Systemic oestrogen remains the most effective treatment for vasomotor symptoms, but it has clear contraindications. These include unexplained vaginal bleeding, current or past breast cancer, active or past venous thromboembolism, active liver disease, and a history of stroke or myocardial infarction.
A woman with a uterus needs a progestogen alongside oestrogen to protect the endometrium. Transdermal oestrogen carries a lower venous clot risk than oral oestrogen and is often preferred in women with raised clot risk factors, such as obesity.
- Ask about unexplained bleeding, breast cancer, clots, stroke, heart attack and liver disease before prescribing
- Add a progestogen whenever the uterus is present
- Consider transdermal oestrogen when venous clot risk is raised
- Review the need for treatment at least yearly
Why it matters
Hormone therapy works best when it is given to the right woman in the right form.
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