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Transdermal and oral hormone replacement therapy and the risk of stroke: a nested case-control study

BMJ 2010; 340 doi: (Published 04 June 2010) Cite this as: BMJ 2010;340:c2519

Decisions in taking post menopausal hormone replacement therapy among aging women

Dear editor,

As a budding epidemiologist and junior researcher I have been following
the studies on postmenopausal hormone replacement therapy and was pleased
at the publication of this latest article, which seeks to improve on the
information for evidence based decision to be made about postmenopausal
Hormonal therapies in aging women.

The decision for taking replacement therapy is clearly whether the risks
out-weigh the benefits. Since publications from clinical trials indicate
that postmenopausal hormonal therapy increases the risk of stroke, women
like me are struggling with the decisions of whether use of replacement
therapies will be the best decision in postmenopausal years. Although
others may contend that the results were not generalizable it is still
good scientific ground on which to stand. Menopausal years add a new
dimension to women’s health and other health related issues, therefore
there has to be continued dialogue geared towards understanding how to
arrive at the best possible remedies for an unavoidable life event.

The results then on transdermal replacement verses oral replacement,
showing that the risk differs according to the route of administration and
dose, is likened to a light at the end of the tunnel. The reductions in
the risks associated with different routes of administration have all but
eliminated the increased risk of heart disease. Understanding that
observational studies are a step towards getting much needed data from
clinical trials we look forward to more studies that will address
confounding factors that were considered in the interpretation of these
current findings. Confounding intermediate factors to be considered are
health seeking behaviors and lifestyle practices. Understanding these
factors could possibly make the consumption of such therapies better for
women who inevitably pass through this period in their lives and will no
doubt lessen the internal confusion in making informed decision towards
their health in their latter years.

Competing interests:
None declared

Competing interests: No competing interests

08 June 2010
Denese A McFarlane
Ministry of Health, Jamaica