Book Review

Menopause: Biology and Pathobiology

N Engl J Med 2000; 343:1976-1977December 28, 2000

Article

Menopause: Biology and Pathobiology
Edited by Rogerio A. Lobo, Jennifer Kelsey, and Robert Marcus. 672 pp., illustrated. San Diego, Calif., Academic Press, 2000. $159.95. ISBN: 0-12-453790-1

It is axiomatic that a thorough understanding of the biology and physiology of a given condition or disease is a prerequisite for wise clinical practice and for designing the next round of basic and clinical investigations. Comprehensive knowledge is even more critical when the study of a condition or disease crosses several disciplines. In the absence of a common appreciation of the underlying biology, it is difficult to foster the interdisciplinary communication needed to meld molecular and clinical insights. Menopause: Biology and Pathobiology aims to provide a scientific foundation for understanding the many manifestations of menopause and to cover the relevant clinical aspects of a common condition that is inherently interdisciplinary. As the editors note in the preface, the years after menopause may account for up to 40 percent of a woman's life in developed countries such as the United States. Thus, it is critical that scientific and medical professionals address the health challenges that accompany menopause. Although women are indeed living longer, their ovaries still have an unchanged life span.

The objectives of this book are certainly laudable and timely, but they are also ambitious and problematic. Inevitably, experts from different disciplines will each know different parts of a problem best. Unless there is heavy editorial control, some variation in quality is probably unavoidable. Although this book is comprehensive in scope and content, it contains the usual shortcomings of a textbook that is a collection of the informed views of a variety of experts in different disciplines. The most important pitfall is that there is no consensus on topics that are covered in more than one chapter. Since there is no mechanism for reconciling differences of perspective within the book itself, the task falls to the reader. Another limitation is that some chapters are far more thorough than others. In short, this book clearly fills a void, but not all topics are equally well covered. That criticism aside, I believe Menopause: Biology and Pathobiology will receive, and deserves, the attention of investigators and clinicians who study menopause and perimenopause.

The book begins with a chapter on the molecular biology of estrogen and progesterone receptors and ends, after 45 more chapters, with a review of decision analysis. Almost every conceivable aspect of menopause is covered. The content is for the most part logically organized, and the book does not have to be read sequentially for a given chapter to be intelligible. This feature makes the book a worthy reference for experts in menopause from all disciplines. However, I suspect that specialists in menopause will find some chapters limited or biased. On the other hand, for readers seeking background information in areas outside their own specialized areas, the coverage will probably be satisfactory and provide a reasonable introduction to a given set of concepts and data.

Although the overall organization of the book is logical, I am mystified as to why the “Study of Women's Health across the Nation” merits an entire chapter that includes a list of all the investigators and sites, whereas prevention trials are described together, more briefly, in a single chapter. In general, each chapter contains a variety of illustrations, but the overall quality of most of them is pedestrian. Many of the chapters are obligatory and customary; a few are unique and timely. Given the potential effect on society of a burgeoning population of older people, it is refreshing to find a chapter on demographics, another on distinguishing the effects of aging from those attributable to menopause, and yet another on “manopause,” or aging in men. The chapter on alternatives to hormone-replacement therapy is lucid and balanced. Likewise, the chapter on hormone-replacement therapy and breast cancer covers key data and concepts without being either alarmist or falsely reassuring. I was pleased to see a chapter devoted to the health effects of exercise but surprised not to see a comparable chapter on nutrition. Nutritional issues are considered where relevant within various chapters, but given the importance of diet in the pathogenesis and management of diseases commonly found in menopausal women, the omission of complete coverage of this topic seems unfortunate.

In summary, Menopause: Biology and Pathobiology is a useful resource for those seeking a panoramic overview of menopause or a focused consideration of one aspect of it. Some chapters are more technical than others, but most are appropriate for both practicing physicians and investigators seeking methodologic expertise. Although the book is not stylistically consistent and although the quality of the chapters varies, the aggregation of so much relevant information in one book is an important asset.

Sarah L. Berga, M.D.
University of Pittsburgh School of Medicine, Pittsburgh, PA 15213