. Abnormal vaginal bleeding
Women who have unexplained vaginal bleeding should not use HRT until the cause of the bleeding has been determined. This is because HRT can mask the symptoms of certain gynecological conditions, such as endometrial cancer.
HRT can be an effective treatment for menopausal symptoms, but it is not suitable for everyone. Women who have a history of breast cancer, endometrial cancer, blood clots, a blood clotting disorder, liver disease, or abnormal vaginal bleeding should not use HRT. If you are considering HRT, it is important to discuss the risks and benefits with your naturopathic doctor or other health care provider trained in HRT prescribing. They can help you determine if HRT is right for you and, if so, what type and dose of HRT is appropriate.
Book in for an initial naturopathic consultation to learn more about your options. We are here to help!
In health and happiness,
Dr. Meghan van Drimmelen, ND | Naturopath Victoria BC
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