To improve the quality of healthcare for women, authors Winnifred Cutler, Ph.D. and Elizabeth Genovese-Stone, M.D. offer recommendations to the general practitioner and internist readership, based on scholarly review of significant studies through August 1998, citing 250 references.

In the monograph, the authors evaluate the current research on:

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Excerpts of interest from the monograph Disease-a-Month:
• 1.  The seven years before menopause have recently been revealed to be an extremely complex era.  During this period, some women increase their estrogen levels to new lifetime highs; others start an unequivocal decline, and still others vary from month to month.  Coupled to this variability in estrogen is an equally variable set of changes in progesterone secretion by the ovary as androgen secretion patterns also change.  Many women show increases in circulating androgens while many others show deficiencies.  Both the adrenal and the ovarian sources of these hormones show age-related changes that alter a woman's capacity to attract sexual attention through both her physical appearance (and condition) and her pheromonal excretions. 
  
  
• 2.  Each of the known ovarian and adrenal steroid sex hormones plays numerous roles in maintaining the harmonious workings of the entire self.  Studies of post-40 year old women on HRT have been reviewed to assess the benefits and risks of various regimens.  Given diverse regimens of both natural and synthetic hormones, physicians should consider results of each study as specific to the type and pattern of hormone use and only generalize with caution.  Nonetheless, our analysis of the literature does reaffirm the intuitively obvious idea that HRT succeeds best, the more closely it approximates the structurally human components and "natural" cycle.
  
  The harmonic nature of the fertile reproductive system forms the background against which HRT can be understood to best serve women.  Not all hormonal replacement therapies and wellness regimens serve women well.  Some regimens have the potential to produce disease, especially over-the-counter remedies like dehypdroepiandrosterone and the formulas that contain estrogen.  Some regimens profoundly improve the quality of life for many women. Some women do not need or want such regimens.  All sex hormones affect physiologic systems including the cardiovascular system, bone metabolism, cognitive function, sexual response, and sexual attractiveness.
  
  
• 3.  The complex contributions to the overall health of a woman may not always be understood.  Often a hysterectomy can exacerbate- rather than ameliorate- the conditions that led to the surgery.  One in 2 American women is offered a hysterectomy, a rate 5 times higher than that of the European countries for which data are available.  Ninety percent of hysterectomies are not related to cancer; they are elective procedures.  Avoidance of elective hysterectomy helps prevent its side effects: sexual deficits, acceleration of cardiovascular and bone disease, and more rapid aging.  No efficacy data exist that suggest that elective hysterectomy works better than the alternative approaches that do not induce these side effects.
  
  When the cervix is retained, a procedure more common in Europe than the United States, there seems to be a retention of some of the sexual sensory pleasures that both the woman and her partner used to experience before surgery.  The health and well-being of women who have already had hysterectomies, with or without ovariectomies, can be improved by a recognition of the cascade of difficulties that must be addressed.  Estrogen, progesterone, and androgens all tend to be compromised by hysterectomy; all should be considered for replacement.

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  The entire 120 page monograph includes 250 references and is available for purchase through Athena Institute.

  Available in paperback only. $18.50