Which condition represents an absolute contraindication to systemic estrogen-containing menopausal hormone replacement therapy?

Answer and explanation

Correct answer: B. History of active deep vein thrombosis or pulmonary embolism

  1. Step 1: Estrogen promotes hepatic synthesis of clotting factors and downregulates antithrombin, increasing the risk of venous thromboembolism.
  2. Step 2: A documented history of active or previous venous thromboembolism (DVT or pulmonary embolism), active liver disease, or estrogen-sensitive breast/endometrial cancer represents an absolute contraindication to systemic estrogen therapy.
Answer
History of active deep vein thrombosis or pulmonary embolism.
Why not the others: Osteopenia is an established clinical indication for estrogen replacement therapy to prevent postmenopausal bone resorption. Vasomotor symptoms (hot flashes and night sweats) represent the primary clinical indication for menopausal hormone therapy. Well-controlled hypertension is a relative precaution that requires monitoring rather than an absolute contraindication.

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