Which of the following is an absolute contraindication to hormone therapy?

• A. Undiagnosed vaginal bleeding
• B. Osteoporosis
• C. Hypertension
• D. Hyperlipidemia

Answer: (A)

The main concept is that starting estrogen-containing hormone therapy requires ruling out underlying pathology that could be worsened by estrogen. Undiagnosed vaginal bleeding is an absolute contraindication because estrogen stimulates endometrial growth. If there’s an unknown lesion such as endometrial hyperplasia or cancer, giving estrogen could promote progression or obscure the diagnosis, delaying proper treatment. This is why starting therapy isn’t appropriate until the bleeding is investigated and ruled out as benign or managed appropriately.

Osteoporosis, hypertension, and hyperlipidemia are not absolute barriers to hormone therapy. HT can be chosen or adjusted with these conditions in mind, such as using appropriate routes (e.g., transdermal) or ensuring conditions are controlled and monitored, rather than withholding therapy outright.