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August 11, 2004

Effects of Estrogen-Only Treatment in Postmenopausal Women

Author Affiliations

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2004;292(6):683. doi:10.1001/jama.292.6.683-c

To the Editor: In contrast to their current report, the WHI investigators1 previously reported that the use of estrogen-plus-progestin increased the risk of breast cancer.2 More than 40% of women who received unopposed estrogen had had their ovaries removed. The ovaries continue to produce hormones well after menopause, albeit at lower levels.3 Supplemental estrogen after oophorectomy may be beneficial in that it helps replace physiological levels, whereas extra estrogen given to women who already have physiologically normal levels of estrogen, given their age, is additive and may be harmful. Thus, the authors should have analyzed these 2 groups separately.