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Best practices in care for menopausal patients

16 years after the Women's Health Initiative

DeNeui, Terri DNP, ACNP, APRN-BC1; Berg, Judith PhD, RN, WHNP-BC, FAAN, FAANP, FNAP2; Howson, Alexandra MA, PhD3

Journal of the American Association of Nurse Practitioners: July 2019 - Volume 31 - Issue 7 - p 420–427
doi: 10.1097/JXX.0000000000000186
Clinical and Case Study Article

The Women's Health Initiative (WHI) was a large, randomized clinical trial funded by the National Institutes of Health to determine whether menopause hormone therapy (MHT) prevented heart disease, breast and colorectal cancer, and osteoporotic fractures in postmenopausal women. Two WHI trials were stopped early, and the findings had a profound effect on the clinical practice guidelines related to postmenopausal health. This article provides an overview of the WHI MHT clinical trials and findings, discusses the early stoppage of the trials and subsequent implications, and details the current nomenclature and treatment options for women transitioning through menopause in light of the WHI. This study is based on a comprehensive literature review and an education activity developed by the American Association of Nurse Practitioners. To best serve patients and individualize therapy, clinicians must provide the best estimate of potential risks or benefits to the individual patient. It is important to balance evidence of symptom relief with long-term risks and benefits that fit the patient's characteristics of family and personal health history. Armed with evidence to support various hormonal and non-hormonal options, well-informed clinicians can counsel women about MHT and potentially avoid negative impact on quality of life.

1EVEXIAS Medical Centers, Southlake, TX

2The University of Arizona College of Nursing, Tucson, AZ

3Thistle Editorial LLC, Snoqualmie, WA

Correspondence: Terri DeNeui, DNP, ACNP, APRN-BC, Clinical Education, 920 S Kimball Ave. Ste 100, Southlake TX 76092; E-mail:

Authors' contributions: Terri DeNeui, Judith Berg, and Alexandra Howson developed the content and edited and revised the manuscript.

Competing interests: The authors report no conflicts of interest.

Received June 20, 2018

Accepted November 26, 2018

© 2019 American Association of Nurse Practitioners
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