A more recent analysis of a Swedish cohort found that women who underwent an oophorectomy before age 50 years had an increased risk of total stroke (HR, 1.47; 95% CI, 1.16 1.87) compared with women with no hysterectomy and no oopho- Finally, in a recent analysis of data from the WHI focused on women with a history of hysterectomy (without capture of age before natural menopause), no association was found for oophorectomy versus ovarian conservation and risk of total stroke in all women (HR, 1.04; 95% CI, 0.87 1.24) or those women without a history of hormone use (HR, 1.31; 95% CI, 0.92 1.87) after multivariable adjustment.247 Menopause Onset: Summary and Gaps Results of existing studies of the association between age at menopause or premature or early menopause, whether natural or surgical, and stroke risk appear to suggest increased risk of stroke with earlier onset of menopause, although the evi- dence is not entirely consistent. Few data on the association of other surrogate markers for endogenous hormone exposures, such as lifetime estrogen exposure, duration of ovarian activ- ity, or time since menopause, and stroke risk exist. Additional studies are needed to determine the influence of the onset of menopause on stroke risk. Studies should aim to determine whether the association between menopause onset and stroke is limited to ischemic events and whether and how the type of menopause (natural or surgical) may impact this association. Postmenopausal HT Early observational evidence suggested a potential benefit of HT on cerebrovascular disease248 ; however, even as early as 2002, evidence was emerging that HT may have detrimental effects. 