The WHI (Women's Health Initiative) estrogen-progestogen trial demonstrated which cardiovascular finding that changed postmenopausal HRT prescribing?

• A Combined HRT reduced coronary heart disease events in all postmenopausal women
• B Estrogen-only HRT increased coronary heart disease risk in women after hysterectomy
• C HRT had no effect on cardiovascular outcomes when started within 10 years of menopause
• D Combined HRT (CEE+MPA) increased coronary heart disease, stroke, VTE, and breast cancer in older postmenopausal women ✓

Explanation

The WHI combined HRT arm (conjugated equine estrogen + medroxyprogesterone acetate) in women aged 50–79 found increased risks of coronary heart disease (HR 1.29), stroke (HR 1.41), VTE (HR 2.11), and invasive breast cancer (HR 1.26), leading to early trial termination. This fundamentally changed HRT prescribing. The 'timing hypothesis' emerged later (KEEPS, ELITE trials) showing cardiovascular benefit when started within 10 years of menopause — but this was a post-WHI concept, not a WHI finding. Estrogen-only WHI (post-hysterectomy) did not significantly increase CHD.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.