Intended for healthcare professionals


Reassurance for many healthy women considering HRT

BMJ 2017; 359 doi: (Published 13 October 2017) Cite this as: BMJ 2017;359:j4652
  1. Chrisandra Shufelt, professor1,
  2. C Noel Bairey Merz, professor1
  1. 1Barbra Streisand Women’s Heart Center, Cedars-Sinai Heart Institute, Los Angeles, California, USA
  1. Correspondence to: C Shufelt Chrisandra.shufelt{at}

But individual assessment of risk benefit balance remains essential

Many women remain fearful of using menopause hormone therapy because of concerns about the risk of heart attack, stroke, and breast cancer. These concerns were prompted by the two Women’s Health Initiative (WHI) clinical trials that were stopped early in 2002 and 2004. In the first trial women who took conjugated equine oestrogen and medroxyprogesterone had an increased incidence of heart attacks, strokes, and breast cancer compared with those taking placebo.1 The second trial in women with a hysterectomy found an increased incidence of stroke and venous thromboembolism in those treated with conjugated equine oestrogen compared with the placebo group but no increased risk of breast cancer.2 Neither trial reported an increase in total mortality among actively treated women compared with placebo (hazard ratio 0.98 (95% confidence interval 0.82 to 1.18) for the oestrogen plus progestin trial and 1.04 (0.88 to 1.22) for the oestrogen trial).12

The results sent shock waves through affected patient and healthcare communities. Prescriptions for hormone therapy, …

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