Special Report: How comorbidities and contraindications to hormone therapy influence treatment pathways

In the sixth episode of the Contemporary OB/GYN Special Report series, JoAnn V. Pinkerton, MD, and Jill Liss, MD, MSCP, FACOG, discussed how comorbidities and contraindications influence treatment eligibility for hormone therapy in women experiencing vasomotor symptoms (VMS). The conversation highlighted evolving perspectives on patient safety, individualized care, and the role of nonhormonal options.

Pinkerton emphasized that certain conditions remain clear contraindications to hormone therapy. “The first one is estrogen-sensitive cancers—breast cancer, uterine cancer. These are women that we really want to avoid using hormone therapy,” she explained. She also cited previous heart attack, stroke, spontaneous coronary artery dissection, migraine with aura, and severe endometriosis as situations that require careful risk-benefit assessment. For these patients, she said, nonhormonal treatments have become increasingly valuable alternatives.

Pinkerton also discussed a group she described as “previvors”—women with BRCA gene mutations who undergo prophylactic oophorectomy at a young age. “They’re 42 or 44, and we’re worried about the health risks of early menopause,” she said.¹ “It’s become a lot more clear that we can actually give estrogen until the average time of menopause for those women and then re-evaluate.”² She noted that this approach can mitigate risks associated with premature estrogen loss, including cardiovascular disease, osteoporosis, cognitive decline, and sexual dysfunction.

Liss agreed that addressing the needs of women facing early or surgical menopause is essential. “Those are people who may suffer greatly based on premature surgical menopause or chemoprophylaxis,” she said. She noted that awareness of the importance of tailored hormone use in this group is increasing, but acknowledged that “change always happens slowly.”

Our Experts:
JoAnn V. Pinkerton, MD, division director, Midlife Health Center, University of Virginia.

Jill Liss, MD, MSCP, FACOG, associate clinical professor of Obstetrics and Gynecology, University of Colorado School of Medicine.

Liss has no relevant disclosures to report. Relevant disclosures for Pinkerton include Bayer.

References:

1. Kauntiz A. Is menopausal hormone therapy safe when your patient carries a BRCA mutation. MDedge. 2018. Accessed October 17, 2025. https://live.mdedge.com/content/menopausal-hormone-therapy-safe-when-your-patient-carries-brca-mutation
2. Stuenkel CA, Davis SR, Gompel A, et al. Treatment of Symptoms of the Menopause: An Endocrine Society Clinical Practice Guideline. The Journal of Clinical Endocrinology & Metabolism. 2015;100(11):3975-4011. doi:https://doi.org/10.1210/jc.2015-2236