Is active smoking a contraindication to starting menopausal hormone therapy (HRT) in a post-menopausal woman with severe vasomotor symptoms and no other cardiovascular risk factors?

What, as an endocrinologist, deters you from prescribing HRT for postmenopausal women with vasomotor symptoms?

• The need for regular pelvic and breast exams
• WHI trial findings in 2002 showing increased risk of VTE, cardiovascular disease, and breast cancer
• Limited education on HRT for women during medical training
• I am not deterred from prescribing HRT
• Other