Measurement of BP before initiation of hormonal contraception is recommended (Class I; Level of Menopause and Postmenopausal HT Menopause Onset Exposure to endogenous estrogen has been hypothesized to be protective for stroke in premenopausal women; however, given logistical difficulties in collecting longitudinal data on endogenous hormones and the large sample sizes that would be required to study stroke in younger women, no study has investigated the relationship between endogenous hor- mones and stroke as women transition through menopause. The association between onset of menopause and stroke risk has been the subject of 2 recent reviews, one focusing on the association of age at menopause and stroke risk and the other focusing on the association of premature or early meno- pause and stroke risk.237,238 In the first review by Lisabeth and the authors concluded that the few studies that considered the association between age at menopause and incident stroke had inconsistent findings. The findings of these studies were summarized briefly. Hu et al239 found that age at natural menopause was not associated with risk of total stroke, IS, or hemorrhagic stroke among 35616 women in the Nurse s Health Study who reported no use of HT. In a cohort study of 5731 postmenopausal Korean women who did not use HT, no association was found between age at natural menopause and risk of total stroke, IS or hemorrhagic Lisabeth et al,241 using data from the Framingham Heart Study (n=1430), found that women with natural meno- pause before age 42 years had twice the IS risk (RR, 2.03; 95% CI, 1.16 3.56) as women who had natural menopause at 42 years of age after adjustment for age, risk factors, and postmenopausal estrogen use. 