In 2002, the Women’s Health Institute published a study that would draw major criticism from other members of the scientific community.  The study claimed that hormone replacement therapy (HRT) was associated with increased risk of breast cancer risk and a lack of overall benefit. In the immediate years following the publication, prescription of HRT decreased by as much as 65%. In his lecture at EMAS 2019, Dr. Robert Langer presented how this has impacted public health.
The flaws of the WHI study
The 2002 WHI study has been identified as having many flaws.
WHI looked at only one dose and type of combined HRT or estrogen only HRT
The profile of the American women in the WHI study are much older (average age 63.2) than usually expected, with this meaning higher absolute risk of stroke, heart disease and breast cancer
The dose used, was appropriate for younger menopausal women starting HRT, but too high for the older women included in the study
The majority of the women in the study were overweight (average BMI of 28.5), a recognised risk for heart disease and breast cancer
The study had high drop out rates and flawed methodology
The media response
Immediately following publication of the WHI study, there was a significant negative response from the media about HRT. Many women lost confidence in the treatment and in the years that followed, many young healthcare professionals would not be taught about the benefits of HRT for treating menopausal symptoms.
A wealth of research followed WHI which demonstrated that HRT is likely to be beneficial for many women, especially those between the ages of 50-59. The risks were far less significant as first reported by the WHI. Regardless, little media coverage has been made of these studies and the number of women using HRT remains low even today.
The public health impact
Dr. Langer explained that the public health impact of the WHI has been significant. In a study on morbidity and mortality in postmenopausal US women since the WHI, overall life expectancy has decreased since 2002. There have been 50,000 to 60,000 additional deaths since the WHI study.
Breast cancer morbidity has increased
Ischemic Heart Disease (IHD) morbidity has increased
Stroke mortality has increased
Hip fracture morbidity and mortality has stabilised
Dementia morbidity and mortality has increased
Combined mortality for all of the above has increased
For breast cancer and IHD, mortality has improved since 2002. Dr. Langer suggested that this was due to the improvements in prevention, detection and treatment over the last 17 years.
The impact on quality of life
Impact on women’s quality of life must also be considered. Many women experiencing severe menopausal symptoms may not be accessing HRT that could benefit them. HRT could assist with VMS, help prevent cardiovascular disease and support treatment of sexual dysfunction. It is important to continue to educate women and healthcare professionals, support women’s decision making and to encourage access to HRT now and in the future.
 Rossouw J. E., Anderson G. L., Prentice R. L, et al. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women's Health Initiative randomized controlled trial. Jama. 2002;288:321–33.