Cover image for Menopause and the mind : the complete guide to coping with memory loss, foggy thinking, verbal slips, and other cognitive effects of perimenopause and menopause
Menopause and the mind : the complete guide to coping with memory loss, foggy thinking, verbal slips, and other cognitive effects of perimenopause and menopause
Warga, Claire L.
Personal Author:
Publication Information:
New York : Free Press, [1999]

Physical Description:
xxiii, 388 pages : illustrations ; 25 cm
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RG186 .W34 1999 Adult Non-Fiction Central Closed Stacks

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"Menopause and the Mind gives every woman the survival kit she needs to manage the thinking and memory symptoms - long overlooked by the medical establishment - that accompany the onset of perimenopause and menopause." "Neuropsychologist Claire Warga provides the first scientific explanation for this common "hormonal misconnection" syndrome. Drawing upon recent brain and clinical research, she shows that forgetfulness, malapropisms, and lost concentration are not manifestations of dementia or senility: instead, they result from the depletion of estrogen in the brain cells of women as they enter perimenopause and menopause. Armed with this knowledge, Warga offers women a breakthrough plan for regaining control and confidence in their minds." "Warga explains the full range of thinking, speech, short- and long-term memory, behavior, spatial, and time sense symptoms in extensive detail, complete with an array of examples. Most important are a self-screening test and symptom chart that every women can use to understand the extent of her symptoms and accurately assess her condition, with or without her ob/gyn. Women can also make practical use of Warga's detailed guide to treatment options, which include estrogen therapy, dietary and behavioral changes, and techniques for improving memory."--BOOK JACKET.Title Summary field provided by Blackwell North America, Inc. All Rights Reserved

Reviews 3

Booklist Review

WHMS, which stands for Warga's Hormonal Misconnection Syndrome, is a convenient umbrella term covering the problems listed in the book's subtitle. A person has to have a certain confidence to name a syndrome after herself. Neuropsychologist Warga identifies problems faced by many women that involve not knowing what is happening to them and fearing Alzheimer's or the possibility that they are losing mental control. Warga relates such problems to menopause and documents her assertions with solid medical and scientific literature. Her book aims at two large groups: women who have long struggled with the problems covered, and physicians who either do not know about such conditions or do not care. Warga sounds an individualizing note by citing a variety of case histories, and she discusses current research and points out where additional work is needed. For those who can't take estrogen, she offers alternative approaches. The matters she covers are constituents of a rapidly growing field, and this book has much to offer. --William Beatty

Publisher's Weekly Review

The author of the much-discussed 1997 New York magazine article "Estrogen and the Brain" aims to bring public and professional attention to a decade of new research on the link between hormonal change and lapses in the cognitive faculties of women in the years leading up to and during menopause. Citing studies that relate declining estrogen levels to a range of "slips" in memory, speech, thinking, attention span and sense of time and space, Warga makes a fascinating argument for the biological, even evolutionary basis of such behaviorsÄin men as well as women. An advocate of hormone replacement therapy to reverse these symptoms, Warga, a Ph.D. in neuropsychology, is highly skilled at making science accessible to the general reader. The book's emphasis, however, is on identifying and establishing a medical syndrome the author calls WHMS, for Warga's Hormonal Misconnection Syndrome, that she contends is separate from the physical symptoms associated with menopause. Readers, especially women from 35 to 60, who have experienced frustrating and sometimes frightening "senior moments" may welcome the book, but they should understand that less than a quarter of it deals with treatment and coping strategies. For those unable or unwilling to take synthetic hormones, there are helpful suggestions about estrogen "mimics," including serotonin boosters, exercise and a dietary regimen that includes moderate amounts of sugar and caffeine. (Apr.) (c) Copyright PWxyz, LLC. All rights reserved

Library Journal Review

Mood swings and other more severe psychological disorders during perimenopause have already been documented and attributed to estrogen deprivation (Marcia Lawrence's Menopause and Madness, LJ 4/15/98). Here, neuropsychologist Warga focuses on the cognitive deficits that result from estrogen loss, detailing such changes as losing one's train of thought, the "what did I come here for" sensation, having the wrong words pop out, reversing words while speaking, briefly forgetting how to do things, and experiencing erratic fine motor coordination. She postulates the existence of Warga's Hormonal Misconnection Syndrome to describe these symptoms and suggests remediesÄhormone replacement therapy as well as nonhormonal approaches involving glucose, antioxidants, anti-inflammatory agents, aerobic exercise, and behavioral training. Although one might chide the author for naming her theory after herself, her book is reassuring and worthwhile. Recommended for consumer health and health sciences collections.ÄLinda M.G. Katz, Allegheny Univ. of the Health Sciences Lib., Philadelphia (c) Copyright 2010. Library Journals LLC, a wholly owned subsidiary of Media Source, Inc. No redistribution permitted.



Introduction This book is intended for women in their thirties, forties, fifties, and beyond who may be experiencing unusual come and go memory, speech, attention, behavior, thinking, and time-tracking symptoms no expert ever prepared them for and who want help in understanding and possibly treating such symptoms. It is for all women who may in the future experience such symptoms and prefer to be forewarned and forearmed rather than be caught helpless. It is for women who want to know the latest research news on the estrogen and Alzheimer's disease evolving frontier. This book is also for women's physicians who want to understand the plausible basis for cognitive, speech, and behavioral symptoms women experiencing perimenopause, menopause, or estrogen loss for any reason may be reporting to them. Lastly, this book is for neuroscientists eager to mine not merely a good but a "great" research topic rife with the potential for yielding not only major pure science discoveries about the mind and brain but discoveries that will have life altering applications for millions and millions of women now and in the future. In this book I make a rather dramatic revelation, I report that there is something new under the sun about women's biology that has been missed before: a set of interior, sometimes visible symptoms that frequently occur in association with menopause and perimenopause in many but not all women that are as common, normal, similar in cause, and variable in pattern as hot flashes are. These symptoms have been previously overlooked because no one asked women the right questions. Most of the health and mental experts women see today, I maintain, now know virtually nothing about the symptoms, yet neuroscientists studying the brains of different species have been wondering expectantly how their findings would manifest in women. They have been looking for these symptoms. Here they are. I link these symptoms to very recent but as yet little-known brain and clinical research evidence in the neurosciences that I argue explains why the symptoms occur, indicates that the symptoms can largely be reversed, and reveals how this may be done. I present for the first time anywhere in symptomatic detail the lives of many women who have experienced these symptoms in great perplexity, isolation, and often fear and describe how they coped with and around them. I offer women multiple tools for assessing, speaking about, and getting competent help for treating their symptoms, if they need to -- and many don't -- and for assessing whether any proposed treatment is actually helping. For many women simply understanding what is happening may be all the help they need. I also propose that I have detected the "larger meaning" of these symptoms within the framework of evolutionary biology. I believe these symptoms lead us to important clues about how our human psychology has been adaptively shaped, honed, buffed, and polished by evolution. I contend that the cognitive/behavioral/speech symptoms that commonly show up in women during perimenopause and menopause, when fertility sequentially declines and then ceases, are the opposite or flip side of the very traits of mind and behavior that "nature" most highly values and typically keeps tightly regulated, controlled, or "girdled" during women's reproductive years because they confer unique survival advantages to those who have them. When the stakes of reproducing the species, i.e., species survival, are no longer an issue, "nature," I contend, pragmatically draws an exhaling breath of relaxation and says in effect, "You no longer need to be as tightly tuned for hypervigilance as before. It's OK to just 'be' during this time." The subtle symptoms of what I have named the WHM Syndrome (WHMS), for Warga's Hormonal Misconnection Syndrome, I contend, are the outward signs of that relaxation, of that altered biological agenda. For modern women who intend to live long and well beyond the end of their fertility and whose quality of life is affected by these symptoms, biology need not be destiny I say. I point to plausible ways for living longer well, presenting the input of neuroscientists, menopause, and memory experts, who offer scientific rationales for treatments. I offer self-help behaviors that can have neurological/physiological consequences, along with practical little-known self-help aids and tools. I argue that these symptoms are now epidemic among women because the first waves of the baby boom generation have reached the maturational landmarks of perimenopause and menopause and will continue to hit those markers in great numbers for some two decades to come. Ignoring women who suffer most with this syndrome, I suggest may have important public health consequences now and quite possibly for the future of our nation. My goals in this book are: * First and foremost to help women with these symptoms understand what they are experiencing now * To educate the medical and mental health professionals women see so they can help women now * To put this syndrome on the scientific map so that researchers can investigate all facets of its basis and devise multiple safe strategies for helping women now * To offer researchers a testable scientific rationale for the syndrome that has heuristic value, that can be aimed at and validated, or if need be, shot down * To draw attention to an as yet unrecognized major public health epidemic affecting the lives of millions of women now that may have important long-term consequences. BACKGROUND In this book I report on a discovery I made in the fall of 1996 -- the WHM Syndrome -- after several years of initially detecting "glitches" in speech and behavior in women I knew very well in diverse settings. Some of the women I knew well from my work as a New York state-licensed psychologist treating patients with health and stress-related problems with the tools of health psychology and behavioral medicine. They told me things, which at first I didn't understand, but which I mentally tucked away somewhere. Some of the women I knew well from belonging to two reading groups that met monthly for over a decade -- that still meet -- and that included, on average, eighteen to twenty women, some my age, some older, and some younger, spanning in recent years ages from about thirty-eight to sixty-two. I knew these women to be highly bright and verbal. And the monthly spacing of our meetings provided sufficient distance to "see" changes in some of them over time. The intimate familiar nature of these groups also made it possible for me during my initial inklings of discovery to get individual confirmation from more than a few women in private about the reality of the symptoms I was detecting. I received more of the same confirmation from interviews with women I had come to know while living outside of New York City for a number of years, who were, on average, four to seven years older than me. The women I collectively observed in these settings were all either perimenopausal or menopausal. Considerable trust I believe is essential for discussing these symptoms, though sometimes need alone will suffice. Confirmation of what I was detecting fueled my later drives to obtain interviews with many women I did not know about what cognitive or behavioral or speech symptoms they associated with perimenopause and menopause. I solicited interviews with these women through advertisements and referrals made by ob/gyns. I also interviewed women I did not know who responded to an article I wrote in New York magazine in 1997. But I am getting ahead of myself. At some point in the fall/winter of 1996 I could stand it no longer and set off one evening to find out if science knew anything about the symptoms I was detecting in women. I went to do a computer search at the medical library of New York University Medical Center, where for three years I had done research on Alzheimer's disease years before, as a clinical research psychologist testing Alzheimer's patients on a neuropsychological test battery before and after experimental treatment with hyperbaric oxygen. I loved the medical library and knew it well. Fishing to see what would turn up, I typed into the computer such paired terms as "menopause" and "mind" and came up with very little if anything. I persisted typing in different terms until I suddenly hit gold. I had typed in "estrogen" and the "brain" and out poured a wealth of references and abstracts mainly from the 1990s from leading research laboratories that represented a virtual revolution in prior thinking about both the brain and the roles of estrogen. Estrogen loss, some of the studies noted, could produce detectable changes in parts of the brain having to do with memory and attention and could affect multiple neurotransmitter systems involved in thinking and memory. Other clinical studies found small but consistent (reliable) evidence of changes in verbal memory and learning in women with estrogen loss. I'll let you read about these discoveries in chapters 3, 4, and 5. I didn't initially understand the overall significance of many of these studies, but what I did understand was that they could easily dovetail with the observations about unusual symptoms I had made in women -- they dealt with overlapping areas of function. In my readings later I discovered that neuroscientists had actually been wondering how their basic-science discoveries in animals about the potential effects of estrogen loss on the brain would show up in women. After reading through these studies, facilitated by my earlier study of the neurophysiology of sleep and wakefulness with the eminent scientist Dr. Raul Hernandez-Peon, and later research on the psychophysiology of sleep, dreams, and sexual arousal, I next started calling for interviews with the experts who had published the research I had discovered in the medical library. I had learned that I could pretty much call any expert for an interview, when I had adventitiously stumbled into a side career as a medical/science broadcast and print journalist, during a return to graduate school for a doctorate in psychology at New York University, after a near decade engaged in exciting research as an experimental psychologist. (I had a master's degree in experimental psychology and additional graduate courses.) My interviews with these experts convinced me that the symptoms I thought I had detected were not merely a figment of my imagination and that there was a plausible scientific basis for them. Dr. Bruce McEwen, an eminent research psychologist and neuroscientist who had done much of the important research in this area with students and colleagues at Rockefeller University and was president of the Neuroscience Society that year, in particular, surprised me by being aware that women were having these difficulties. He urged me on in my efforts. I wanted to find out if women were being told by anyone about these possible symptoms, since the research evidence supporting their existence was "out there." And so I next called officers of the American College of Obstetrics and Gynecology and the North American Menopause Society to see if their organizations formally recognized any speech, memory, attention, or cognitive/behavioral symptoms in women, in the educational materials they made available to women patients in doctor's offices. They didn't, I soon learned. I decided to find out why. So I called the presidents or scientific directors of these organizations to find out if they were aware of the estrogen/mind/brain research. They were, I discovered. Why then, I asked, weren't they informing women that cognitive changes could be associated with the hormonal changes of perimenopause and menopause. "It was too soon," the leader of one group said. They were waiting "to develop consensus," a leader of the other group said. Meanwhile, as I saw it, millions of perimenopausal and menopausal baby boomer women in the midst of high-demand lives were floundering in the dark, silently wondering what was happening to them. I felt I had to act in some way. I contacted the director of the New York City branch of the Women's Health Initiative, the huge government-sponsored national study assessing among other things the effects of estrogen on women, and met with her, presenting a list of the symptoms I had by then enumerated. She was very interested in what I had to say, appeared to recognize the merits of what I was describing, and suggested I write up an "ancillary study" for her to submit for review to the national head of the Women's Health Initiative Study at their upcoming meeting in two weeks. The ancillary study was submitted and ultimately rejected. I decided to use my sideline skills as a published medical/science journalist to get word out to women about these possible symptoms, which I had discovered could vary in intensity and inconvenience in different women in much the same way that hot flashes did. On August 11, 1997, I succeeded in having published a cover article in New York magazine titled within the magazine "Estrogen and the Brain" and "Can Estrogen Make You Smart?" on the cover. The focus of the article was the little-known new research on estrogen and the brain and a conference titled "Estrogen and the Brain" that had been held recently at Mount Sinai Medical Center to present the new research. At that conference the president of the Mount Sinai School of Medicine and the Mount Sinai Hospital, Dr. John Rowe, himself a leading researcher on aging, had opened the proceedings by saying that on the basis of the new research "The equation for taking estrogen has now changed....We know now that women taking estrogen after menopause reduce their chances of getting cognitive impairments" -- not a wishy-washy statement. My article alluded briefly to the symptoms perimenopausal and menopausal women were experiencing and that I describe in detail for the first time in this book. After the article was published, I received countless phone calls from friends and friends of friends -- total strangers -- who said they were so relieved that there was a basis for their symptoms and that they didn't, as feared, have Alzheimer's disease or a brain tumor. For months after the article came out, at parties and meetings, women with the symptoms came up and told me conspiratorially what had happened to them. The president of the Ms. Foundation, Marie Wilson, who had experienced some of the symptoms I described, reported that friends of hers too feared they were developing early Alzheimer's disease or a brain tumor, in a letter to the editor at New York magazine published September 9, 1997, in response to my article. (In my article, the president of the National Organization for Women, Patricia Ireland, also had acknowledged experience with word loss and uncharacteristic scheduling errors -- WHMS symptoms -- before treatment reversed her symptoms.) Shortly after the article came out, when I attended a meeting of the North American Menopause Society in early September in Boston that year, I was amazed to discover how many people there were suddenly familiar with the article. At a party at the New York Academy of Sciences I discovered that copies of the article had been distributed by the academy at a fall meeting on estrogen and the brain. I was delighted that the message I had sent out was finding an audience. That message is presented in much greater detail in this book. Looking back it seems to me now that virtually everything I have ever done professionally as a basic sciences researcher, and as a clinician interested in seeing how "adaptation to stress" really works in people from the "laboratory" vantage point of a private practice (in health psychology), has been relevant to my detecting these symptoms and what I suspect they mean. Even many of the readings I did as a science journalist in preparation for radio interviews with leading scientists, while working toward my doctorate in psychology were interviews in the fields of sociobiology, evolutionary psychology, anthropology, and physiology: interviews with Edward O. Wilson, Donald Symons, Niles Eldredge, Donald Johanson, Mary and Richard Leakey, Tim White, Rene Dubos, Sir John Carew Eccles, and others. Even the many articles I wrote for medical and popular magazines on women's reproductive lives, infertility treatments, and other aspects of women's health have proven relevant. Reviewing the work I have been engaged in most of my adult life has revealed to me that unwittingly I have been virtually "tap dancing" around topic areas that border on the study of the science of perimenopausal and menopausal women in virtually a connect-the-dot fashion that leads to the present picture. In the study of adult life development my life would make an interesting case example of something, I'm not certain what, since not only self-direction but factors I had no control over -- the deaths of two relatively young people I worked for -- shaped the course of my work. My earliest research was at Bar Harbor's Jackson Laboratory for Mammalian Genetics Research. There under a National Science Foundation fellowship I independently studied what pregnancy, over its course, does to the self-regulation skills of the body -- its bounce-back ability (homeostasis). I examined the effects of different stages of pregnancy on the ability of mice to get their body temperature back to normal after exposure to cold, a stressor. For this research I studied reproductive endocrinology and the physiology of temperature regulation, both areas that prefigured my present interest in the effects of hormonal changes in women (hot flashes). I later did research on the psychophysiology of sleep, dreams, sexual arousal during sleep, insomnia, and the effects of different emotions on the body at the Psychophysiology Laboratory of what was then Downstate Medical Center and is now known as SUNY Health Sciences Center in Brooklyn. After the fifty-three-year-old leader of our research group unexpectedly died, I studied sleep and dreams again in research at New York University's Research Center for Mental Health. Both research positions again entailed study of topics that bear directly on the many mysteries that still surround the experience of perimenopause and menopause for many women: potential sleep disruptions, potential changes in sexual arousal, potential changes in emotional lability and baseline mood. When yet again the relatively young leader of our research team died unexpectedly at fifty-four, I became involved in research on an experimental treatment for Alzheimer's disease and studied the research literature on memory, aging, and Alzheimer's at NYU Medical Center's Rusk Institute for Rehabilitation Medicine. I observed "up close and personal" all the cognitive/behavioral/speech "glitches" of patients in different stages of decline during lengthy hours of testing and of interviewing them and their relatives, before and after treatment with hyperbaric oxygen. Familiarity with these patients primed me for "thinking about thinking" and for detecting WHM Syndrome symptoms. Familiarity with Alzheimer's patients also prepared me for noting the distinctions between Alzheimer's disease and WHMS symptoms even when they appear related. A return to graduate school for a doctorate after this research led to my doing a doctoral dissertation in the field of neuropsychology on the role of the two hemispheres of the brain in the expression of positive and negative emotions and how these can show up in subtle differences between the two sides of the face during the expression of emotions. The topics of brain-control-over-emotion and neuropsychology again bear upon issues central to my interests in understanding perimenopausal and menopausal women. After receiving my doctorate from NYU in 1982, I became director of research programs at the new Institute for the Advancement of Health, then in New York City. It was devoted to funding and giving prominence to the then-emerging interdisciplinary mind/body/health field of psychoneuroimmunology. I began to fund research, organize and attend conferences, and write about developments in different facets of psychoneuroimmunology. At that time psychologists/psychiatrists didn't know or read much about immunology, and immunologists didn't know or read much about the mind and brain. I loved my work and in relation to it even studied immunology at Mount Sinai's School of Medicine. I was immersed daily in research findings that described the negative compromising effects of stress on different aspects of the body, brain, and mind. But while the research was highly credible and intriguing intellectually, the fact was that it didn't mesh with my personal experience in living. I had long thrived on stress. Stress made me feel intensely alive, and I enjoyed rising to the occasion of it, having "Mission Impossible" tasks to accomplish in "x" number of minutes or hours. I enjoyed the "rush" of skiing and even liked to play the piano and type fast, even if I did both badly. I had long enjoyed the excitement of working on multiple projects at once, e.g., the science journalism while in graduate school. Intrigued by conferences I had been part of, and experts I had heard, to make sense of it all, I decided to become retrained in the "applied" end of psychoneuroimmunology, the then also emerging fields of health psychology and behavioral medicine, and see how life really played itself out in relation to stress. My prior research in psychophysiology related directly to this new work. Over the course of three years I received training in biofeedback; cognitive therapy; hypnosis; pain management; and the self-regulation tools of progressive relaxation training, imagery, breathing and meditation techniques (initially being as much of a skeptic and an unrelaxed person as one could be). Before starting my own private practice I trained in the offices of a neurologist who had many car accident patients suffering profound headaches, backaches, and post-traumatic stress reactions. My main interest was in wanting to hear and understand what happened to people with life stresses -- acute and chronic illnesses, pain states, panic attacks, headaches, irritable bowel problems, upcoming surgery -- how they managed, what they said to themselves, what made things better, what made them worse. I was very interested in what happened to patients' lives around their symptoms, and over time, I became adept at teaching and applying the tools of health psychology and behavioral medicine and looking for patterns. You could say I became a sick person's delight. I didn't easily tire hearing the details of symptoms. I wanted to understand their subtleties, detect their sequence in relation to other events, understand what thoughts and feelings they triggered. I enjoyed demonstrating how even a fast-talking, hyper child of wound-up Holocaust survivors could relax in an instant, becoming a puppeteer over my nerves and muscles and mind when I needed to. I enjoyed teaching patients how they could make use of a "medicine shelf" of behavioral tools that could be "popped" in an instant, anywhere, once learned, that could adjust and "tune down" their physiology and mind efficiently and with multiple levels of "payoff." The relevance of this work to the present is that I became a fairly good listener and observer tuned into observing people and trying to understand the subtleties of their symptoms from their perspective. Biofeedback, for example, taught me not to trust my first impressions. From working with it I learned that people who could look outwardly cool and calm could be highly tense when measured with muscle-tension and temperature-monitoring devices. So here I am. It is my hope that this book helps many women now and over the long run. In the course of researching it I have also come to the suspicion that for similarly hormonal reasons, having to do with estrogen's newly discovered roles in both men's brains and bodies, that some men at similar ages also experience at least some WHMS symptoms. In chapter 14 of this book I explain what I have uncovered in this regard. I also believe that WHMS symptoms are "normal" in the way that hot flashes are "normal" and use new evidence I present of WHMS symptoms existing in estrogen-deprived breast-feeding women in chapter 6 to frame the claim of "normality." I also propose that the experience of women with WHMS symptoms may offer us a novel perspective on one possible basis for the symptoms of attention deficit disorder in children. So stay tuned. This is an evolving story that will have many ramifications. The postwar population boom we commonly refer to as the baby boom generation lasted for an amazing length of time -- twenty years according to some sources, eighteen according to others. In 1997 the first wave of baby boomer women reached the average age of menopause. For the next eighteen years millions of baby boomer women will be hitting that marker if they haven't already. Many of these women during years of perimenopause have already been experiencing in great perplexity the on-and-off array of intermittently flashing symptoms I have named the WHM Syndrome, without knowing what was happening to them or who they could turn to for help. These women need to understand now what is happening to them. Before they give up careers and jobs they have often spent long years training for and striving at. Before they start sidelining themselves out of dreams and plans and hopes from a sense of despair and hopelessness. Before others needlessly sideline them out of a salary they and their families may be depending on for survival. At present, as I see it, the world of science knows virtually nothing about the many kinds of WHMS symptoms that are possible with estrogen loss. The research "pipeline" of science could take years to investigate and credit this syndrome with the gold-standard imprimatur of double-blind, placebo-controlled trials. The results of the Women's Health Initiative Study will not be out until the year 2008. And at present in this study the effects of estrogen on some aspects of cognitive functioning are only being examined in women sixty-five years and older. While interest in women of menopausal age is growing at the research level, it will take a long long time, I fear, before researchers in turn discover that some proportion of women, even in their thirties, can be affected cognitively by hormonal loss (as you will see in this book). It is my belief that the converging evidence on what estrogen does, in different animal models, in women deprived of estrogen for different reasons and given replacement hormones, in women at different hormonal tides in their menstrual cycle, in cell culture, from epidemiological studies of the effects of estrogen therapy on the risk of developing Alzheimer's, collectively offers a sufficient basis for alerting women now to what may be happening to them and to their options, particularly since estrogen replacement therapy is already an available treatment with many other proven benefits to women. In view of the epidemic number of women potentially affected by WHMS symptoms today and in the near future, in view of the evidence of the potential reversibility of the symptoms by estrogen and in the future likely with yet-to-be designed estrogen substitutes, in view of the fact that knowledge alone can relieve the suffering of women fearful about the meaning of WHMS, and in view of the potential personal and public health costs of not doing so, I believe women need to be informed of their options now so that they can become health research advocates acting to secure the research they need now. So they can educate each other and, if necessary, their doctors. To do otherwise, to not inform women in light of what I know, for me would constitute neglect. Lastly, as you read this book I ask you to ponder, as I often have, the question "How could this syndrome have been kept a secret for so long?" Claire L. Warga, Ph.D. Copyright © 1999 Claire Warga. All rights reserved.