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To the Editor: Dr Cushman and colleagues¹ presented data from the Women’s Health Initiative (WHI) Estrogen Plus Progestin (E + P) trial and concluded that this combination was associated with increased risk for venous thromboembolism. The authors note that these results apply to the combination of oral conjugated equine estrogen (CEE) with medroxyprogesterone acetate (MPA) and are not necessarily relevant to other types of hormone therapy; they describe the association with transdermal estrogen therapy as controversial.

The Estrogen and Thromboembolism Risk (ESTHER) study showed that oral but not transdermal estrogen was associated with venous thromboembolism risk.² Three other studies reported estimates of venous thromboembolism risk among users of transdermal estrogen,³ but the results were based on few cases with transdermal estrogen use, and each study was inconclusive. Biological data support the difference in venous thromboembolism risk between oral and transdermal estrogen because randomized short-term trials have shown that oral but . . . [Full Text of this Article]

Pierre-Yves Scarabin, MD
scarabin@vjf.inserm.fr

Emmanuel Oger, MD; Tabassome Simon, MD; Geneviève Plu-Bureau, MD
Cardiovascular Epidemiology
Inserm
Paris, France

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