Universidad Católica de Santiago de Gua… 176 PUBLICATIONS 2,420 CITATIONS

Methods: Citations were selected from a PubMed search and the authors ’ files according to their clinical and experimental relevance. Results and Discussion: Although experimental and some observational data have supported the fact that estrogens are beneficial for the female vascular system, these positive actions have been challenged by the results of theWomen’s Health Initiative trial and theMillion Women Study, which demonstrated an increase in cardiovascular risk and related adverse events. The role of hormone therapy for the menopause has shifted from a preventive use to a limited role in symptom management, for which it remains the most effective intervention. Baseline evaluation of menopausal women should include individual cardiovascular risk assessment, including hypertension, dyslipidemia, elevated body weight, and the metabolic syndrome. Concomitantly, new factors influencing cardiovascular risk have been de-lineated among postmenopausal women, namely sleeping disorders, depression, vitamin D insufficiency, rheumatoid arthritis, sexual dysfunction, stress, and psychosocial factors. Therefore, a new landscapemay be recognized for men-opausal women management. Precise evaluation and treatment of each factor should be separately assessed to im-prove quality of life and reduce cardiovascular disease prevalence. At present, cardiovascular risk reduction strategies are a requisite (albeit underused) for menopausal women. These include education in terms of health, healthy lifestyle, and pharmacologic preventive interventions to reduce co-morbid conditions. (Fertil Steril 2009;92:1171–86. 2009 by American Society for Reproductive Medicine.