MHT Pre-Prescribing Assessment

Step 1 Absolute contraindications

Check any that apply. If any box is ticked, MHT is not appropriate.

Known CVD / CAD / prior MI / stroke History of VTE or PE Personal history of breast cancer Active liver disease Unexplained vaginal bleeding Active malignancy (hormone-sensitive)

Step 2 10-year ASCVD risk (ACC/AHA estimator)

Calculate using the ACC/AHA Risk Estimator, then select the applicable tier.

Step 3 Additional risk factors

Female-specific risk factors

Premature menopause (<40 yrs) History of preeclampsia / GDM PCOS Autoimmune condition (SLE, RA) Preterm delivery history

VTE risk factors

Known thrombophilia Family hx unprovoked VTE (1° relative) Obesity (BMI >30) Prolonged immobilisation

Other relevant risk factors

Current or long-term smoker Hypertension (uncontrolled) Dyslipidaemia Diabetes

Step 4 Baseline investigations

Document completion before prescribing.

BP measured today Lipid panel (fasting) BSL / HbA1c if indicated LFTs (if hepatic concern) Mammogram up to date Cervical screening up to date CAC score (if borderline/intermediate risk) Thrombophilia screen (if VTE hx)