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Gambone • How we got to the Women’s Health Initiative trial A menopause, defined as the last menstrual period, is an integral and normal physiologic event in a woman’s life, it represents a sudden and dramatic change in reproductive capability, health risks, and self-image. The perimenopause (the 3 to 5 years before and after menopause) is characterized by symptoms of estrogen deficiency, such as hot flashes, mood swings, insomnia, and difficulty concentrating. The postmenopausal period is associated with increases in more serious health risks, including osteoporosis, cancer, and cardiovascular disease. As with many women’s health issues, however, menopause traditionally has been poorly understood. Although publications as early as the sixth century noted the characteristic onset of menopause during a woman’s middle age,1 philosophic explorations frequently lacked such simple acumen. As recently as the latter half of the 20th century, authors set menopause in stark terms. In the popular book Feminine Forever,2 Wilson described menopause as “the death of womanhood.” Menopause, he said, often destroyed a woman’s “character as well as her health”

How we got to the Women's Health Initiative hormone replacement trial