Hormonal therapy contraindications

Alternatives to estrogen for hot flushes are shown in Table 31-6. Progesterone alone may be an option in women with a history of breast cancer or venous thrombosis, but side effects limit their use. For women with contraindications to hormone therapy, selective serotonin reuptake inhibitors and venlafaxine are considered by some to be first-line therapy, but efficacy of venlafaxine beyond 12 weeks has not been shown. 

Each patient should be evaluated for the presence of indications (i.e., menopausal symptoms such as hot flushes or vaginal dryness) and possible contraindications. The risks and benefits of hormone therapy should be discussed with the patient so that she can weigh the risks and benefits versus alternatives and make a rational decision about whether to use hormone therapy. 

Postmenopausal symptoms, such as hot flushes and vaginal dryness, remain a valid indication for hormone therapy in the absence of contraindications. For short-term use of hormone therapy for the relief of menopausal symptoms, the benefits for many women generally outweigh the risks. For symptoms of genital atrophy alone, local estrogen and/or nonhormonal lubricants should be considered. 

Hormonal therapy is absolutely contraindicated in women who want to become pregnant due to the risk of sexual organ malformation in a developing fetus. ... 

Most important, glucocorticoids should not be withdrawn abruptly in cases of acute infections or severe stress, such as surgery or trauma. Myasthenia gravis, peptic ulcer, diabetes mellitus, hyperthyroidism, hypertension, psychological disturbances, pregnancy (first trimester), and infections may be aggravated by glucocorticoid administration. Hormone therapy is contraindicated in these conditions and should be used only with the utmost precaution. 

Grapefruit juice is contraindicated when taking some medications, but not thyroid hormone therapy. 

These dragp are contraindicated in patients who are hypersensitive to the bisphosphonates. Alendronate and risedronate are contraindicated in patients with hypocalcemia Alendronate is a pregnancy Category C drug and is contraindicated during pregnancy. These drugp are contraindicated in patients with renal impairment with serum creatinine less than 5 mg/dL. Concurrent use of these dm with hormone replacement therapy is not recommended. 

List the adverse effects of and contraindications to hormone-replacement therapy. 

Osteoporosis Oral calcium supplementation (1000-5000 mg/day) Oral vitamin D Calcifediol (1000 lU/day) Calcitriol (0.5 mcg/day) Hormone-replacement therapy Calcitonin or oral bisphosphonates If daily intake less than 1000 mg elemental calcium Documented deficiency If kidney functioning If kidney not functioning Post-menopausal women without contraindications Documented loss in bone mineral density greater than 3% Data lacking for bisphosphonates in patients with Rl... 

Long-term use of hormone-replacement therapy and concurrent use of progestins appear to contribute to breast cancer risk.7 The use of postmenopausal estrogen-replacement therapy in women with a history of breast cancer generally is considered contraindicated. However, most experts believe that the safety and benefits of low-dose oral contraceptives currently outweigh the potential risks and that changes in the prescribing practice for the use of oral contraceptives are not warranted. Oral contraceptives are known to reduce the risk of ovarian cancer by about 40% and the risk of endometrial cancer by about 60%. 

Adrenocorticotropic hormone (ACTH) gel, 40 to 80 USP units, may be given intramuscularly every 6 to 8 hours for 2 to 3 days and then discontinued. Studies with ACTH are limited, and it should be reserved for patients with contraindications to first-line therapies (e.g., heart failure, chronic renal failure, history of GI bleeding). 

Teriparatide can be used if bisphosphonates are not tolerated or contraindicated. Testosterone replacement therapy should be considered in men, and high-dose hormonal oral contraceptives can be considered for premenopausal women with documented hypogonadism. 

Hormone replacement therapy (HRT), including tibolone, is not recommended for postmenopausal women over the age of 50 years unless other treatments for osteoporosis are contraindicated or not tolerated (MHRA, 2005). 

Quick relief can be obtained with a p-adrenoceptor blocking drug (judge dose by heart rate) though these do not block all the metabolic effects of the hormone, e.g. on the myocardium, and the basal metabolic rate is unchanged. For this reason they should not be used as sole therapy except in mild thyrotoxicosis in preparation for radioiodine treatment, and should be continued in these patients until the radioiodine has taken effect. They do not alter the course of the disease, nor biochemical tests of thyroid function. Any effect on thyroid hormonal action on peripheral tissues is clinically unimportant. It is desirable to choose a drug that is nonselective for pj and p2 receptors and lacks partial agonist effect (e.g. propranolol 20-80 mg 6-8-hourly, or timolol 5 mg once daily). Usual contraindications to P-blockade (see p. 478) should be observed, especially asthma. 

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