The menopause in perspective. From potions to patches

This article attempts to survey our current understanding of the human female climacteric and the role of hormone replacement in its treatment. As a potential endocrinopathy, the climacteric deserves appropriate diagnostic recognition and selective preventive pharmacotherapy. The impact of sometimes conflicting influences such as nutritional, dietary or lifestyle changes, exercise, smoking, drugs, alcohol and other medications, all need differentiation from true hormonal responses. The climacteric, one syndrome occurring over a period of time, has potentially lethal effects, notably coronary heart disease and complications of osteoporotic fractures. However, therapy itself carries major problems, the cancer question being the most important. The dilemma of risk-benefit planning is reviewed and likely future developments are outlined. The role of the new North American Menopause Society is explained.