[Thoughts on long-term estrogen substitution--should gynecologists change their mind?]

Public opinion and a large proportion of physicians believe that very often women must necessarily experience a restricted quality of life as a result of menopause, postmenopause and the senium, and that even a possible early death from the sequels of osteoporosis is quite natural and hence inevitable. However, the present state of the art rules out such fatalism, since it has been established beyond doubt that early initiation of oestrogen and progestagen substitution after the menopause is of high prophylactic value both from the viewpoint of social medicine and also in each individual case. Calculations of cost and effect in elderly women have shown that treatment results in reduced morbidity and mortality caused by carcinoma of the breast and of the endometrium, and also by cardiovascular disease, quite apart from an enhanced quality of life. Hence, all women who would like to receive such prophylactic treatment--in particular, also risk patients likely to suffer from osteoporosis-should definitely not be deprived of regular long-term administration of oestrogen that should continue until old age. The only basic condition is the sequential administration of oestrogen and progestagen at low dosage levels.