Is oestrogen replacement therapy contraindicated in patients with a history of liver disease? The p

Fråga: Is oestrogen replacement therapy contraindicated in patients with a history of liver disease? The present case concerns a female with menopausal symptoms who suffered from hepatitis in her childhood. No liver function tests have been performed.

Sammanfattning: Special risks are attached to the administration of active doses of oestrogens in patients with a history of hepatic disease. In the present case where the patient has a history of hepatitis and if the liver function tests are normal, low doses of oestrogen for replacement therapy should not be considered contraindicated. However, the therapy should be used with care and we recommend transdermal administration for oestrogen replacement therapy.

Svar: Oestrogen is recommended to be avoided in patients with a present liver disease and impaired liver function. In addition, oestrogen is recommended to be used with care in patients with a history of liver disease, due to a possible latent subclinical liver function disturbance (1). The recommendations are based on the fact that oestrogen is extensively metabolised in the liver. A great interindividual variation exists in the extent of oestrogen metabolism due to differences in the expression of the liver enzymes. It is well known that interaction with enzyme inducing drugs may occur (2).

There is a risk of dose related adverse reactions in the liver from oestrogen in oral contraceptives. Oral oestrogen has been shown to to cause mild hepatocellular damage which is manifested by a transient rise in serum transaminases. Long term use has been shown to lead to changes in the hepatic ultrastructure. Benign liver tumours and an increased risk of gall-stones and jaundice due to oestrogen therapy have also been reported (2,3). However, transdermal oestrogen administration has been shown to give a much lower risk of change in the liver function tests than orally administered oestrogen (1). We found one case report of transdermal oestrogen replacement therapy in a patient with chronic active hepatitis. The patient was besides the hormone treatment on concomitant treatment with corticosteroids. The drug therapy gave no deterioration in her liver function tests (4).