Stephen J.LurieMD, PhD, Senior Editor
To the Editor: In the WHI study,1 as in previous observational studies, the dose of 0.625 mg/d of Premarin or its equivalent has been chosen—a "one size fits all" approach irrespective of the patient's age or weight. This dose, the usual one chosen to treat women with hot flashes in early menopause, often causes breast tenderness and, when combined with progestin, vaginal bleeding and unpleasant effects on mood; thus, it would not seem to be appropriate for elderly women who are not experiencing hot flashes. Surely it is not surprising that there should be an increase in the incidence of strokes and cardiac events caused by giving 2 drugs that are both known to increase the incidence of thromboembolism at high doses.
Pearson Murphy BE. Risks of Postmenopausal Hormone Replacement. JAMA. 2002;288(22):2820. doi:10.1001/jama.288.22.2820-JLT1211-1-3