HRT HRT Contraindications & Risk Factors 2

Question 1

Which personal medical history item should be elicited FIRST when screening a new patient for HRT candidacy?

Accepted Answer

Personal or family history of hormone-sensitive cancers and blood clots

Answer

Hormone-sensitive cancers (breast, endometrial) and prior VTE are the most critical red flags that may contraindicate HRT and must be identified at initial screening.

Question 2

A patient with a BRCA1 mutation who has undergone risk-reducing bilateral mastectomy and oophorectomy — is HRT contraindicated?

Accepted Answer

No — breast tissue is removed, so estrogen-driven breast cancer risk is dramatically reduced

Answer

After risk-reducing bilateral mastectomy and oophorectomy, HRT is generally considered acceptable because the primary target organ for BRCA1-linked breast cancer has been removed.

Question 3

In a patient with controlled hypertension, which HRT route is generally preferred to avoid further BP elevation?

Accepted Answer

Transdermal estrogen

Answer

Oral estrogen increases hepatic synthesis of angiotensinogen, which can raise blood pressure, whereas transdermal estrogen has a neutral effect on the renin-angiotensin system.

Question 4

Gallbladder disease risk is specifically associated with which route of estrogen administration?

Accepted Answer

Oral estrogen

Answer

Oral estrogen increases biliary cholesterol saturation through hepatic first-pass processing, raising the risk of gallstone formation and gallbladder disease.

Question 5

For a patient with a history of hormone receptor-negative breast cancer in complete remission, how should HRT candidacy be approached?

Accepted Answer

Individualized shared decision-making with oncology input, as absolute contraindication is less clear than for ER+ cancer

Answer

Hormone receptor-negative breast cancers are not stimulated by estrogen, making the contraindication less absolute, but oncology consultation and individualized risk discussion remain essential.

HRT - Hormone Replacement Therapy Certification Practice Test

HRT - Hormone Replacement Therapy Certification Practice Test

HRT HRT Contraindications & Risk Factors 2