Which hormone type should generally be avoided in women with severe liver disease?

In women with severe liver disease, the use of estrogen and progestin should generally be avoided due to potential complications in liver function and hormonal balance. Estrogen can exacerbate existing liver conditions, as the liver is responsible for metabolizing this hormone. In cases of severe liver impairment, there is a risk of increased estrogen levels in the body, which can lead to adverse effects such as fluid retention, coagulopathy, and an elevated risk of thromboembolic events.

Progestins, while typically safer than estrogen in some contexts, may also pose risks in women with liver disease because they can affect liver metabolism and contribute to hormonal imbalance. Moreover, the synthetic progestins can have varying effects on the liver and may lead to similar complications as estrogen, even though they are not as commonly associated with extreme health risks.

Thus, the contraindication of both hormones in women with severe liver disease stems from their significant impact on liver function and the consequent health risks. This is particularly important in clinical practice, as it influences decisions around hormone replacement therapy and contraceptive options for these patients.