Geriatric gynaecology

The menopause is the physiologic cessation of normal, cyclic ovarian function. The development of vasomotor symptoms, atrophic changes in the genito-urinary system and osteoporosis are associated with oestrogen deficiency. Osteoporosis is the most important consequence of ovarian failure because it causes considerable morbidity and mortality. There is no simple screening test for detecting postmenopausal women who are at risk of developing osteoporosis. Oestrogen replacement therapy affects lipid metabolism and may be associated with the risk of developing endometrial cancer, breast cancer and thromboembolic disease. The addition of a progestogen regime have shown to reduce the risk of endometrial pathology. The most consistent and beneficial effect of oestrogen is the prevention of osteoporosis and subsequent fractures. Non-hormonal treatment regimes for postmenopausal osteoporosis include calcium, calcitonin and 1-alpha hydroxyvitamin D. It may be possible to use hormonal treatment for the optimal control of menopausal symptoms and non-hormonal treatment as long term prophylaxis.