Replacement Therapy · Episode 7 of 8 · 22 min
The Twenty-Four Year Detour
On July 9, 2002 the Women's Health Initiative stopped its estrogen-plus-progestin arm early, and for eight days the public had the headline but not the paper. A 26 percent rise in breast cancer meant roughly four cases per thousand women becoming five. Use fell by nearly half, mostly among younger women the trial never studied. Later work on timing, route and progestogen type corrected the picture.
Who's who
- JoAnn E. MansonPrincipal WHI investigator; lead author of 2017 and 2024 papers
Where it happens
- United States+16 more episodesWhere hormone therapy use fell by nearly half after 2002
Timeline
- 1993The Women's Health Initiative begins enrolling women, through 1998
- July 9, 2002Estrogen-plus-progestin arm stopped early; press conference held
- July 17, 2002The JAMA paper appears, eight days after the headline
- 2004The estrogen-alone arm is stopped, with breast cancer trending down
- 2017Eighteen-year mortality follow-up published in JAMA
- 2022Menopause Society position statement favors treating symptomatic women under 60 within ten years of menopause
Still debated
Whether early hormone therapy protects the heart is still argued; the Danish study's cardiovascular result was not pre-specified. The progestogen-type contrast on breast cancer comes from observational data only, and the prescribing-drop figures are approximate.