ENOPAUSE REPRESENTS, perhaps, the single most influential biological or health-related event for most middle-aged women, and it is estimated that the average woman will spend at least half of her adult life with decreased levels of circulating estrogen. 1,2 Decisions concerning hormone replacement therapy represent major concerns for postmenopausal women. Declining estrogen levels characterize menopause with effects on a range of systems including, in addition to the reproductive system, the cardiovascular and skeletal systems. 3 Furthermore, there is evidence that estrogen affects basic neural processes in mature animals. 4 Estrogen has also been shown to affect cognitive function in animals, for example, improving working memory in rats. 5 Observational studies and clinical trials have examined the influence of estrogen on cognitive function, particu

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SUMMARY Chlamydia trachomatis is the most common bacterial sexually transmitted pathogen worldwide. Infection can result in serious reproductive pathologies, including pelvic inflammatory disease, ectopic pregnancy, and infertility, in women. However, the processes that result in these reproductive pathologies have not been well defined. Here we review the evidence for the human disease burden of these chlamydial reproductive pathologies. We then review human-based evidence that links Chlamydia with reproductive pathologies in women. We present data supporting the idea that host, immunological, epidemiological, and pathogen factors may all contribute to the development of infertility. Specifically, we review the existing evidence that host and pathogen genotypes, host hormone status, age of sexual debut, sexual behavior, coinfections, and repeat infections are all likely to be contributory factors in development of infertility. Pathogen factors such as infectious burden, treatment failure, and tissue tropisms or ascension capacity are also potential contributory factors. We present four possible processes of pathology development and how these processes are supported by the published data. We highlight the limitations of the evidence and propose future studies that could improve our understanding of how chlamydial infertility in women occurs and possible future interventions to reduce this disease burden.

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