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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

Eye opener for menauposal women on HRT

Dear Editor

I read the article entitled: "Transdermal and Oral Hormone
Replacement Therapy and Risk of Stroke: a nested case-control study", with
great professional and personal interest. As a practicing nurse and member
of the menopausal woman community in a developing country like South
Africa the article was very significant. In South Africa we are
increasingly seeing younger women some in the mid-forties to early fifties
suffering from stroke.

The findings of this study are interesting; the increased risk of
stroke associated with the oral use of HRT and with use of high dose
transdermal HRT (patches) compared with no use is something that
stimulates thinking. In South Africa the majority of women are dependent
on public (state) women health and/or gynaecological care. In many cases
they consult with a general practitioner rather than a specialist
gynecologist. The most likely form of HRT to be prescribed is the oral
formulation despite evidence of high risk for stroke. Unfortunately,
unlike developed nations, often times the availability of Evidence Based
Information is not easily accessible to clinicians in resource poor

Further, a significantly smaller proportion of women in South Africa
have medical insurance which affords them private and specialist care. In
my experience more and more women are placed on the transdermal HRT for
prolonged periods of time. It will be an oversight for me to conclude that
the high number of women diagnosed with stroke at a relatively younger age
among the affluent group in South Africa today is associated with
prolonged transdermal HRT. However, there is an urgent need for health
researchers in South Africa to investigate the influence of the route of
administration of HRT and the dosage on the risk of stroke diseases.

Lastly I want to commend the researchers for a very rigorous research
methodology and for explicitly reporting the steps that were followed in
the study.

Competing interests:
None declared

Competing interests: No competing interests

07 June 2010
Annette M Ntswane
Nurse Lecturer
University of the Witwatersrand, Johannesburg, 2093