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Estrogen replacement therapy: new options, continuing concerns.

To the Editor. —The articles by Dr Speroff and colleagues 1 and the Writing Group for the Postmenopausal Estrogen/ Progestin Intervention (PEPI) Trial 2 address a number of relevant issues regarding postmenopausal hormone replacement therapy (HRT) and lend additional weight to the growing body of evidence that suggests that continuous combined estrogen-progestin therapy may be the optimal regimen for HRT in women with an intact uterus. The Editorial by Dr Insogna and colleagues 3 further states that the data from the Postmenopausal Estrogen/Progestin Interventions (PEPI) trial and the Continuous Hormones as Replacement Therapy (CHART) study suggest that continuous conjugated equine estrogen-medroxyprogesterone acetate (CEE-MPA) is superior to continuous norethindrone acetate—ethinyl estradiol (NA-EE 2 ) in terms of effect on lipid profile. By highlighting key findings in the 2 studies, the Editorial provides useful direction for clinical decision making. However, both the Editorial's authors and The Journal's editors appear to have ignored disturbing