IntroductionArm in arm, the women walked toward the doors of the Natcher Auditorium at the National Institutes of Health. It was the end of February 2006. Dressed in brightly colored coats to keep out the late-winter chill, they entered the conference center and were handed rose boutonnieres to distinguish them from the fleets of doctors, scientists, and journalists who were also slowly making their way to their seats.The occasion was a two-day summit to discuss the results of the Women's Health Initiative (WHI), a massive clinical trial that had studied possible preventative approaches to problems that plague aging women -- primarily heart disease, osteoporotic fracture, and breast and colorectal cancer. When we call the trial massive, we mean in scope, duration, and expense. Started in 1991 and involving 161,808 participants, the WHI cost millions of government dollars and spanned fifteen years.The clusters of middle-aged women proudly sporting the flowers on their lapels were members of that 161,808-strong sisterhood. Although they looked like any other people their age, these women had accomplished an incredible feat.

Though they might not have understood it at the time they signed up to take hormone replacement therapy, make changes in their diet, and commit to decades of calcium and vitamin D capsules, these women had transformed the way that women in North America, Europe, and indeed much of the world experience menopause. For at least a century, the transition from fertility to menopause had been medicalized and treated as a disease. For over five decades, hormone treatment (HT) drugs were assumed to be the first line of defense for all women against this presumed illness. The WHI confirmed what some daring scientists and women's health advocates had been saying for years: hormones weren't the answer, and beyond that, menopause itself was a natural process that wasn't necessarily in need of any medical intervention.None of this would have been possible without the trial participants and the generations of women who have experienced and talked about menopause in spite of prevailing medical opinions, drug fads, and dangerous social taboos. This conference, as organizer Marcia Stefanik made explicit in her opening remarks, was to honor their contribution.Although it was a scientific meeting, the atmosphere at the NIH was closer to a school reunion. Images of the quilts created by WHI participants flashed on the main screen between presentations heavy with charts, figures, and seemingly endless statistical analyses.

On panels, WHI subjects sat side by side with experts, doctors, and scientists. The message could not have been more clear: after decades of women being told what to do about their menopause by doctors, scientists, and drugmakers, at last the voices of women themselves were being heard.As we -- Barbara and Laura, the authors of this book -- watched the results of the WHI unfold between 2001 and 2003, we couldn't help but wonder how we had arrived at a cultural point where we needed to be reminded that menopause was part of a woman's natural life cycle. We were amazed by the shock women experienced as the WHI was publicized and were impressed by their desire to understand the seismic shifts in menopause medicine. There were so many questions that needed answers, and we wanted to give menopausal women an easy-to-read but thorough, honest but optimistic way to understand how "the change" has, well, changed.Things That Were, Things That Might Have BeenAs long as women have been around, they have been going through menopause. It is a bodily process that is as old as human birth, death, and, of course, menstruation. There is a cultural myth that before the twentieth century, women didn't live long enough to experience menopause in significant numbers.

Such a claim is simply not born out by the facts; a visit to any cemetery thick with grave.