Interesting. I retrieved the September 1993 BCMJ issue on menopause, edited by Dr Tim Rowe. The cover illustration is a drawing of a grey-haired woman in a dowdy dress cooling off at an open window. Autumn leaves blow around her. I do not think women are content with that image today! In that issue were letters and editorials on topics such as walk-in clinics, long waiting lists, bed and hospital closures, and the practice of alternative medicine. Little has changed. On the topic of menopause were articles on osteoporosis, women’s attitudes, and HRT and the heart. The last was contributed by the late Dr William Vlahos, whom we certainly miss.

Our understanding of the menopause and the value of hormone therapy has been undergoing some change, especially in the area of heart disease. It had been accepted, until the results of the HERS study were available, that there was definite benefit to HRT use in the prevention of cardiovascular disease. From Dr Hammell’s article in Part 1 [10] of this series, the lack of clarity is apparent. What else do we not know about hormone therapy?

The main purpose of our patients’ visits to discuss their perimenopausal symptoms is to help them decide whether to use hormone therapy. This certainly must be individualized, and I hope the following articles will help you educate your patients so they can make an appropriate decision.

If you have particular interest in the subject of the menopause, I recommend that you become acquainted with the North American Menopause Society; their web site is at www.menopause.org [11].

—Vera Frinton, MD, FRCSC 
Clinical Professor 
Faculty of Medicine, University of British Columbia