The publication of the combined treatment arm of the women's health initiative study in July 2002 led to a dramatic fall in the use of hormone replacement therapy and a revision of the package insert for all hormone therapy preparations. This clinical trial randomised 16 608 women, aged 50-79 years, to 0.625 mg conjugated equine oestrogen and 2.5 mg medroxyprogesterone acetate or placebo.1 The study was stopped early, at an average follow-up of 5.2 years, because analysis did not find the expected benefit in preventing coronary heart disease. In addition, the global index score—which measures the balance between benefit and harm—showed that the benefits in preventing hip fracture and colorectal cancer were outweighed by the increased risk of breast cancer, stroke, and deep vein thrombosis.

This week's BMJ sees the publication of the women's international study of long duration oestrogen after menopause by Vickers and colleagues.2 This study was originally powered to detect a 25% reduction in the number of cases of coronary heart disease and aimed to recruit 22 300 women for 10 years' follow-up. The UK Medical Research Council stopped recruitment after the first publication from the women's health initiative, however, and 5692 women, age 50-69 years (mean age 63), …