Discontinue treatment in case of jaundice or deterioration in liver function, significant increase in BP, new onset of migraine-type headache; if VTE develops. Temporarily discontinue HRT or treatment for 4-6 wk earlier if prolonged immobilisation is to follow elective surgery. Not intended for contraceptive use. Recurrence or aggravation of conditions during pregnancy or previous hormone treatment including leiomyoma or endometriosis, risk factors for estrogen dependent tumors (eg, 1st degree hereditary for breast cancer) & thromboembolic disorders, HTN, liver disorders (eg, liver adenoma), DM w/ or w/o vascular involvement, cholelithiasis, migraine or severe headache, SLE, history of endometrial hyperplasia, epilepsy, asthma, otosclerosis. Increased risk of endometrial cancer from increasing duration of use & of endometrial wall thickness; breast cancer; ischaemic stroke from 1st yr of treatment especially in older age. Slightly increased risk of ovarian cancer in long-term use (at least 5-10 yr). Premature menopause. Breakthrough bleeding & spotting during 1st mth of treatment. VTE (ie, DVT or pulmonary embolism) risk factors including use of estrogens, older age, major surgery, prolonged immobilization, obesity (BMI >30 kg/m
2), pregnancy/postpartum period, SLE & cancer. MI in patients w/ or w/o existing CAD. Dose-dependent decrease in HDL cholesterol. Reduced levels of triglycerides & lipoprotein(a). Minor decrease in thyroid binding globulin & total T4. Decrease sex-hormone-binding globulin level. Patients w/ known thrombophilic states; pre-existing hypertriglyceridemia. Women on anticoagulant therapy. Carefully assess each woman for endometrial cancer in those w/ risk of stroke, breast cancer & those w/ intact uterus. Take complete personal & family medical history before initiating treatment. Perform periodic checkup during treatment. Investigate changes in breast using appropriate imaging tool eg, mammography; any irregular/unscheduled vag bleeding either on or off HRT to exclude malignancy before starting treatment. Report any breakthrough bleeding or spotting persisting after 6 mth of treatment. Screen patients w/ no personal history of VTE but w/ 1st degree relative w/ history of thrombosis at young age. Observe patients w/ cardiac or renal dysfunction for fluid retention. Galactose intolerance, Lapp lactase deficiency or glucose-galactose malabsorption. W/draw treatment immediately if pregnancy occurs. Increased risk of probable dementia in women who start using continuous combined or estrogen-only HRT after 65 yr.
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