Despite its universality in human female aging, the menopause and its biology are not completely understood. New biologic mechanisms by which sex hormones may be detrimental or confer protection are continually being discovered.
We are now starting to understand that the role of the estrogen receptor is not identical in all tissues. Important nongenomic effects for sex hormones have also been described. Hormone replacement therapy (HRT) has produced effects on health risks: some are reduced, some are increased, and the rest remain uncertain. HRT is being used by an increasing number of women to alleviate climacteric symptoms in the perimenopausal period and to prevent osteoporosis and cardiovascular disease later. Positive effects on Alzheimer's disease and dementia on the one hand, and an increase in venous thrombosis on the other, are currently being reported by several groups. Both the preventive benefits and the risk of breast cancer seem to be linked to long-term and current use. HRT requires further testing through specific clinical trials, currently underway in the United States, before confident recommendations may be made about the full range of benefits and risks.

Inhalt
I. Menopause as a Medical and Social Issue.- The Problem of Menopause in Europe.- Menopause: Problems and Interventions in the United States.- Hormone Replacement Therapy and Oral Contraceptives: Limitations of Epidemiological Studies.- II. Ovarian Senescence.- Genetic Factors in Follicular Aging.- Premature Menopause.- When Should Hormonal Replacement Therapy Be Introduced? Associated Problems.- III. Connective Tissue and Bone.- Connective Tissue Changes.- The Effect of Low Dose Estrogen on Bone Mass in the Late Postmenopausal Years.- Perimenopausal Changes in Body Weight, Body Fat Distribution, Hormonal Replacement Therapy.- IV. Osteoporosis.- The Effects of Estrogen Receptor Gene Disruption on Bone.- Osteoporosis: Different Treatment Options.- Inherited Risk of Osteoporosis: A Piece in the Puzzle of Menopause Genetics.- Estrogen Replacement Therapy And Osteoporosis: Practical Implications Of New Research Findings.- V. Cardiovascular Risk.- HRT, Plasma Risk Factors, and Cardiovascular Disease.- Menopause, HRT, and Hemostasis.- Angina in Women.- Effect of Estrogen on Anatomical and Functional Sequelae of Coronary Artery Disease.- Cardiovascular Disease: Reduced Mortality with Long-Term HRT Treatment.- HRT and The Secondary Prevention Of Coronary Heart Disease.- VI. Vascular Biology.- Effects of Hormone Replacement Therapy on Lipids and Lipoproteins in Dyslipidemic Postmenopausal Women: A Comparison Between Transdermal and Oral Estrogen.- Which Effects Does Early HRT Have on Perimenopausal Changes in the Lipoprotein Profile, Glucose Metabolism, and Blood Coagulation-Fibrinolysis System?.- Blood Flows in Cerebral Arteries after Suspension of Postmenopausal Hormone Replacement Therapy. A Randomized Crossover Study.- Influence of Melatonin on the Internal Carotid Artery Pulsatility Index of Young and Aged Women.- VII. Cognitive Processes and Dementia in Elderly Women.- Epidemiology of Alzheimer's Disease and Other Types of Dementias.- Estrogen Replacement Therapy and Cognitive Functions in Elderly Women.- Hormonal Replacement Therapy, Cognitive Disturbances, and Alzheimer's Disease.- VIII. Central Nervous System.- Hormone Replacement Therapy in the Prevention and Treatment of Climacteric Depression.- Estrogen Across the Lifespan and Alzheimer's Disease.- Estrogen Effect on Brain Biology and Cognition.- Dysphoria and Mood Disorders in Menopause.- A Model System for the Study of Estrogen Receptor Activity in Cells of Neural Origin.- IX. Neoplasia.- The Risk of Breast Cancer in Relation to Hormone Replacement Therapy.- Potential Benefits cf Estrogen and Progestogen on Malignancy.- Hormone Replacement Therapy After Breast Cancer.- X. HRT and the Endometrium.- >Endometrial Histology: Findings from the Postmenopausal Estrogen/Progestin Interventions (PEPI) Trial.- Effects of Quarterly Hormone Replacement Therapy on Climacteric Symptoms, Endometrial Safety, and Lipoproteins.- XI. HRT: Addressing the Needs of Women and Physicians.- Individualization of Hormone Replacement Therapy.- Clinical Experiences with a Combination of Estradiol Valerate and Cyproterone Acetate for Hormone Replacement.- HRT: From Motivation to Compliance.- XII. The Overall Benefit and Safety Profile of CEE+MPA In a Continuous Sequential or Combined Regimen.- The Pharmacologic Profile of Conjugated Equine Estrogens.- Hormone Replacement Therapy with Conjugated Equine Estrogens and Medroxyprogesterone Acetate.- Bleeding Patterns and Compliance with CEE plus MPA Continuous Sequential or Combined Regimens in Postmenopausal Women.- CEE-MPA: A Relevant Reduction inCardiovascular Disease Risk.- Hormone Replacement Therapy and Breast and Gynecologic Cancers.- XIII. New Drugs and Alternative Treatment.- Raloxifene HCl: A Tissue Selective Estrogen Receptor Modifier (SERM) for Replacement Therapy in Postmenopausal Women.- Dietary Phyto-Estrogens and the Menopause.- Primary and Secondary Prevention of Cardiovascular Diseases in Menopausal Women: Alternative Treatment to Hormonal Replacement Therapy.