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To the Editor: We have 2 concerns about the design of the WHIMS trial.¹ First, the authors grouped a number of unrelated causes of dementia, including AD, vascular dementia, hydrocephalus, Parkinson disease, and alcohol related dementias, into a single outcome variable. It may not be valid to group all "probable dementias" into a single category for statistical analysis. While the WHIMS groups (hormone therapy and placebo) were significantly different for the incidence of probable dementia, the number of cases in the subgroups was too small to be clinically relevant.

Second, we are concerned that participants in the WHIMS trial did not begin receiving hormone therapy until age 65 years. In clinical practice, hormone therapy is usually prescribed during the early phases of menopause, which may occur 10 or more years earlier. It is not clear that the effects of hormonal therapy are identical in early menopause and in women aged . . . [Full Text of this Article]

Istvan Nyirjesy, MD; Frank S. Billingsley, MD
Department of Obstetrics and Gynecology
Georgetown University School of Medicine
Washington, DC

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