The Women's Health Initiative (WHI) trial finding that is MOST relevant to combined (oestrogen-progestogen) HRT prescribing in postmenopausal women is:
- A Combined HRT significantly increases risk of ovarian cancer
- B Combined HRT is cardioprotective when started within 5 years of menopause
- C Combined HRT increases risk of invasive breast cancer, coronary heart disease, stroke, and VTE when started >10 years after menopause ✓
- D Oestrogen-only HRT (in hysterectomised women) increases breast cancer risk similarly to combined HRT
Correct answer: C. Combined HRT increases risk of invasive breast cancer, coronary heart disease, stroke, and VTE when started >10 years after menopause
Explanation
The WHI trial (2002, JAMA) showed that combined conjugated equine oestrogen plus medroxyprogesterone acetate was associated with increased risks of invasive breast cancer (HR 1.26), coronary events (HR 1.29), stroke (HR 1.41), and VTE (HR 2.13) in older post-menopausal women (mean age 63, started >10 years after menopause). The 'timing hypothesis' subsequently showed that HRT initiated close to menopause (<10 years; 'window of opportunity') does not increase — and may reduce — coronary events. Oestrogen-only HRT actually showed a trend toward reduced breast cancer in the WHI.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.