We evaluated the bone tissue modifications which occur in pre-, peri- and postmenopausal women by means of an ultrasound (US) device which measures US propagation velocity in the distal metaphysis of the proximal phalanxes of the hand. Before starting the study, two operators assessed the in vivo short-term precision of the device in 12 volunteers, each measured 10 times (5 times by each operator). Then the US velocity in the dominant (DO) and non-dominant (ND) hand was measured in 228 women to evaluate whether there was a difference between US values measured at these sites. Finally, another selected group of 417 healthy pre-, peri- and postmenopausal women, aged from 40 to 65 years, was studied to evaluate the physiological climacteric changes in the US parameter measured: amplitude-dependent speed of sound (AD-SoS). In the 12 volunteers, intra- and inter-observer short-term precision (CV) was 0.4% (for both the operators) and 1.0%, respectively. DO and ND hand AD-SoS values (2074.1 +/- 63.8 m/s and 2077.1 +/- 65.5 m/s, respectively) proved to be highly correlated (r = 0.96, p < 0.0001) in the 228 women studied. AD-SoS distribution (417 subjects) was correlated with age, climacteric condition (premenopause with regular or irregular cycles and natural postmenopause) and body mass index (BMI). In premenopause (253 subjects) the US velocity was higher among women with regular cycles (2107.2 +/- 48.5 m/s) than among those with irregular cycles (2074.7 +/- 44.1 m/s) (p < 0.0001). In postmenopause (164 subjects) an inverse correlation between AD-SoS and the time elapsed since menopause was found (r = -0.42, p < 0.0001). Furthermore, age and BMI were shown to be inversely related to AD-SoS (r = -0.47, p < 0.0001 and r = -0.30, p < 0.0001, respectively) when evaluated in the whole study group. The results obtained confirm that US transmission at the phalanxes is sensitive to pre-, peri- and postmenopausal bone changes. Further studies are needed to evaluate its ability to predict osteoporotic fracture risk.