Abstract
Although hormone replacement therapy (HRT) for menopausal women is widespread and increasing, clinicians generally lack adequate information about contraindications to HRT and their prevalence. We conducted a study on the prevalence of select HRT contraindications using a database of abstracted medical records of a randomly selected sample of adult female members (age range 40 to 55 years) of a large health maintenance organization (HMO). Breast cancer and endometrial cancer were defined as absolute contraindications; 13 other conditions cited as contraindications in three or more recent articles on HRT were defined as relative contraindications. Almost 9% of women had an absolute contraindication, and 44% of women had a relative or an absolute contraindication for HRT documented in their medical records. In each 5-year period between 40 to 55, 1 in 5 women had at least one relative contraindication documented in her medical record. Since HRT may be considered for therapeutic or preventive use in virtually all perimenopausal and postmenopausal women, these data suggest that contraindications may play a significant role in usage among these women. Further, lack of consensus regarding contraindications to HRT in the literature (and probably in practice) suggests a need for better epidemiologic data on contraindications and for clinical practice guidelines that specifically address contraindications. Research on the efficacy of nonhormonal management strategies could benefit those who cannot or will not take replacement hormones for menopausal symptom management or for prevention.
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