At the Mie International Symposium held in Japan in April 1994, leading scientists reviewed recent advances in the understanding of the contractile mechanism in smooth muscle. The present volume collects the papers presented at the symposium, summarizing the latest advances in smooth muscle function and emphasizing important components of the contraction-relaxation cycle. Topics include a discussion of the smooth muscle cell membrane, with emphasis on its ion channels; the regulation of cytosolic Ca2+ levels and the relationship to force in smooth muscle; aspects of the two key regulatory enzymes involved with myosin phosphorylation-dephosphorylation; the molecular basis for pharmacomechanical coupling in smooth muscle; developments in the basic contractile mechanisms involving the crossbridge cycle of tonic and phasic muscle; the role of myosin light chains; and many others. The approach is broad and presents contemporary opinions in pharmacology, physiology, and biochemistry as they relate to smooth muscle function. The book will appeal not only to those working in these disciplines, but to vascular clinicians, obstetric-gynecological physicians, and gastroenterologists as well.

It is in the surgical aspect of their specialty that the gynecologists' work may be most frequently judged by their peers or by the litigious society that currently exists. Great and commendable progress has been made over the past 30 years in the basic scientific, endocrinologic and obstetric aspects of the specialty, but this has occurred with a commen surate de-emphasis of surgical procedures and surgical training, a decline in devotion to technical detail and perfection, and a tendency to take surgery for granted. Obstetric and gynecologic residency programs provide increasing numbers of specialists with average competence in the performance of the common, rather standardized gynecologic operations. In general, technical skill in the extirpative operations can be acquired far more readily than proficiency in the art of reconstructive surgery. At present, for a number of reasons, gynecologic surgical training is most deficient in regard to the surgical correction of severe forms of obstetrically damaged genital tract supports. The operations for pro lapse defy standardization and require great technical individualization; this must be based on the surgeon's judgment developed through expe rience, a thorough understanding of normal pelvic anatomy, and recog nition of the deficiency responsible for the prolapse in individual cases.

The advent in the 1960s of the unique and exciting new form of energy called laser brought to medicine a marvelous tool that could accomplish new treatments of previously untreatable disorders as well as improved treat ment of mundane problems. This brilliant form of light energy is many times more powerful than the energy of the sun yet can be focused microscopically to spot sizes as small as 30 microns. Lasers can be directed into seemingly inaccessible areas by mirrors or fiberoptic cables or can be directly applied into sensitive areas such as the retina without damage to intervening structures. There has been a rapid proliferation in the use of lasers in all surgical specialties. Starting with bold ideas and experiments of "thought leaders" in each specialty, the application of lasers has evolved into commonplace usage. Beginning with the era when laser presentations and publications were an oddity, now nearly all specialty areas have whole sections of meetings or journals devoted exclusively to laser usage. Laser specialty societies within a specialty have developed and residency training programs routinely instruct trainees in laser techniques. Basic science and clinical experimentation has supported laser knowledge. Laser usage has also become international. Newer wavelengths and accessories have added to the armamentarium of laser usage. Despite the rapid growth in laser interest, no single source exists to instruct the many new laser users in proper, safe, and effective use of this new modality."

The hypothesis that cancer of the cervix is infectious was raised more than 150 years ago (Rigoni-Stern 1842). The first cell-free transmissions of papillomas were reported 95 years ago (McFadyan and Hobday 1898). A report of cell- free trans-mission of human warts was published in 1907 (Ciuffo). Thus, since these initial discoveries papillomavirus research has had to go a long way before it became possible to link these infections to cancer of the cervix (Durst et al. 1983; Boshart et al. 1984). Table 1 lists a selection of the publications that form the basis for our present understand- ing of the role of human pathogenic papillomaviruses (H PV) in human cancers. The identification of specific H PV types in cervical cancer in 1983, 1984 and in subsequent years substantially boosted activities in papillomavirus research. In part this is because cancer of the cervix ranks first in cancer incidence in develop- ing countries and is an important cause of cancer death in affluent societies (Parkin etal. 1984; I.A.R.C. 1989). Premalignant cervical lesions, particularly in affluent soci- eties, also contribute considerably to morbidity. Moreover, the availability of cell lines harboring H PV DNA and the identification of H PV genes as oncogenes have permitted in vitro analyses of H PV genome persistence, gene expression, and gene functions.

How well do you really know your body?

How easy do you think it will be for you to get pregnant - or NOT to get pregnant?

You've probably never really been educated about your reproductive years - perhaps you learnt everything you know from friends, or from the media, or online. You might be ready for a baby now; or, like so many other women, you might want to delay the birth of your first child while you establish your career. Perhaps you're thinking about freezing your eggs.

Professor Joyce Harper is an internationally recognized expert on female fertility and fertility education, and in 12 chapters she covers the full scope of your reproductive years, from your first period to menopausal symptoms. Her straightforward, scientifically based advice will give you all the information you need to make informed decisions about your reproductive choices. Only when you really understand your menstrual cycle works can you optimise your lifestyle to get pregnant successfully - while being properly aware of how and when your fertility will decline.

Your Fertile Years answers all your questions about things like egg freezing and IVF, and debunks not only the myths surrounding fertility treatment, but also the misinformation and scare stories that surround conception and pregnancy, including the bottom line on supplements, diet and holistic therapies.

A shining beacon in the murky fertility landscape, this book will accompany you through your fertile years, giving you the guidance you need to make decisions that work for you, your family, your career and your body.

A growing majority of women in the western hemisphere have been delaying initiation of childbearing to later in life. Consequently, more than ever before, women in their late 30s to early 40s are attempting their first pregnancy. Since the incidence of most cancers increases with age, delayed childbearing results in more female cancer survivors interested in fertility preservation." Fertility Preservation in Females: Emerging Technologies and Clinical Applications" contains a selection of the valuable chapters and protocols of Seli and Agarwal s previously published hardcover text "Fertility Preservation: Emerging Technologies and Clinical Applications." Newly available in this convenient and affordable softcover format, this unique and practical reference guide for reproductive endocrinologists, gynecologists, embryologists, reproductive scientists, and oncologists provides strategies for fertility preservation in women, using a format that combines concise scientific background with practical methodological information and easy-to-grasp algorithms."

The state of health care is reflected by perinatal and neonatal morbidity and mortality as well as by the frequencies of long-term neurologic and developmental disorders. Many factors, some"without immediately recognizable significance to childbearing and many still unknown, undoubtedly contribute beneficially or adversely to the outcome of pregnancy. Knowledge concerning the impact of such factors on the fetus and surviving infant is critical. Confounding analyses of pregnancy outcome, especially these past two or three decades, are the effects of newly undertaken invasive or inactive therapeutic approaches coupled with the advent of high technology. Many innovations have been intro duced without serious efforts to evaluate their impact prospectively and objectively. The consequences of therapeutic misadventures character ized the past; it seems they have been replaced to a degree by some of the complications of applied technology. Examples abound: after ov eruse of oxygen was recognized to cause retrolental fibroplasia, its restriction led to an increase in both neonatal death rates and neurologic damage in surviving infants. Administration of vitamin K to prevent neonatal hemorrhagic disease, particularly when given in what we now know as excessive dosage, occasionally resulted in kernicterus. Prophy lactic sulfonamide use had a similar end result. More recent is the observation of bronchopulmonary dysplasia as a complication of re spirator therapy for hyaline membrane disease. The decade of the eighties opened with the all-time highest rate of cesarean section in the United States."

T HE prediction of the probability of the safe passage of the fetus through the birth canal is the primary function of the attendant at the start of labor. The means of determining the relative size of the fetal head and the internal diameters of the pelvis have therefore been the objects of deep concern down through the centuries. Manual techniques of clinical evaluation of cephalo-pelvic relations reached their peak a generation or two ago. A massive nomenclature existed with respect to pelvic planes and diam eters. To these were related various positions, attitudes, stations, and synclitisms of the fetal head. Measurements depended on digital efforts to explore the interior and on dubious implications drawn from external pelvimetry. The mechanisms of labor, as it might occur under the innumerable possible pelvic measure ments and fetal orientations, were the subject of hours of stu dent drilling and remained a lifelong preoccupation of the most seasoned specialist. The increasing safety of cesarean section somewhat miti gated the consequences of error. When a borderline internal conjugate was digitally determined, a trial labor might be per mitted with the assurance that an ultimate solution was in reserve. Mistakes of two kinds persisted, however. On the one hand, trial labor might be permitted to continue too long and, with penicillin not yet discovered, a delayed cesarean section v vi Foreword could be perilous. Alternately, to be on the safe side, many un necessary elective sections might be carried out.

The fetal period of human growth and development has become an area of intense study in recent years, due in large part to the development of diagnostic ultrasound. More than 2,000 articles have been published in the last five years describing anatomy and pathology in utero, as reflected in sonographic images. Yet, no stan dard reference exists to correlate these images with fetal gross anatomy and at tempts to draw parallels from adult structure have often led to false assumptions. The dictum "the newborn is not a miniature adult" is all the more valid for the fetus. This text aims to provide a comprehensive reference for normal sectional anat omy correlated with in utero ultrasound images. In addition, magnetic resonance images of therapeutically aborted or stillborn fetuses are paired with similar gross sections to serve as a foundation upon which current in vivo studies may build. Lastly, a miscellaneous section illustrates several anatomic points useful in the understanding of fetal anatomy. These points include the changing anatomy of the fetal brain during gestation and the anatomy of the meninges, the fetal heart, and ductus venosus. It is our hope that this atlas will provide a clear picture of fetal anatomy, rectify some of the confusion which exists in antenatal diagnosis, and stimulate further interest in fetal development."

This book on fibroid uterus focuses on surgical challenges in minimal access surgery that a surgeon faces while treating this condition. This book explores the role of various imaging modalities in both diagnosis and planning of the treatment. Various surgical techniques, such as hysteroscopy, laparoscopy, and robotic are discussed which will help readers to understand the pros and cons of each one. Teaching practical tips from experts regarding these procedures, the book aims to help surgeons make clinical decisions while they choose surgical procedures for their patients in various clinical settings. The book highlights both the conservative (techniques of myomectomy) and hysterectomy by various methods for treating fibroids. Key Features How to use various imaging modalities for preoperative evaluation of fibroids Issues in preoperative counseling and consent before surgery for fibroids Overview of surgical treatment of fibroids Individual chapters on practical tips by experts for various surgical techniques used for both myomectomy and hysterectomy Discusses the controversy in morcellation and how to perform it safely Covers the problem of parasitic fibroids that have increased in recent times Discusses issues like breach in endometrial cavity during myomectomy, surgery for adenomyosis, uterine rupture and recurrence after myomectomy When to call it a day and convert from laparoscopy to laparotomy

Dedication to Professor Dr. med. Dr. h. c. mult. Benno Runnebaum on his 65th Anniversary The name of Benno Runnebaum is closely tied to the status of gynaecological endocrinology and reproductive medicine. Therefore, we would like to dedicate this conference book entitled "Fertility Control" to him in recognition of his achieve- ments. Who is Benno Runnebaum? Benno Runnebaum was born on 22 July, 1933, in Ruschendorf, Germany. After taking his A-levels, he studied medicine in Munster, Bonn and Cologne. He graduated from Cologne University in 1961 and then prepared his doctoral thesis on the "Identificati- on and quantification of progesterone, 20a-dihydroprogesterone, 20~-dihydroproge- sterone and 17a-hydroxyprogesterone in the plasma of human placental blood". This Benno Runnebaum VI Preface publication was the first to describe the progestin cycle in the feto-placental unit. His thesis was supported by Professor Dr. med. Dr. h. c. Josef Zander. It was graded "sum- ma cum laude" and won him a scholarship from the National Institute of Health for training in steroid biochemistry at the Biochemical Institute in Salt Lake City (Profes- sor Samuels) in 1962 and 1963. After his return to Germany he worked at the Univer- sity Women's Hospital of Cologne. He received his further specialist training in 1964 at the Heidelberg Women's Hospital, under the chairmanship of his teacher, Professor Zander.

The chapters in this book represent presentations at the first meeting ever held on the regulation and actions of follicle stimulating hormone. The meeting took place on the campus of Northwestern University, Evanston, Illinois, from October 25 to 28, 1990. The idea for this meeting was conceived by Neena B. Schwartz, and the valuable advice of the organizing committee contributed greatly to its scientific success. We gratefully acknowledge the funding and coordination of this meeting by Serono Symposia, USA. We also wish to acknowledge the financial contributions made by Northwestern University. We especially thank the invited speakers, poster presenters, and discussion participants who pro vided the science, interest, and enthusiasm that made this meeting on FSH a success. MARY HUNZICKER-DUNN NEENA B. SCHWARTZ vii Contents Preface. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xv 1. An Overview of FSH Regulation and Action . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ULRIKE LUDERER AND NEENA B. SCHWARTZ Part I. Neuroendocrinology of FSH Secretion 2. Modulation of Gonadotropin Secretion by Proteins of the Inhibin Family: Studies in the Female Rat. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 CATHERINE RIVIER AND WYLIE V ALE 3. Control of Follicle Stimulating Hormone Secretion in the Male Rhesus Monkey (Macaca mulatta) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 TONY M. PLANT 4. The Physiology of Puberty in Seasonally Breeding Birds . . . . . . . . . . . 54 BRIAN K. FOLLETT 5. Hypothalamic Regulation of FSH Secretion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66 JON E. LEVINE, LISA A. CONAGHAN, ULRIKE LUDERER, AND FRANK J. STROBL 6. Photoperiodic Control of Reproduction in Male Hamsters: Role of FSH in Early Stages of Photo stimulation . . . . . . . . . . . . . . . . . . . . . . . 83 FRED W. TUREK AND NEENA B."

The decision taken during the First International Congress on the Menopause in June 1976 to repeat the exercise 2 years later turned out to be a good one. In the last few years much work has been done on the subject of the menopause. I t is, of course, a subject of many facets, but of particular importance recently has been the work done as a result of the reports appearing in 1975 and 1976 alleging an increase in the incidence of endometrial carcinoma in women who had used oestrogens, and of other effects, some beneficial others deleterious, reportedly seen when oestrogens were administered. 1978 seemed the right time to re-assess the situation, and the Second Inter national Congress on the Menopause provided a good platform. The congress was held in Jerusalem in June 1978. It took the form of a series of 12 workshops, each of which, within a prescribed framework, was planned and presided over by a moderator experi enced in that particular field. The 12 moderators were free to organize their sessions in whichever way they wished, and to invite whoever they wished to present papers and to join in the discussions. In addition the workshops were open to anyone who wished to attend."

The state of health care is reflected by perinatal and neonatal morbidity and mortality as well as by the frequencies of long-term neurological and developmental disorders. Many factors, some without immediately recognizable significance to childbearing and many still unknown, undoubtedly contribute beneficially or adversely to the outcome of pregnancy. Knowledge concerning the impact of such factors on the fetus and surviving infant is critical. Confounding analyses of pregnancy outcome, especially these past 2 or 3 decades, are the effects of newly undertaken invasive or inactive therapeutic approaches coupled with the advent of high technology. Many innovations have been introduced without serious efforts to evaluate their impact prospectively and objectively. The consequences of therapeutic misadventures character ized the past; it seems they have been replaced to a degree by some of the complications of applied technology. Examples abound: after overuse of oxygen was recognized to cause retrolental fibroplasia, its restriction led to an increase in both neonatal death rates and neurologic damage in surviving infants. Administration of vitamin K to prevent neonatal hemorrhagic disease, particularly when given in what we now know as excessive dosage, occasionally resulted in kernicterus. Prophy lactic sulfonamide use had a similar end result. More recent is the observation of bronchopulmonary dysplasia as a complication of re spirator therapy for hyaline membrane disease. The decade of the eighties opened with the all-time highest rate of cesarean section in the United States."

The Helene Harris Memorial Trust has become recognized as providing one of the most important international fora for the presentation of research in ovarian cancer. Four biennial meetings have taken place, the most recent of which was held between May 11-14, 1993, in Toronto, Canada. This forum has grown in stature from its inception in 1987 and has brought together interdisciplinary clinical and scientific researchers from around the world who are endeavouring to perform 'cutting edge' studies in the field. The assembled group of presti gious investigators met on this occasion to present their data, to exchange ideas, and to arrange collaborations with the goal of developing new means of detection, treatment and cure of ovarian cancer. The incentive for the establishment of the Trust and its international forum was the prema ture loss through ovarian cancer of Helene Harris, the wife of Mr John Harris. Mr Harris and the Trustees looked for a meaningful way to honour the memory of Helene and to advance the noble cause of gaining an increase in the scientific knowledge of the subject. For those of us who spend most of our waking hours assisting patients and their families who are devastated by this disease, the Trust's generosity provides inspiration, hope and the opportunity for their practical application in a unique professional forum.

The peri-menopause is emerging more and more as a subject for study by the doctor, the psychologist, the social worker, the gerontologist, the clinical chemist, the public health specialist, the sociologist, the psychiatrist and the experimental pathologist. The results of studies are gradually becoming known to the public, particularly to the prospective clients, ageing women. Women have begun to ask for treatment and they will most likely determine whether oestrogen replacement therapy comes into vogue. Psychosomatics in peri-menopause is an important sub ject, since the life-span of the woman has extended to nearly twice that of her fertile period. The life-expectancy for women in industralized countries is now some 70-75 years. This means that most can now expect to spend one third of their lives in the post-menopause. Consequently, there is now much more time than before in which to notice, experience and be bothered by peri menopausal changes. Moreover modern medicine has much more to oner than mere moral support to sufferers from ailments connected with progressing ovarian failure during peri-menopause. Although we cannot promise eternal youth - as Wilson does -there are more possibilities for treatment than 10 years ago."

The International Women's Health Coalition was pleased to be the convenor and host of the first Christopher Tietze International Symposium, held in Berlin in September 1985. The papers in this volume represent a wide range of international views and experience with the prevention and treatment of contraceptive failure. We believe the issues discussed at the Tietze Symposium to be of interest and concern to women throughout the world and to those who would serve them. The Coalition intends to l1'ive broad distribution to this volume and encourages those interested in these issues to be in touch with the Coalition in New York City (see address below). We would like to thank The Ford Foundation, Stewart Mott, The David and Lucile Packard Foundation, the Population Crisis Committee, and The Uockefeller Foundation for their support of this Symposium. In particular we would like to express our appreciation to Sarah Lewit Tietze and Uta Landy for the devotion ann dedication which made this Symposium possible and a worthy memorial to Christopher Tietze.

This book describes key knowledge concepts, skills and up-to-date algorithms pertaining to common emergencies that can take place in a pediatric office, including: seizures, anaphylaxis and shock, and diabetic ketoacidosis. The authors supported by peer review from top specialists in Pediatric Emergency Medicine at the Baylor College of Medicine offer the first comprehensive educational resource on pediatric office emergency preparedness devoted exclusively to the practicing primary care health care provider and his/her team. During emergencies, providers and their staff are called on to work efficiently as a "code-team" which is a source of considerable apprehension for many primary care pediatricians. This unique reference guide contains a wealth of information and resources in a compact and practical form. It presents the most important knowledge, skills, office resources and team interactions required by practitioners to successfully treat pediatric emergencies in the office.

The treatment of menopausal and postmenopausal symptoms is a focus of considerable debate, on account of both the medical and social factors involved. And perhaps the cause of the greatest current interest and concern is not so much the effectiveness of present-day treatment but its safety. Opinions on the subject vary; and to resolve the arguments we must turn to the results of scientific experiment, both the clinical and biological. It is only by comparing experimental results that it is possible to move forward, albeit slowly, towards a generally agreed consensus based upon objective scientific data. It is for this reason that we are particularly grateful to Ayerst Laboratories whose support and help have enabled us to turn our original proposal for an International Symposium into a reality. We are also grateful to the publishers for the efficiency with which they have organized the publication of the Proceedings. It is our hope and that of all the distinguished participants that all readers of this volume will be able to find something in it which will stimulate further thought and discussion - even though they may not necessarily agree with all the conclusions expressed - for the success of a Symposium turns not only on the subject under examination but also on the quality of debate and discussion it encourages.

This volume contains papers presented at the Conference on the Demographic and Programmatic Consequences of Contraceptive In novations, which was sponsored by the Committee on Population and held at the National Academy of Sciences, October 6-7, 1988. The papers consider how new contraceptive methods currently being developed and changes in the use of already available contraceptives could affect contraceptive practice, levels and patterns of abortion use, and the health of women. In addition, several of the papers re view the probable consequences of introducing new technology into family planning programs in developing countries. The Committee on Population sponsored this conference in order to stimulate think ing and to provide a forum for scientists, family planning program managers, and donor agency personnel to exchange information and ideas about these important issues. The committee is publishing these papers to expand the discussion of consequences of contracep tive innovations and to give scientists, policy makers, and members of the public who could not attend the conference an opportunity to learn about new developments in fertility control and their likely consequences for individuals and the societies in which they live. NEED FOR NEW METHODS While a strong case can be made that the pill and the intrauterine device (IUD) have contributed to declines in the level of unintended pregnancies around the world, it is also clear that for many couples existing methods present problems.

About 21 years ago prenatal diagnosis became part of the physician's diagnostic armamentarium against genetic defects. My first monograph in 1973 (The Prenatal Diagnosis of Hereditary Disorders) critically assessed early progress and enunciated basic principles in the systematic approach to prenatal genetic diagnosis. Six years later and under the current title, a subsequent volume provided the first major reference source on this subject. The present second (effectively third) edition, which was urged in view of the excellent reception of the two earlier volumes, reflects the remarkable growth of this new discipline and points to significant and exciting future developments. Notwithstanding these advances, the use of the new tools and techniques for the benefit of at-risk parents has taken many more years than most anticipated. Key factors have been the lack of teaching of human genetics in medical schools in the preceding decades and the difficulty of educating practicing physicians in a new scientific disci pline. Even today the teaching of genetics in medical schools leaves much to be desired and this will further delay the introduction of newer genetic advances to the bedside."

Interest in sexuality and reproductive function does not cease when people begin to age. Instead, a new set of questions arises. Women want to know if it is safe to have babies in their late thirties and early forties. They want to know more about hot flashes and other symptoms of menopause-which ones are dangerous and which are merely uncomfortable. They are eager to learn about the relative risks and benefits of estrogen replacement therapy. Men, too, are concerned about age-related changes in their sexual function. Experts in reproductive physiology, gerontology, and genetics met at the National Institutes of Health in June of 1984 to discuss these and other concerns about aging and the reproductive system. The conference on Aging, Reproduc tion, and the Climacteric was sponsored by the American Fertility Society, The National Institute on Aging, and the National Institute of Child Health and Human Development. This volume is based on the proceedings of that confer ence."

The 15th International Symposium of the Japan Human Cell Society on Cell and Molecular Biology of Endometrial Carcinoma brought together leading researchers from Japan and around the world. The papers collected here are the work of twenty-two leaders in their field and are organized in ten major categories. The first section, in vitro experimental systems, takes up the pioneering work by Kuramoto in 1968 and Nishida in 1980 in establishing, respectively, the HEC-1 and hormone-responsive endometrial carcinoma cell lines. Other topics include apoptosis, proliferation, and growth factors; cell cycle regulators; signaling pathways; angiogenesis; carcinogenesis; hormones and hormone receptors; genes and gene expression; endometrial receptivity; and chemo-resistance and -sensitivity. Presenting the latest work in the cell and molecular biology of endometrial carcinoma, this volume is a valuable resource for gynecologists, pathologists, and molecular biologists.

The no-man's-land between reproductive physiology and immunology is becoming crowded. The last 10 years have seen a revolution in our under standing of many reproductive processes, brought about by the application of ever more sophisticated immunological methods. The increasing precision of these techniques has given us specific ways of assaying, enhancing or blocking hormonal mechanisms to yield more critical and interpretable information. In this volume eleven authors have presented the current status and future prospects of some immunological aspects of reproduction and fertility con trol. These include the relationships between mother and fetus, the diagnosis of pregnancy, the immunological complications seen in clinical management of human reproduction and some novel approaches for immunological control of fertility. We hope that in these chapters we have achieved an up-to-date account of a fast-moving field that calls on several disciplines. We intend the book to provide an adequate background and a current review for research workers and clinicians who wish both to understand the complex mechanisms involved and to develop improved scientific and clinical methods. We hope too that the student and newcomer will find this a useful reference book."

Years of involvement, firsthand experience and research at the Menopause Clinic of the Groote Schuur Hospital, Cape Town, exist as the background to this book. The Clinic itself, however, as one of the first in the world to be established, if not the first, has a story and a lesson of its own to offer, and is therefore deserving of a brief description as the preface to the book. In 1967, shortly after Christiaan Barnard had completed the historical first human heart transplant at the Groote Schuur Hospital, I happened to be in West Berlin and was invited to visit a major international pharmaceutical firm. A new female hormone was mentioned, and thereby started my interest in the subject. Upon my return to Cape Town, I spent many hours in the large medical school library and completely surveyed the menopause literature to 1967. I was stunned by its general inadequacy and was bitten by a challenge to clarify what menopause really was, and to define the proper place of hormone replacement therapy.