The Women's Health Initiative (WHI) trial significantly influenced prescribing of HRT. Which specific finding regarding combined (oestrogen + progestogen) HRT was most impactful?

• A Increased risk of endometrial carcinoma with combined HRT
• B Reduced risk of all-cause mortality in all postmenopausal women
• C Protection against osteoporosis without any cardiovascular risk
• D Increased risk of breast carcinoma, coronary heart disease, and pulmonary embolism with combined HRT ✓

Explanation

The WHI randomised trial (2002) of combined CEE + MPA in postmenopausal women found increased risks of breast cancer (HR 1.26), coronary heart disease (HR 1.29), stroke (HR 1.41), and pulmonary embolism (HR 2.13), which led to widespread discontinuation of HRT. The trial also found reduced risk of colorectal cancer and hip fractures. The findings were later contextualised — risks were primarily in older women (>60 years) starting HRT late, and younger perimenopausal women have a more favourable risk-benefit profile.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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