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S Health and Menopause National Heart, Lung, and Blood Institute Office of Research on Women’s Health Giovanni Lorenzini Medical Science Foundation I NTERNATIONAL P OSITION P APER on W OMEN’ S H EALTH AND M ENOPAUSE: ACOMPREHENSIVE A PPROACH NATIONAL INSTITUTES OF HEALTH I NTERNATIONAL P OSITION P APER on W OMEN’ S H EALTH AND M ENOPAUSE: ACOMPREHENSIVE A PPROACH NATIONAL HEART, LUNG, AND BLOOD INSTITUTE OFFICE OF RESEARCH ON WOMEN’S HEALTH NATIONAL INSTITUTES OF HEALTH AND GIOVANNI LORENZINI MEDICAL SCIENCE FOUNDATION NIH PUBLICATION NO. 02-3284 JULY 2002 CHAIRS AND EDITORS Chair and Editor Cochair and Coeditor Nanette K. Wenger, M.D. Claude J. M. Lenfant, M.D. Professor of Medicine (Cardiology) Director Emory University School of Medicine National Heart, Lung, and Blood Institute Atlanta, GA, U.S.A. National Institutes of Health Bethesda, MD, U.S.A. Cochair and Coeditor Rodolfo Paoletti, M.D. Cochair and Coeditor Professor of Pharmacology Vivian W. Pinn, M.D. Director, Department of Pharmacological Sciences Associate Director for Research on University of Milan Women’s Health Milan, Italy Director, Office of Research on Women’s Health National Institutes of Health Bethesda, MD, U.S.A. PANEL MEMBERS Elizabeth Barrett-Connor, M.D. Louise A. Brinton, Ph.D. Professor and Chief Chief, Environmental Epidemiology Branch Division of Epidemiology National Cancer Institute Department of Family and Preventive Medicine National Institutes of Health University of California, San Diego School of Bethesda, MD, U.S.A. Medicine La Jolla, CA, U.S.A. Aila Collins, Ph.D. Associate Professor Martin H. Birkhäuser, M.D. Psychology Section Professor Department of Clinical Neuroscience Division of Gynecological Endocrinology Karolinska Institute Department of Obstetrics and Gynecology Stockholm, Sweden University of Bern Bern, Switzerland II Peter Collins, M.D. Susan Hendrix, D.O. Reader and Honorary Consultant Cardiologist Associate Professor Imperial College School of Medicine and Royal Division of Gynecology Brompton Hospital Department of Obstetrics and Gynecology London, United Kingdom Wayne State University School of Medicine Hutzel Hospital Pier Giorgio Crosignani, M.D. Detroit, MI, U.S.A. Professor and Chairman First Department of Obstetrics and Gynecology Carlo La Vecchia, M.D. University of Milan Head, Laboratory of Epidemiology Milan, Italy Mario Negri Institute for Pharmacological Research Lorraine Dennerstein, A.O., M.B.B.S., Ph.D., Professor of Epidemiology D.P.M., F.R.A.N.Z.C.P. University of Milan Professor and Director Milan, Italy Office for Gender and Health Department of Psychiatry Robert Lindsay, M.D., Ph.D. University of Melbourne Chairman of Medicine Royal Melbourne Hospital Helen Hayes Hospital Parkville, VIC, Australia Professor of Clinical Medicine College of Physicians and Surgeons Bruce Ettinger, M.D. Columbia University Senior Investigator New York, NY, U.S.A. Division of Research Kaiser Permanente Medical Care Program Adriana Maggi, Ph.D. Oakland, CA, U.S.A. Professor of Biotechnology and Pharmacology Director, Molecular Pharmacology Laboratory Jan-Åke Gustafsson, M.D., Ph.D. Department of Pharmacological Sciences Professor and Chairman University of Milan Department of Medical Nutrition Milan, Italy Chairman, Department of Biosciences Karolinska Institute Joan A. McGowan, Ph.D. Novum, Huddinge University Hospital Director, Musculoskeletal Diseases Branch Huddinge, Sweden National Institute of Arthritis and Musculoskeletal and Skin Diseases Victor W. Henderson, M.D., M.S. National Institutes of Health Professor Bethesda, MD, U.S.A. Departments of Geriatrics and Neurology Donald W. Reynolds Center on Aging Alzheimer’s Disease Center University of Arkansas for Medical Sciences Little Rock, AR, U.S.A. III Anne McTiernan, M.D., Ph.D. Susan M. Resnick, Ph.D. Associate Member Investigator Public Health Sciences Division Cognition Section Fred Hutchinson Cancer Research Center Laboratory of Personality and Cognition Research Associate Professor National Institute on Aging Department of Epidemiology National Institutes of Health University of Washington Schools of Medicine and Baltimore, MD, U.S.A. Public Health and Community Medicine Seattle, WA, U.S.A. Jacques E. Rossouw, M.D. Acting Director, Women’s Health Initiative Maryann Redford, D.D.S., M.P.H. National Heart, Lung, and Blood Institute Director, Clinical Trials and Epidemiologic National Institutes of Health Studies Program Bethesda, MD, U.S.A. National Institute of Dental and Craniofacial Research Sherry Sherman, Ph.D. National Institutes of Health Director, Clinical Endocrinology and Bethesda, MD, U.S.A. Osteoporosis Research National Institute on Aging National Institutes of Health Bethesda, MD, U.S.A. NONPANEL COAUTHORS Janet R. Guthrie, Ph.D., M.Sc. Stefan Nilsson, Dr. Med. Sci. Research Fellow Associate Professor Office for Gender and Health Affiliated to Department of Medical Nutrition Department of Psychiatry Karolinska Institute Faculty of Medicine, Dentistry, and Novum, Huddinge University Hospital Health Sciences Huddinge, Sweden The University of Melbourne Parkville, VIC, Australia Nanette Santoro, M.D. Division Director Barbara E. K. Klein, M.D., M.P.H. Division of Reproductive Endocrinology Professor of Ophthalmology and Visual Sciences Department of Obstetrics, Gynecology, and Ocular Epidemiology Women’s Health University of Wisconsin-Madison Albert Einstein College of Medicine Madison, WI, U.S.A. Bronx, NY, U.S.A. IV WITH APPRECIATION FOR THE EXPERTISE OF THE FOLLOWING, WHO GRACIOUSLY REVIEWED AND COMMENTED ON THE PRELIMINARY INDIVIDUAL CHAPTERS: Beth Alder, Ph.D. Silvia Franceschi, M.D. Professor and Director of Research Chief, Unit of Field and Intervention Studies Faculty of Health and Life Sciences International Agency for Research on Cancer Napier University Lyon Cedex, France Edinburgh, United Kingdom Ulysses J. Gaspard, M.D., Ph.D. Gloria A. Bachmann, M.D. Professor and Chief Professor Service of Gynecology Department of Obstetrics and Gynecology University Center of Liege Robert Wood Johnson Medical School Liege, Belgium University of Medicine and Dentistry of New Jersey Anna Glasier, M.D., Ph.D. New Brunswick, NJ, U.S.A. Consultant and Director Family Planning and Well Woman Services Linda Cardozo, M.D. Lothian Primary Care Professor of Urogynecology Edinburgh, United Kingdom Department of Obstetrics and Gynecology King’s College Hospital Elina Hemminki, M.D., Ph.D. London, United Kingdom Research Professor National Research and Development Centre for Sir Richard Doll Welfare and Health, STAKES Emeritus Professor of Medicine Helsinki, Finland Clinical Trial Service Unit and Epidemiology Study Unit (CTSU) Myra S. Hunter, Ph.D. University of Oxford Department of Psychology Harkness Laboratory St. Thomas Hospital Oxford, United Kingdom London, United Kingdom Timothy M. M. Farley, Ph.D. Won-Whe Kim, M.D. Epidemiological Research Professor Special Programme of Research Department of Obstetrics and Gynecology Development and Research Training in Human Pusan National University School of Medicine Reproduction Pusan, Korea Department of Reproductive Health and Research World Health Organization Britt-Marie Landgren, M.D., Ph.D. Geneva, Switzerland Professor Department of Obstetrics and Gynecology Marcha Flint, Ph.D. Huddinge University Hospital Department of Anthropology Stockholm, Sweden Montclair State University Upper Montclair, NJ, U.S.A. V Lenore Manderson, Ph.D. Henri Rochefort, M.D., Ph.D. Director and Professor Hormones and Cancer Unit Key Centre for Women’s Health in Society INSERM U540 Faculty of Medicine, Dentistry, and Montpellier, France Health Sciences The University of Melbourne Giuseppe Rosano, M.D., Ph.D. Carlton, VIC, Australia Institute of Cardiology San Raffaele del Monte Tabor Hospital Olav Meirik, M.D., Ph.D. Rome, Italy Senior Research Associate Chilean Institute of Reproductive Medicine Raymond Rosen, Ph.D. Providencia, Santiago, Chile Robert Wood Johnson Medical School Department of Psychiatry Daniel R. Mishell, Jr., M.D. Piscataway, NJ, U.S.A. Lyle G. McNeile Professor and Chairman Department of Obstetrics and Gynecology Karin Schenck-Gustafsson, M.D., Ph.D. Keck School of Medicine Associate Professor, Department of Cardiology University of Southern California Director, Women’s Health Center Los Angeles, CA, U.S.A. Karolinska Institute Stockholm, Sweden Bert O’Malley, M.D. Department of Molecular and Cellular Biology Peter Schmidt, M.D. Baylor College of Medicine National Institute of Mental Health Houston, TX, U.S.A. National Institutes of Health Bethesda, MD, U.S.A. Bent Ottesen, M.D. Department of Obstetrics and Gynecology Ethel Siris, M.D. Hvidovre Hospital Madeline C. Stabile Professor of University of Copenhagen Clinical Medicine Copenhagen, Denmark Director of the Toni Stabile Osteoporosis Center Columbia University David Purdie, M.D. New York, NY, U.S.A. Centre for Metabolic Bone Disease Hull Royal Infirmary Sven O. Skouby, M.D. Hull, United Kingdom Professor, D.M.Sc. Department of Obstetrics and Gynecology Lawrence G. Raisz, M.D. Frederiksberg University Hospital Program Director Copenhagen, Denmark General Clinical Research Center University of Connecticut Health Center Leon Speroff, M.D. Farmington, CT, U.S.A. Department of Obstetrics and Gynecology Oregon Health Sciences University Portland, OR, U.S.A. VI John C. Stevenson, M.B.B.S. Cornelia Van Duijn, M.D. Endocrinology and Metabolic Medicine Department of Epidemiology and Biostatistics Mint Wing, St. Mary’s Hospital Erasmus University Medical School London, United Kingdom Rotterdam,
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