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	Since this article does not have an abstract, we have provided the first 113 words of the full text and any section headings.

In their commentary, Kannel and Levy¹ thoroughly describe studies of the relationship between hormones, menopause, and CHD. They noted that CHD rises substantially after menopause, whether surgical or natural, and whether the ovaries were removed or not. What accounted for the low incidence of CHD before menopause remained unclear. They did not discuss whether menstrual blood loss could explain the finding.

I believe that menstrual blood loss alone could explain the protection against CHD in premenopausal women. Possible mechanisms include lowered blood viscosity, lowered blood pressure, lowered coagulopathy, or reduced body iron.

AUTHOR INFORMATION
Correspondence: Dr Terplan, Department of Medicine, University of California, San Francisco, 490 Post St, San Francisco, CA 94102 (elizterp@yahoo.com).

Martin Terplan, MD

1. Kannel WB, Levy D. Menopause, hormones, and cardiovascular vulnerability in women. Arch Intern Med. 2004;164:479-481. FREE FULL TEXT

Arch Intern Med. 2005;165:120.

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RELATED ARTICLE

Menopause, Hormones, and Cardiovascular Vulnerability in Women
William B. Kannel and Daniel Levy
Arch Intern Med. 2004;164(5):479-481.
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