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Systemic estrogen (e.g., pill) is contraindicated, but low-dose vaginal estrogen may be considered in select cases Vaginal bleeding with an unknown cause Current blood clots Serious liver or gall bladder disease Current or past history of angina, heart attack, or other heart problems [16] If you have certain conditions, you should be careful with hormone therapy (speak to your doctor about treatment options and dosage): Migraine Diabetes with vascular effects History of blood clots Gall bladder disease History of endometrial cancer Lupus Dementia Asthma Epilepsy Porfyria Non-hormonal medication As an alternative to hormone therapy, there are several non-hormonal medications that can help address perimenopause symptoms

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