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Double-blind randomized controlled trials of estrogen and/or testosterone on sexual function among natural or surgical menopause in women are reviewed. Power, validity, hormone levels, and methodological issues were examined. Certain types of estrogen therapy were associated with increased frequency of sexual activity, enjoyment, desire, arousal, fantasies, satisfaction, vaginal lubrication, and feeling physically attractive, and reduced dyspareunia, vaginal dryness, and sexual problems. Certain types of testosterone therapy (combined with estrogen) were associated with higher frequency of sexual activity, satisfaction with that frequency of sexual activity, interest, enjoyment, desire, thoughts and fantasies, arousal, responsiveness, and pleasure. Whether specific serum hormone levels are related to sexual functioning and how these group effects apply to individual women are unclear. Other unknowns include long-term safety, optimal types, doses and routes of therapy, which women will be more likely to benefit from (or be put at risk), and the precise interplay between the two sex hormones.

Women experience a high prevalence of mood and anxiety disorders, and comorbidity of mood and anxiety disorders is highly prevalent. Both mood and anxiety disorders disturb sleep, attention and, thereby, cognitive function. They result in a variety of somatic complaints. The mood disorder continuum includes minor depression, dysthymia, major depression and bipolar disorder. Chronobiological disorders, such as seasonal affective disorder as well as premenstrual dysphoric disorder, occur in some women, with comorbid seasonal affective disorder and premenstrual dysphoric disorder in just under half of these individuals [1] . Early life experience, heritability, gender, other psychiatric illness, stress and trauma all interact dynamically in the development of mood and anxiety disorders. The epidemiology, nomenclature and clinical diagnostic issues of these illnesses in midlife woman are reviewed.

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The early and late perimenopausal transition is characterized by changing cycle length as well as by menopausal symptoms in some women, including increasing hot flashes and night sweats. Breast tenderness decreases as women enter the late transition. This review, as part of the clinical reviews on the menopausal woman with comorbidity, covers the endocrine phenomena of perimenopause, terminology and the observed clinical characteristics of the transition. It should be noted that the definitions covering this period vary between publications. The average duration of perimenopause is approximately 5A years. The earliest detectable hormonal change is a fall in ovarian secretion of inhibinA B, with a subsequent rise in follicle-stimulating hormone and maintained or increased levels of estradiol. As women transit the perimenopause, cycle irregularity increases, with the more frequent occurrence of prolonged ovulatory and anovulatory cycles. Levels of follicle-stimulating hormone and estradiol fluctuate increasingly and luteal function declines. Vasomotor symptoms tend to be most frequent around the time of final menses. The perimenopause is thus a time of cycle and hormone variability and single hormone measurements provide little useful information, with the clinical history being the most appropriate method of assessing menopausal status. This information will be very helpful to the clinician treating the concerned and symptomatic patient. It will also aid clinicians to avoid unnecessary laboratory testing and help them educate their patients about their perimenopause.