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Correspondence
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Volume 346:942-943 March 21, 2002 Number 12
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Estrogen-Replacement Therapy after Ischemic Stroke

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To the Editor: Viscoli et al. (Oct. 25 issue)1 report that estrogen-replacement therapy does not reduce the risk of stroke in women with a history of cerebrovascular disease. The fact that the women in this study were treated with estrogen alone, without a progestin ("unopposed estrogen"), arouses concern. The mitogenic effect of unopposed estrogen on the endometrium has been an issue of concern for decades.2 In 1995, a randomized clinical trial, the Postmenopausal Estrogen/Progestin Interventions (PEPI) trial, verified the hazards of the use of unopposed estrogen with respect to endometrial hyperplasia and hysterectomy.3 On the basis of these and other . . . [Full Text of this Article]

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