Cardiovascular disease remains the leading cause of death in women. Given accumulating evidence on sex- and gender-based differences in cardiovascular disease development and outcomes, the need for more effective approaches to screening for risk factors and phenotypes in women is ever urgent. Public health surveillance and health care delivery systems now continuously generate massive amounts of data that could be leveraged to enable both screening of cardiovascular risk and implementation of tailored preventive interventions across a woman’s life span. However, health care providers, clinical guidelines committees, and health policy experts are not yet sufficiently equipped to optimize the collection of data on women, use or interpret these data, or develop approaches to targeting interventions. Therefore, we provide a broad overview of the key opportunities for cardiovascular screening in women while highlighting the potential applications of artificial intelligence along with digital technologies and tools.

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Every woman, if she lives long enough, will transition into menopause, and as the US population ages, women will be spending more time in a postmenopausal state than before. For postmenopausal women, the decision to initiate menopausal hormone therapy should be individualized. A thorough evaluation of the patient's cardiovascular, venous thromboembolic, cancer, and fracture risk should be considered along with the woman's quality of life. Hormone therapy exerts its therapeutic effects on vasomotor symptoms, the skeleton, and the genitourinary system independent of age since menopause and these benefits are lost once hormone therapy is stopped. Here we review the pharmacologic properties dose, formulation, mode of administration, timing of initiation, and duration of hormonal therapies in regard to optimizing benefit and minimizing risk to the patient. This discussion will focus on the effects of common hormonal therapies including estrogen (local and systemic), progesterone, estrogen receptor agonist/antagonist, and local dehydroepiandrosterone and include a brief review of compounded bioidentical hormone therapy.

E strogens are the principal sex hormones responsible for female reproductive maturation and sexual characteristics. However, androgens are also important for female sexual health and well-being. 1 The physiologic effects of androgens are in part due to their role as precursors for estrogen synthesis, but these hormones also have independent effects on female reproductive tissues, mood, cognition, breasts, bones, muscles, vasculature, and other systems. 1 See related editorial, page 44Here we will discuss the physiologic roles of androgens as well as the indications and best-practice recommendations for androgen therapy in women. ■ ANDROGEN SYNTHESIS, PRODUCTION, AND MEASUREMENT IN WOMENThe biologically active androgens in women are dehydroepiandrosterone sulfate (DHEA-S), dehydroepiandrosterone (DHEA), androstenedione, testosterone, and dihydrotestosterone. In women, roughly 25% of androgen production occurs in the adrenal glands, 25% occurs in the ovaries, and the rest occurs peripherally. 2 DHEA-S, DHEA, and androstenedione are the main prohormones that are peripherally converted to the active androgens testosterone and dihydrotestosterone. DHEA-S is almost exclusively produced in the adrenal glands, whereas DHEA, androstenedione, and testosterone are produced in the adrenal glands and ovaries and by peripheral conversion. In target tissues, circulating testosterone is converted to dihydrotestosterone by 5-alpha-reductase and aromatized to estradiol .

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