A Modern Approach to the Perimenopausal Years

Contents 6
Opening remarks 8
Prologue 10
Some aspects of oogenesis, follicular growth, and endocrine involution 18
1. Physiology and pathophysiology of the perimenopausal years 18
The climacteric syndrome 46
Skin and the menopause 64
Osteoporosis: occurrence and diagnosis 76
Lipids, hormonal status and the cardiovascular system in the postmenopause 84
Psychosocial aspects in the perimenopause 94
The bladder in the menopausal woman 100
Discussion 110
The influence of nutrition and exercise 116
2.1. General aspects 116
Non-hormonal medication 124
Discussion 133
2.2. Hormonal treatment 136
Selection of patients — kind and duration of treatment 136
Routes of estrogen administration 148
2. Management of the climacteric patient 151
Sex steroids and lipoproteins 156
Discussion 160
2.3. Risk-benefit evaluation of hormonal therapy 164
Prospective study on long term risk of hormone replacement therapy 164
Long-term metabolic effects of estrogen therapy 170
Hormonal replacement therapy and breast cancer 184
Prevention of endometrial abnormalities 196
Estrogen/progestogen as a prophylactic treatment of postmenopausal osteoporosis 214
Discussion 220
Management of the premenstrual syndrome 228
2.4. Special aspects in premenopausal women 228
Contraception in premenopausal age 240
Discussion 256
Closing remarks 258
Epilogue 260
List of contributors 262

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