Which risk factors are important to discuss when considering hormone therapy?

• A. VTE/MI/stroke risk and breast cancer risk
• B. Hair color
• C. Age alone
• D. Exercise type

Answer: (A)

Safety concerns with hormone therapy center on major systemic risks that can shape decisions and long-term outcomes: venous thromboembolism, myocardial infarction, stroke, and breast cancer. These are the factors that most influence how therapy is prescribed, including the choice of regimen, route of administration, and how long it’s used. Estrogen-containing regimens raise the risk of VTE, particularly with oral estrogen and in older users or those with obesity or smoking history; using transdermal estrogen can lower that risk. Myocardial infarction and stroke risk increase with age and with existing cardiovascular risk factors, so assessing baseline cardiovascular risk is crucial before starting therapy. Breast cancer risk is higher with combined estrogen–progestin therapy, and risk generally grows with longer use, though estrogen alone (in women without a uterus) has a different risk profile. Factors like hair color or exercise type do not address these meaningful safety concerns, and age alone isn’t enough to guide risk discussion. Tailor the conversation to the patient’s personal and family history, prior thrombotic events, breast cancer risk, and overall cardiovascular risk, and explain how regimen, dose, route, and duration can modify these risks.