The Women's Health Initiative (WHI) trial published in 2002 reported the risks of combined estrogen-progestogen hormone replacement therapy (HRT). Which of the following is an accurate summary of WHI findings that influenced global prescribing practice?
- A HRT increased all cardiovascular outcomes without any mortality benefit
- B HRT increased breast cancer, coronary heart disease, stroke, and VTE but reduced colorectal cancer and hip fractures ✓
- C HRT increased VTE and stroke only, with no effect on breast cancer
- D HRT had a net benefit for all women under 60 years and net harm only in older postmenopausal women
Correct answer: B. HRT increased breast cancer, coronary heart disease, stroke, and VTE but reduced colorectal cancer and hip fractures
Explanation
The WHI conjugated equine estrogen plus medroxyprogesterone acetate trial (JAMA 2002) found increased risks of breast cancer (HR 1.26), coronary heart disease (HR 1.29), stroke (HR 1.41), and VTE (HR 2.11), but significantly reduced colorectal cancer (HR 0.63) and hip fracture (HR 0.66) in combined HRT users. These findings caused a major reduction in HRT prescribing. Subsequent re-analyses revealed a 'timing hypothesis' — benefits may predominate in younger postmenopausal women (within 10 years of menopause), while risks predominate in older women.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.