GYN TRIAD
Limitations of WHI
Women with prominent vasomotor symptoms, the most common reason for initiating HT, were
excluded from the study.
The mean age of 63 was 10 years past the age that most women begin HT, thus missing the
“window of opportunity” immediately after menopause.
The same hormone dose was used in both older and younger women.Estrogen therapy continues to be the most effective and FDA-approved
method for relief of menopausal vasomotor symptoms (hot flashes), as well as
genitourinary atrophy and dyspareunia.
The Women’s Health Initiative (WHI) study of the National Institutes of
Health (NIH) studied 27,000 postmenopausal women with mean age 63.
These included women with a uterus on hormone therapy (HT), both estrogen
and progestin, and hysterectomized women on estrogen therapy (ET) only.
Table II-12-5. Critique of Women’s Health Initiative StudyExcludes patients with vasomotor symptoms
Primary indication for hormone replacement
Mean patient age was 63 years
Missed the 10-year “window of opportunity”
Same dose of hormone for all ages
Older women don’t need as a high dose as do younger women
Patients were not all healthy
Hypertension (40%), ↑ cholesterol (15%), diabetes mellitus (7%), myocardial infarction (3%)Benefits: Both HT and ET groups in WHI had decreased osteoporotic
fractures and lower rates of colorectal cancer.
Risks: Both HT and ET groups in WHI were found to have small increases in