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EDITORIALS: Deborah Grady and Elizabeth Barrett-Connor Postmenopausal hormone therapy BMJ 2007; 334: 860-861 [Full text]

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calcium supplements in the perimenoausal period

Angela L Salter   (9 May 2007)

Inappropriate illustration

Mary Seed   (15 May 2007)

calcium supplements in the perimenoausal period 9 May 2007
Angela L Salter, General practitioner Bere Regis BH20 7HB Send response to journal: Re: calcium supplements in the perimenoausal period	As a GP I have recently observed that calcium supplements taken in the perimenopausal period appear to reduce both hot flushes and other menopausal symptoms. I would be grateful if anyone knows of any study of this as I cannot find any and indeed hope to do one myself. I assume that as oestrogen promotes the absorbtion of calcium from the gut that the absorption of dietary calcium declines with declining oestrogen levels. The symptoms of the 'hot flush' are very similar to hyperthyroidism except for normal measured thyroid function. I assume that the 'hot flush' occurs when there is a normal calcium level either through dietary intake or increased parathyroid hormone in the early morning promoting renal reabsorbtion and is due to T4 (thyroxine) being metabolised to the active T3(tri-iodothyronine). If extra calcium is ingested on a regular basis then the thyroid hormone is metabolised more regularly. As it is now not considered such a good idea to prescribe hormone replacement therapy so widely perhaps we should instead look at early calcium supplementation which may also have a longer lasting effect on preventing osteoporosis if continued into old age. Yours sincerely Angela Salter Competing interests: None declared
Inappropriate illustration 15 May 2007
Mary Seed, Consulting Physician Charing Cross Hospital, London W6 8RF Send response to journal: Re: Inappropriate illustration	I was dismayed to see the illustration chosen to accompany the editorial by Grady and Barrett-Connor (1). Their paper discussed the recent reassessment by the North American Menopause Society of data from the Womens Health Initiative, in which the HRT treatment arm was oral conjugated equine oestrogen, with or without oral medroxy progesterone acetate, and an increase in venous thrombotic events was observed. The photograph of the application of a transdermal patch was particularly inappropriate as there is no increase in VTE with such preparations due to the lack of the hepatic first pass effect (2). The metabolic effect of sex steroids, including HRT, is dependent on route of administration; transdermal preparations avoid a number of the unwanted metabolic effects found with oral therapy. In the same issue there was a short report on a recently published study, from the Million Women Study Group, of the incidence of ovarian carcinoma in long term users of HRT. I am sorry that your editorial authors did not take the opportunity to comment on the findings. References. 1. Grady D, Barrett-Connor E. BMJ 2007; 334: 860-861. 2. Canonico H, for the ESTHER Study Group. Circulation 2007; 115(7): 840- 845 Competing interests: None declared