WHI Study Details: Initially, design allowed women with a uterus to be randomized to receive estrogen only.

But after Postemenopausal Estrogen/Progestin Intervention trial results, changed protocol so that women with uterus were randomized to either estrogen/progestin or placebo only. Follow-up: contacted 6 weeks after randomization to assess sx. Reassess every 6 months thereafter. Annual mammograms and breast exams. ECG done at 3 and 6 yrs. Outcomes CV: CHD was defined as acute MI requiring overnight hospitalization, silent MI from ECGs, or CHD death Cancer: breast, colorectal, endometrial cancers confirmed via pathology reports. Fractures: hip, vertebral, osteoporotic fractures recorded. Rate of CHD events increased by 29% for estrogen + progestin compared to placebo. Most of these CHD events due to nonfatal MI. Stroke rates also higher in women on estrogen/progestin 41% increase. Venous thromboembolism events (DVT and PE) rates also higher in estrogen/progestin group Total CHD events was increased by 22% in estrogen/progestin group Breast Cancer: 26% increase in estrogen/progestin group Colorectal cancer was reduced by 37% Endometrial cancer incidence was not affected??? Fractures: reduced by 24% with estrogen/progestin vs placebo.
JAMA. 2002;288(3):321-333. doi:10.1001/jama.288.3.321

Writing Group for the Women's Health Initiative Investigators. 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(3):321-333. doi:10.1001/jama.288.3.321

w/ hysterectomy
The Women's Health Initiative Steering Committee*. Effects of Conjugated Equine Estrogen in Postmenopausal Women With Hysterectomy: The Women's Health Initiative Randomized Controlled Trial. JAMA.2004;291(14):1701-1712. doi:10.1001/jama.291.14.1701. 1. Louden K. Bupivacaine Injection Reduces Menopausal Hot Flashes by 50%. Medscape [serial online]. Available at http://www.medscape.com/viewarticle/812669. Accessed October 21, 2013.

Coney, P. MD Menopause. Medscape (serial online). Available at http://emedicine.medscape.com/article/264088-overview#showall. Accessed December 1, 2013.

http://www.uptodate.com/contents/clinical-manifestations-and-diagnosis-ofmenopause?source=search_result&search=menopause&selectedTitle=1~150