HRT HRT Contraindications & Risk Factors 1 — Questions and Answers
Question 1: Which condition is an ABSOLUTE contraindication to systemic estrogen-containing HRT?
- Active or history of estrogen receptor-positive breast cancer (Correct answer)
- Well-controlled hypertension
- Type 2 diabetes
- Mild osteoporosis
Correct answer: Active or history of estrogen receptor-positive breast cancer
Estrogen receptor-positive breast cancer is an absolute contraindication because estrogen can stimulate tumor growth in ER+ tissue.
Question 2: A patient with a personal history of deep vein thrombosis (DVT) who requires HRT should preferably use which route to minimize thrombotic risk?
- Transdermal estrogen (Correct answer)
- Oral conjugated estrogen
- IV estrogen
- High-dose oral estrogen
Correct answer: Transdermal estrogen
Transdermal estrogen does not increase hepatic clotting factor synthesis (as oral estrogen does), significantly reducing the risk of VTE in high-risk patients.
Question 3: Undiagnosed abnormal vaginal bleeding is a contraindication to HRT initiation because it may indicate which serious underlying condition?
- Endometrial cancer or hyperplasia (Correct answer)
- Benign fibroids only
- Ovarian cysts
- Cervical polyps only
Correct answer: Endometrial cancer or hyperplasia
Undiagnosed vaginal bleeding must be evaluated to exclude endometrial cancer or hyperplasia before starting estrogen, which could worsen malignant conditions.
Question 4: Active liver disease is a relative or absolute contraindication to HRT primarily because the liver is responsible for what?
- Metabolizing and clearing exogenous hormones (Correct answer)
- Producing ovarian hormones
- Absorbing hormones from the GI tract
- Regulating FSH and LH secretion
Correct answer: Metabolizing and clearing exogenous hormones
The liver metabolizes sex hormones; active liver disease impairs this clearance, leading to hormone accumulation and increased side effects.
Question 5: Which inherited thrombophilia markedly increases VTE risk with oral HRT and may prompt use of transdermal route instead?
- Factor V Leiden mutation (Correct answer)
- MTHFR heterozygous variant alone
- G6PD deficiency
- Hemophilia A
Correct answer: Factor V Leiden mutation
Factor V Leiden mutation causes resistance to activated protein C, significantly elevating thrombotic risk that is compounded by the procoagulant effect of oral estrogen.
Question 6: Migraine with aura is considered a relative contraindication to combined oral contraceptives and is relevant to HRT because it indicates increased risk of which event?
- Ischemic stroke (Correct answer)
- Hemorrhagic stroke
- Pulmonary embolism
- Myocardial infarction only
Correct answer: Ischemic stroke
Migraine with aura is associated with an increased baseline risk of ischemic stroke, which may be further elevated by estrogen's procoagulant effects.
HRT HRT Contraindications & Risk Factors 1
Which condition is an ABSOLUTE contraindication to systemic estrogen-containing HRT?