Estrogen Therapy Indications and Contraindications
Understanding when estrogen replacement therapy can be of use, and when it cannot will help to ensure that only those who can benefit from this form of HRT will receive it in the safest manner possible. There are certainly strong reasons why a woman should not use supplemental estrogen, either alone or in combination with progestin, just as there are times when the benefits of treatment outweigh any potential risk factors. Knowing these estrogen therapy indications and contraindications can help you make a decision that will provide superior results.
A full spectrum of symptoms fall under the category of menopause, and these may vary greatly from one woman to the next as the level of circulating estrogen in the bloodstream can also vary, and will affect each person in a unique way. Women most often have indications for estrogen therapy starting at the onset of perimenopause and continuing all the way through postmenopause. Symptoms such as hot flashes and night sweats are often the first warning sign that females associate with this life change.
The estrogen replacement therapy contraindications are often associated with those women who are at any increased risk of developing breast cancer, heart disease, blood clots, or stroke based on previous incident or predisposition. The HRT doctor will assess these contraindications to determine who is and is not a candidate for estrogen supplementation.
Who Can Use Estrogen Therapy?
Indications of estrogen therapy are based on two intentions:
- Preventative
- Symptomatic
The use of estrogen replacement therapy for the prevention of menopause is controversial. Some doctors suggest that the risks involved do not warrant giving this treatment to a woman who is not having symptoms that are affecting her life in some way. This is not the same thing as estrogen replacement therapy indications for someone who is dealing with sleepless nights, weight gain, depression, mood swings, vaginal dryness, low libido, memory decline, and other unwanted symptoms in her daily life.
Age also plays a significant role in estrogen therapy indications as its use is not recommended past the age of 59. Other, safer forms of hormone replacement can be used in later years to prevent a woman from dealing with bone loss and other concerns that come with the postmenopausal changes.
Estrogen can be used to reduce the risks associated with high cholesterol, obesity, type 2 diabetes, heart disease, and osteoporosis in later years. The best time to seek out HRT treatment is after symptoms of menopause have started to have an impact on productivity, enjoyment, or life in general.
When is Estrogen Therapy Not Recommended?
Many reports have argued the benefits and risks of estrogen therapy, and they often contradict one another making it difficult to determine if this form of treatment is an ideal choice. The majority of HRT specialists follow the belief that treatment with bioidentical hormones is better than the use of synthetic ones in most situations. A doctor will gather a completed medical history report when assessing estrogen replacement contraindications in each person.
Blood analysis and physical examination will also yield decisive information that will be used to prescribe a medical protocol that will be to the benefit of each individual.
The following list of estrogen therapy contraindications is considered to be the norm in when not to prescribe estrogen HRT:
- Previous history of breast or endometrial cancer
- Increased risk due to family predisposition to breast cancer
- Endometriosis
- Fibroids
- Undiagnosed vaginal bleeding
- Thromboembolic disorders (blood clotting)
- Severe active liver disease
- Hypertriglyceridemia (extremely high triglyceride levels often associated with uncontrolled diabetes and a risk factor for coronary artery disease)
It is also essential to explain that some of the contraindications for estrogen therapy have to do with a combination form of treatment that also includes progestin. This is an important topic to discuss with the HRT specialist.
Hormone Options in Place of Estrogen Therapy
Some women who are viable candidates for estrogen replacement still opt not to receive this treatment solely based on the inherent risk factors. Instead, they suffer through the night sweats, mood swings, weight gain, hot flashes, and other symptoms that are making an annoying presence in their lives. This does not have to be the case. When you understand the contraindications to estrogen therapy, treatment can be prescribed that is still safe to use.
Thankfully, there are also other choices that can be utilized in place of estrogen therapy. That is where the detailed blood analysis performed by the hormone specialist is useful. Many menopausal and postmenopausal women are deficient in the hormones progesterone and/or testosterone.
These two essential chemicals also help maintain strong bones, a healthy heart, sharp mind, balanced mood, and revved up libido. When there are contraindications of estrogen therapy or this treatment is not desired, doctors can safely prescribe the use of testosterone or progesterone to treat the symptoms associated with menopause.
National HRT Staff
Please note that the information provided in this article is for informational purposes only and is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition or treatment.
- Estrogen replacement therapy: Indications, contraindications, and agent selection MorrisNotelovitz MD American Journal of Obstetrics and Gynecology Volume 161, Issue 6, Part 2, December 1989, Pages 1832-1841
- Wikipedia
- MedlinePlus