Pramil N. Singh, DrPH
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
Singh PN. Hormone Replacement Therapy in Postmenopausal U.S. Women. Ann Intern Med. 1999;131:791. doi: 10.7326/0003-4819-131-10-199911160-00019
Download citation file:
Published: Ann Intern Med. 1999;131(10):791.
TO THE EDITOR:
I read with interest the article by Keating and colleagues (1), who reported that in a random sample of U.S. adults, women with diabetes mellitus were less likely to have been prescribed hormone replacement therapy (HRT)—findings that, as the authors indicate, are concordant with data from a large patient population in Canada (2).
When we consider a possible interpretation for this apparent “undertreatment” of postmenopausal women with diabetes mellitus, it is noteworthy that a sizable proportion of these diabetic women would be obese or overweight. There are several possible explanations for why obese postmenopausal women seem to be “undertreated” with HRT. First, because the adipose tissue becomes the primary source of endogenous estrogens after menopause, obese women probably enter menopause with a higher level of endogenous estradiol than their leaner peers and therefore may present with fewer symptoms of menopause that would prompt a physician to prescribe HRT. Data supporting a lower incidence of menopausal effects (such as hot flashes or lower bone density) among heavier women were recently reported (3, 4). In addition, physicians may intentionally withhold estrogen replacement therapy among clinically obese postmenopausal women as a preventive measure against hormone-related cancer.
Learn more about subscription options.
Register Now for a free account.
Copyright © 2016 American College of Physicians. All Rights Reserved.
Print ISSN: 0003-4819 | Online ISSN: 1539-3704
Conditions of Use
This PDF is available to Subscribers Only