一位52歲女性正經歷嚴重的更年期血管舒縮症狀，特別是夜間盜汗與毫不留情的熱潮紅。她來到婦科門診並堅稱：「那些賀爾蒙替代療法（HRT）的藥丸簡直是仙丹。我身體好得很，請直接讓醫生開給我吧。」在徹底審閱病歷後，護理師必須指出哪些過往病史是啟動複合雌激素-黃體素 HRT 的絕對禁忌症？（多選題）
A 52-year-old female experiences severe menopausal vasomotor symptoms, particularly night sweats and unrelenting hot flashes. She arrives at the gynecology clinic and insists, "Those hormone replacement therapy (HRT) pills are miraculous. My body is strong, so please just have the doctor prescribe them for me." Upon thoroughly reviewing her chart, the nurse must identify which historical findings as absolute contraindications for initiating combined estrogen-progestin HRT? (Select all that apply.)
- AA personal history of a deep vein thrombosis (DVT) following a prolonged international flight five years ago.✓ 正解五年前長途國際航班後曾有深層靜脈血栓形成（DVT）的個人病史
- BA strong, documented genetic family history spanning multiple relatives with breast cancer.✓ 正解有明確記錄的多位親屬罹患乳癌的強烈家族遺傳史
- CA past surgical history of a bilateral oophorectomy (removal of ovaries) eliminating endogenous estrogen.曾接受雙側卵巢切除術（移除卵巢）的外科病史
- DA previously diagnosed estrogen-dependent cancer, such as endometrial or breast carcinoma.✓ 正解先前確診為雌激素依賴性癌症，如子宮內膜癌或乳癌
- EEpisodes of undiagnosed, abnormal vaginal bleeding over the past three months.✓ 正解過去三個月有未診斷的不正常陰道出血發作
本題測驗探討更年期賀爾蒙替代療法 (HRT) 的絕對禁忌症。雖然 HRT 能極其有效地緩解血管舒縮症狀（如熱潮紅），但基於強大的科學證據（如 WHI 研究），人造雌激素會帶來致命風險。第一，雌激素會激發極端的高凝血狀態 (Hypercoagulability)；任何曾經有血栓病史（深部靜脈栓塞 DVT 或肺栓塞 PE、中風）的病患皆屬絕對禁忌（選項A正確）。第二，雌激素會促進腺體增生，曾經被診斷或是正患有依賴賀爾蒙生長的癌症（如乳癌、子宮內膜癌），或是具備極高家族遺傳風險者，投與 HRT 等同於灌溉癌細胞（選項B與D皆為正確的紅旗警訊）。第三，任何未確診的異常陰道出血（選項E正確），可能表示體內正存在子宮內膜癌的病變，在完成切片排除惡性腫瘤前，絕對禁止施打雌激素。選項C錯誤：女性如果切除了卵巢，她正缺乏內源性雌激素，只要沒有上述禁忌症，她其實是 HRT 的『適應症』人選，而非禁忌症。
Hormone replacement therapy is contraindicated in clients with a history of deep vein thrombosis due to the risk of exacerbating hypercoagulability. It is also unsafe for those with a strong family history of breast cancer or a diagnosis of estrogen-dependent cancers, as exogenous hormones can stimulate tumor growth. Additionally, undiagnosed abnormal vaginal bleeding must be investigated for endometrial carcinoma before initiating therapy, whereas a history of oophorectomy without other risks is an indication for HRT.
世界兩國針對 HRT 危險因子的警告完全同步。台灣婦產科學會也是強烈宣導：只要你曾經有血栓、現在有異常流血、或是家裡得過乳癌/卵巢癌，這輩子連「植物性大豆異黃酮」這種類雌激素產品都應當極度謹慎避開。