Lessons learned from the WHI: HRT requires a cautious and individualized approach

The Women's Health Initiative (WHI) was a randomized, double-blinded, placebo-controlled study that evaluated the benefits and risks of hormone replacement therapy (HRT) for healthy postmenopausal women. The results indicated that HRT: 1) does not confer cardiovascular or cognitive protection; 2) increases breast cancer risk in women with a uterus; 3) increases stroke risk in women with hysterectomy; and 4) does not improve overall quality of life. HRT does, however, decrease fracture rates and vasomotor symptoms. Because the results were surprising in light of prior observational and animal research, the study generated enormous controversy as to how to use HRT. Our position is that long-term HRT is not appropriate for most postmenopausal women, but treatment should be individualized for each patient.