Bmj Usa: Editorial

Hormone replacement therapy

BMJ 2003; 327 doi: (Published 19 November 2003) Cite this as: BMJ 2003;327:E139
  1. Rebekah Wang-Cheng, clinical professor of medicine, associate editor of BMJ USA (,
  2. Jo Ann Rosenfeld, assistant professor of medicine, associate editor of BMJ USA (
  1. Medical College of Wisconsin
  2. Johns Hopkins University School of Medicine

    What shall we tell our patients now?

    From BMJ USA 2002;September:484

    The controversy about hormone replacement therapy (HRT) was not started but only renewed when the results of the Women's Health Initiative (WHI) were announced in July.1 In the WHI, 16 608 postmenopausal women ages 50 to 79 were randomized to receive estrogen plus progestin or placebo. Although the trial was planned to last 8.5 years, the estrogen-progestin arm was stopped prematurely after 5.2 years because of increased risks.

    The WHI reported a small but significantly higher risk of myocardial infarction (hazard ratio=1.32), stroke (HR=1.41), deep vein thrombosis (HR=2.07), pulmonary embolism (HR=2.13), and invasive breast cancer (HR=1.26) in women receiving continuous conjugated estrogen (0.625 mg) combined with medroxyprogesterone acetate. These relative risks seem small when translated into absolute risks: for every 10 000 women-years of HRT there was an excess of 7 cardiac events, 8 breast cancers, 8 strokes, and 8 pulmonary emboli. On the positive side, there were 6 fewer colorectal cancers and 5 fewer hip fractures.

    These …

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