The Women's Health Initiative (WHI) trial reassessed the risk-benefit of combined oestrogen-progestogen HRT in postmenopausal women. Its key finding that altered prescribing practice globally was:

• A Combined HRT reduces all-cause mortality significantly
• B Oestrogen-only HRT in women with an intact uterus is safe
• C Combined HRT prevents osteoporotic fractures without any adverse cardiovascular effect
• D Combined HRT increases risks of breast cancer, coronary heart disease, stroke, and PE, outweighing benefits in average-risk women ✓

Explanation

The Women's Health Initiative (2002) trial halted the combined oestrogen-progestogen arm (Prempro) early because combined HRT significantly increased risks of invasive breast cancer (RR 1.26), coronary heart disease, stroke, and pulmonary embolism in average-risk healthy postmenopausal women, despite benefits on osteoporotic fractures and colorectal cancer. This publication fundamentally changed global HRT prescribing. Oestrogen-only HRT in women with intact uteri is unsafe due to endometrial hyperplasia risk.

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

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Written and medically reviewed by the StethoPrep medical team.