Clinical management of the menopausal woman

It is estimated that in the future, in industrialized countries, physicians will spend the majority of their time treating women over 65. In terms of the individual female patient, women may expect to live one-third of their lives after menopause. The hot flashes that are experienced by most postmenopausal women, in many cases for 5 years or more, are the most common indications for estrogen replacement therapy, and there are studies showing lower levels of estradiol and estrone in women severely afflicted than in those who are not. A long-range indication for estrogen replacement therapy is osteoporosis, which in the U.S. causes 700,000 bone fractures annually, of which 300,000 are femoral neck (hip) fractures. Another common fracture in this group is vertebral fracture, which is six to ten times as common in postmenopausal women as it is in men of middle or old age. Another condition thought by a majority of researchers to benefit from estrogen replacement therapy is cardiovascular disease. In fact, it is well demonstrated that there is significant reduction of cardiovascular risk in healthy users and in women with other risk factors. Atrophy of mucosal surfaces of the genitourinary tract is treated both by systemic administration of estrogen and by topical administration of estrogen-containing cream. Certain conditions, grouped together as the "menopausal syndrome," may also be indications for estrogen replacement.(ABSTRACT TRUNCATED AT 250 WORDS)