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In Reply: Dr Scarabin and colleagues raise the possibility that transdermal and oral estrogens differ in their association with venous thrombosis. In their case-control study of venous thromboembolism, 30 cases and 93 controls used transdermal estrogen, and no association of transdermal therapy with thrombosis was found.¹ This study, as well as all others addressing this question, included only hospitalized women with idiopathic thrombosis and without a history of coronary heart disease and other illnesses. The 3 other published studies had small numbers of users, but all suggested a 2-fold increased thrombosis risk with transdermal estrogen.^2-4

We maintain that the data on transdermal estrogen and thrombosis risk are inconclusive. Given that millions of women might want to use transdermal therapy for treatment of menopausal symptoms, data from large studies on the safety of transdermal therapy are indeed needed. At present, we lack sufficient evidence that transdermal estrogen is a safe . . . [Full Text of this Article]

Mary Cushman, MD, MSc
mary.cushman@uvm.edu
University of Vermont College of Medicine
Burlington

Ross Prentice, PhD
Fred Hutchinson Cancer Research Center
Seattle, Wash

Bruce M. Psaty, MD, PhD
University of Washington
Seattle

Frits R. Rosendaal, MD, PhD
Leiden University Medical Center
Leiden, the Netherlands

for the WHI Investigators

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