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. Results from a Japanese cohort also suggested that women who underwent meno- pause before 40 years of age were more likely to have an IS than those with menopause between 50 and 54 years of age after adjustment for age and risk factors (RR, 2.57; 95% CI, 1.20 5.49); however, findings appeared to be largely driven by women with surgical menopause.242 A case-control study conducted in Spain found no association between menopause at <53 years of age and the odds of noncardioembolic stroke after accounting for age and risk factors.243 In the review by Rocca et al,238 7 observational cohort stud- ies were summarized to determine whether early or premature menopause is associated with stroke. The findings from 3 of the studies not yet discussed previously are briefly summarized.244 Using data from the Nurse s Health Study, Parker et al245 found that after multivariable adjustment, women with hysterectomy with bilateral oophorectomy had a slightly elevated risk of total stroke compared with women with hysterectomy with ovarian conservation (HR, 1.14; 95% CI, 0.98 1.33), and this associa- tion did not reach significance. 