Suite 313, 179 Whiteladies Road, Bristol, BS8 2AG

Phone: 01225 436 129 / Mobile: 07973 519 702

Appendix 2 – Special Precautions

View HRT Guidance Flow Chart

Angina/Ischaemic Heart Disease Currently no evidence that HRT is beneficial in females with established heart disease. Some risk factors may improve eg. lipid profile
Endometrial Hyperplasia May be corrected by appropriate choice of HRT. If previously treated by hysterectomy, HRT not contraindicated. Advise referral to specialist menopause clinic.
Gall Bladder Disease Deterioration has been reported with estrogen treatment, but to avoid first pass effect transdermal HRT. No contraindication after cholecystectomy.
Lactose Intolerance Advise transdermal route or implant. All oral preparations contain lactose.
Liver Disease Check LFT prior to and after 12 weeks’ treatment. Advise effect transdermal HRT. No. This includes chronic liver disease with mildly adnormal LFTs, previous jaundice, pruritus of pregnancy, Dubin-Johnson Syndrome, Rotox Syndrome.
Otosclerosis May deteriorate with estrogen, but little clinical evidence to support this. Advise referral to specialist menopause clinic.
Ovarian Cancer not always contraindicated, but usually managed in conjunction with gynae oncologist. Advise referral to specialist menopause clinic.
Porphyria May prescribe HRT. Advise referral to specialist menopause clinic.
Systemic Lupus Erythematosus Sometimes deteriorates on HRT. Studies show no clear trend. Use transdermal to minimise thrombotic risk. Advise referral to specialist menopause clinic.
Thrombo-Plebitis HRT not contraindicated with history of superficial thrombo-phlebitis. Defer HRT if disease still active.
Varicose Veins No contraindication if uncomplicated.