Estrogen plus progestin for primary prevention in healthy postmenopausal women

In healthy postmenopausal women, estrogen plus progestin increases the risk of coronary heart disease, stroke, pulmonary embolism, and breast cancer but decreases the risk of hip fractures and colorectal cancer. There is an overall excess of adverse events of 19 per 100 000 person years.

The Women's Health Initiative (WHI) multicentre primary prevention trial randomized 16 608 postmenopausal women aged 50 -70 years to receive either conjugated equine estrogen 0.625 mg/d plus medroxyprogesterone acetate 2.5 mg/d or placebo. The planned duration of the trial was 8.5 years, but it was terminated early after a mean follow-up of 5.2 years. The follow-up of clinical events occurred every 6 months. The study protocol required annual mammograms. The estimated hazard ratios were as follows: coronary heart disease 1.29 (95% CI 1.02 to 1.63), breast cancer 1.26 (1.00 to 1.59), stroke 1.41 (1.07 to 1.85), pulmonary embolism 2.13 (1.39 to 3.25), colorectal cancer 0.63 (0.43 to 0.92), endometrial cancer 0.83 (0.47 to 1.47), hip fracture 0.66 (0.45 to 0.98). For total mortality the hazard ratio was 0.98 (0.82 to 1.18). Absolute health risks per 10 000 person-years were as follows: CHD events 7, strokes 8, pulmonary embolisms 8, invasive breast cancers 8. Absolute risk reductions were as follows: colorectal cancer 6, hip fractures 5. The absolute excess risk of events was 19 per 10 000 person-years.

The following decision support rules contain links to this evidence summary:

• Limiting the duration of hormone replacement therapy

Ədəbiyyat

1. Rossouw JE, Anderson GL, Prentice RL, LaCroix AZ, Kooperberg C, Stefanick ML, Jackson RD, Beresford SA, Howard BV, Johnson KC, Kotchen JM, Ockene J, Writing Group for the Women's Health Initiative Investigators. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women's Health Initiative randomized controlled trial. JAMA 2002 Jul 17;288(3):321-33.