17
Table 9. Specific Cautions to Use of Systemic MHT or
Selective Estrogen Receptor Modulators (SERMs)
a,b
for Treatment of Menopausal Symptoms
In general, ET should not be used in women with any
of the following conditions:
Undiagnosed abnormal genital bleeding
Known, suspected, or history of cancer of the breast
Known or suspected estrogen-dependent neoplasia including endometrial cancer
Active deep vein thrombosis (DVT), pulmonary embolism, or history of these conditions
Active arterial thromboembolic disease (e.g., stroke, myocardial infarction [MI],
or a history of these conditions)
Known anaphylactic reaction or angioedema in response to any ingredient in the medication
c
Known liver impairment or disease
Known protein C, protein S, or antithrombin deficiency, or other known
thrombophilic disorders
c
Known or suspected pregnancy
Caution should also be exercised in women with:
Gallbladder disease (oral ET)
Hypertriglyceridemia (>400 mg/d) (oral ET)
Diabetes
Hypoparathyroidism (risk of hypocalcemia)
Benign meningioma
Intermediate or high risk of breast cancer
High risk of heart disease
Migraine with aura (oral ET)
Other conditions
d
a
Also apply to conjugated estrogens/BZA, ospemifene, and tibolone therapies.
b
Advice not to use estrogens in the specific conditions listed is based on FDA recommendations
and package labeling in the United States. e advice to exercise caution is based on a review of the
literature (including package labeling ) and not dictums generally included in various Menopause
Society guidelines. Because these guidelines are meant to be used internationally, it should be noted
that these considerations may vary from country to country.
c
Specific to CEE ± combination with BZA.
d
Estrogen therapy may cause an exacerbation of asthma, diabetes mellitus, epilepsy, migraine,
porphyria, systemic lupus erythematosus, and hepatic hemangiomas and should be used with
caution in women with these conditions.
