• Endometriosis can lead to a difficult decision having to be made. If you had an oophorectomy, then you will probably have particularly troublesome hot flushes, and if you had the operation before about the age of 45 you will be at a much greater risk of developing osteoporosis, so HRT would seem an important treatment for you. However, the excess tissue that built up in endometriosis may get worse on HRT, even many years after the menopause, suggesting that you should not use this form of treatment. This is obviously something you should talk over with your doctor.

• If you have a family history of cancer of the breast or uterus, your doctor will want to consider what your chances are of developing either of these diseases if you take HRT. Once again, only you can decide by weighing the relative risks against the relative benefits. Benign breast disease needs careful monitoring, but HRT needn’t always be ruled out.

• Fibroids tend to get worse in the presence of oestrogen, and may enlarge if you take HRT. But this doesn’t usually cause extra problems and most women with fibroids who are on HRT find they just have heavier periods.

• The presence of gallstones means HRT has to be prescribed with caution, as it can lead to an increased risk of this condition becoming worse. A non-oral route, such as the patch or implant, avoids the digestive system, so may be acceptable. Oestrogen can make gallbladder disease worse.

• High blood pressure should be investigated before starting on HRT, but once it has been brought under control, your doctor will probably feel it is alright for you to be on HRT. High blood pressure is not in itself a contraindication.

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