The Women's Health Initiative (WHI) trial findings regarding hormone replacement therapy (HRT) caused major changes in prescribing practice. A 52-year-old woman 2 years post-natural menopause, with significant vasomotor symptoms and no contraindications, seeks HRT advice. Which statement about current evidence-based HRT guidance is MOST accurate?
- A HRT is contraindicated beyond age 55 due to cumulative cardiovascular risk shown in WHI
- B Combined oral CEE + MPA HRT at the doses used in WHI was associated with increased breast cancer and cardiovascular risk — transdermal estrogen + micronized progesterone has a more favorable safety profile ✓
- C WHI showed all forms of HRT increase stroke risk equally; therefore all oral and transdermal preparations are equally risky
- D Tibolone is the only form of HRT with proven net benefit in postmenopausal women under 60
Explanation
Post-WHI reanalysis and subsequent studies show: (1) WHI used high-dose oral CEE + MPA in older women (average age 63) — not the standard of care today; (2) transdermal 17-beta estradiol avoids first-pass metabolism and does not increase venous thromboembolism or stroke risk (unlike oral estrogens); (3) micronized progesterone (bioidentical) has less adverse effect on breast density and clotting factors than MPA. The 'timing hypothesis' (WHI) shows HRT started within 10 years of menopause or under age 60 has net cardiovascular benefit. Current NICE/IMS guidelines endorse HRT for symptomatic women <60 years with no absolute contraindications.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.