Impact of WHI conclusions and ACOG guidelines on clinical practice

This past July, the community of physicians practicing obstetrics/gynecology and women's medicine was startled by a paper in the Journal of the American Medical Association, which reported data from one arm of the Women's Health Initiative (WHI). The major finding was that the group of subjects undergoing treatment with combined HRT in the form of Prempro (0.625 mg/day conjugated equine estrogens (CEE) + 2.5 mg/day medroxyprogesterone acetate) was found to have increased risk of breast cancer and no apparent cardiac benefit. Although several benefits were considered, the likely result to be realized by 8 years, interim findings by the study's safety committee at 5 years were deemed sufficiently troubling to stop this arm of the trial at 5.2 years. Reaction was mixed. This paper places findings into a clinical perspective and considers their effect on the practice guidelines of relevant professional organizations.