The Women’s Health Initiative—A Victory for Women and Their Health

The history of medicine abounds with dogmas assumed and later overcome. Nowhere is that dynamic more evident than in women’s health. Several decades ago, menopausal hormone therapy was widely assumed to be beneficial for women, not only to relieve vasomotor symptoms, but also to reduce a woman’s risk for chronic diseases of aging, including heart disease. Observational studies suggested a slight net benefit of hormone therapy, and by the mid-1990s, at least 40% of women in the United States were prescribed hormone therapy.¹ The Women’s Health Initiative (WHI), funded by the National Institutes of Heath (NIH) with taxpayer dollars, has now set the record straight. Evidence first from the original primary end point studies published in 2002² and 2004,³ and now from the 13-year follow-up study published by Manson et al⁴ in this issue of JAMA clearly demonstrates that the hormone therapy story is far more complicated than suggested by the initial observational studies. In addition, there are many lessons to be learned about the value of publicly funded, objective, prevention-oriented clinical studies.