Stephen J.LurieMD, PhD, Senior Editor
In Reply: We agree with Dr Cooper that the results of the WHI do not necessarily apply to women experiencing early natural menopause because the study included only women aged 50 to 79 years. However, the evidence regarding her suggestion that women undergoing early natural menopause may be at increased risk of cardiovascular disease is not clear. As Cooper points out, one study found an association between early age at menopause and increased risk for cardiovascular mortality.1 A later report from the Nurses' Health Study (and involving 1 of us, G.A.C.) found that this association was confined to current smokers; there was no increased cardiovascular risk among women who experienced early natural menopause but never smoked.2 The association Cooper writes of therefore may be due to residual confounding by smoking, a behavior well known to be associated with both increased cardiovascular risk and early menopause and a behavior amenable to treatment.
Fletcher SW, Colditz GA. Hormone Replacement Following Early Menopause—Reply. JAMA. 2002;288(22):2825. doi:10.1001/jama.288.22.2825-JLT1211-2-2