Which of the following is a contraindication to estrogen/progesterone therapy for menopause?

• A. Hypertension
• B. History of breast cancer
• C. Regular exercise
• D. Controlled diabetes

Answer: (B)

Estrogen-containing therapy for menopause is avoided in anyone with a history of breast cancer because estrogen can stimulate growth of hormone-responsive breast cancer cells. If cancer cells express estrogen receptors, exogenous estrogen may promote recurrence or progression, even when a progestin is added to protect the endometrium. So the history of breast cancer makes this therapy inappropriate.

Hypertension, regular exercise, and controlled diabetes do not constitute absolute contraindications to menopausal hormone therapy. They may require evaluation and monitoring, but they do not by themselves preclude therapy, unlike a known history of breast cancer.