Hormone therapy use has undergone dramatic changes over the past 20 years. Widespread use of hormone therapy in the 1980s and 1990s came to an abrupt halt in the early 2000s after initial findings of the Women’s Health Initiative trial were published and the study was terminated. Since then, much has been learned about the characteristics of women most likely to benefit from hormone therapy. There is general agreement that women younger than 60 years or who initiate hormone therapy within 10 years of menopause onset gain short-term benefit in terms of symptomatic relief and long-term benefit in terms of protection from chronic diseases that affect postmenopausal women. Despite accumulating evidence in support of hormone therapy for symptomatic menopausal women, the slow response by the medical community has led to a ‘large and unnecessary burden of suffering’ by women worldwide. Greater efforts are clearly needed to educate physicians and medical students about the pathophysiology of menopause and the role of hormone therapy in supporting women through the transition. This article provides a brief historical perspective of events that led to the backlash against hormone therapy, explores the current position of guideline groups, and provides practical recommendations to guide first-line management of symptomatic menopausal women.

86 patients with spontaneous abortion were interviewed and followed up in a longitudinal study with an interview and standardised questionnaires shortly after the D&C at 7, 13 and 24 months later. Our results indicate profound and long-term adverse psychological sequelae. For most of the patients, a spontaneous abortion was considered to be of major importance. Without regard to the gestational age or ultrasonographic image, the embryo is represented early in fantasies and dreams as a child. The severity of grief reactions following abortion did not correlate well with gestational age or a new pregnancy. Mourning is still present 24 months after the abortion. While grief decreases continuously during the first 7 months following abortion, despair remains constant and self-reproachful coping shows even a statistically significant increase between months 13 and 24. The reason is, because 20% of patients develop a pathological grief reaction with an increase in depression, self-reproachful coping and physical complaints. This risk group of patients, who needs closer and more detailed observation and guidance, may be recognised as early as at the time of abortion.

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Die Beratung klimakterischer Patientinnen in der "Post-WHI-Ära" ist ein zunehmend kompliziertes und schwieriges Unterfangen geworden. Die Indikation für den Einsatz von Sexualsteroiden in dieser Lebensphase muss sehr viel strenger geprüft werden als früher. Darüber hinaus haben sich die therapeutischen Optionen in den letzten Jahren vervielfäl-tigt. Für die Patientinnen ist dies eindeutig ein Vorteil: Anders als vor 20 Jahren ist heute eine extrem individuelle und maßgeschneiderte Therapie für jede Frau möglich, sowohl durch den Einsatz sehr variabler Dosierungen und unterschiedlicher Applikationsformen als auch durch zum Teil sehr unterschiedliche Substanzen mit großer Varianzbreite. Letzteres trifft insbesondere für die Gruppe der Gestagene zu. Die Auswahl des "richtigen" Gestagens ist mitunter schwierig, da es eine Reihe von Eigenschaften dieser Stoffgruppe zu beachten gilt. Die folgende Übersicht soll Entscheidungshilfen und Kriterien darlegen, die im klinischen Alltag beachtet werden müssen.