Who should not take HRT?

Last reviewed July 6, 2026 by Dr. Sapna Jadhav, General Physician. Sources from ACOG, NHS, Mayo Clinic, CDC, NICE, NIH, Cochrane, and peer-reviewed journals.

Bottom lineSystemic HRT is generally avoided with current or past breast cancer, other hormone-sensitive cancers, unexplained vaginal bleeding, or active liver disease, while clot or stroke history, BRCA mutations, and migraine with aura call for specialist input rather than an automatic no - and vaginal estrogen plus non-hormonal options remain available to almost everyone.

Systemic HRT is generally avoided - or needs specialist input - with certain cancers, unexplained bleeding, clot or stroke history, or active liver disease.

Generally ruled out

• Current or past breast cancer, or suspected breast cancer awaiting investigation
• Other known or suspected hormone-sensitive cancers (including untreated endometrial cancer)
• Unexplained vaginal bleeding - this must be investigated before any HRT is started
• Active liver disease with abnormal function
• Pregnancy - worth ruling out in perimenopause, where cycles are erratic but ovulation still happens

Needs specialist advice, not an automatic no

• A history of blood clots (DVT/PE) or stroke - oral HRT is out, but transdermal estrogen may still be an option via a menopause specialist
• A history of heart attack or angina
• A strong family history of breast cancer or a BRCA mutation - a specialist conversation, not a closed door
• Migraine with aura - transdermal estrogen is generally preferred; combined hormonal contraception rules differ from HRT rules
• Untreated high blood pressure - treat the blood pressure first, then revisit

Options if systemic HRT is off the table

Being unable to take systemic HRT does not mean living with untreated symptoms:

• Vaginal estrogen for dryness and urinary symptoms is safe for most women - including many with the conditions above - because almost none is absorbed into the bloodstream.
• Non-hormonal medications (fezolinetant, certain antidepressants at low dose, and others) genuinely reduce hot flashes.
• CBT and lifestyle changes measurably reduce symptom burden.

The deciding factor is an honest, complete medical history - which is exactly what your clinician needs from you at the first appointment.

This is general information, not medical advice. Read the full evidence review: the risks of HRT, and the alternatives: non-hormonal treatments.

Assess your symptoms first: menopause symptom score