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In women with no personal history of VTE but with a first degree relative with a history of thrombosis at young agescreening may be offered after careful counselling regarding its limitationsonly a proportion of thrombophilic defects are identified by screeningIf a thrombophilic defect is identified which segregates with thrombosis in family members or if the defect isseveree.gantithrombinprotein Sor protein C deficiencies or a combination of defectsHRT is contraindicated.

Consistent with the WHI clinical trialobservational studies have also reported an increased risk of breast cancer for estrogen plus progestin therapyand a smaller increased risk for estrogen-alone therapyafter several years of useThe risk increased with duration of useand appeared to return to baseline over about 5 Over the counter chloroquine years after stopping treatmentonly the observational studies have substantial data on risk after stoppingObservational studies also suggest that the risk of breast cancer was greaterand became apparent earlierwith estrogen plus progestin therapy as compared to estrogen-alone therapyHoweverthese studies have not generally found significant variation in the risk of breast cancer among different estrogen plus progestin combinationsdosesor routes of administration.

Safety and effectiveness in pediatric patients have not been establishedEstrogen treatment of prepubertal girls induces premature breast development and vaginal cornificationand may induce uterine bleeding.

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