[Menopause and postmenopause. Prognostic criteria in insurance medicine]

The increasing proportion of elderly people in the population is presenting politics, society and also medicine with significant new challenges. Gerontology and geriatrics play a role in every area of preventive and curative medicine. Since the life expectancy of women is about 8 years longer than that of men and the greater portion of an aging society will be female, gynaecology takes on special significance. The necessity of developing old-age gynaecology becomes more and more urgent, particularly in view of the fact that postmenopausal women still have more than one third of their lives before them, a period which they would like to and should spend in good mental, psychological and physical condition. Postmenopausal hormone replacement therapy has been remarkably successful in treating climateric complaints and in positively affecting the entire organism. The ability of women to virtually avert later consequences of the hormone deficiency, including osteoporosis-induced fractures, heart attacks and strokes, by means of long-term hormone replacement is one of the great achievements of our time. Furthermore, the importance of hormone replacement therapy in the possible reduction of certain types of genital cancer, as endometrial and ovarial carcinoma, cannot be overstated. Gynaecology has taken a great step toward enabling older women to spend this third stage of their lives free of unnecessary disease or suffering. There is a consensus in literature and among medical experts today that the advantages of estrogen replacement during and following menopause have been proven and are to be highly regarded. The advantages and risks of hormone therapy will be explored from the special standpoint of morbidity and mortality ratings, particularly for the disease patterns of osteoporosis, Alzheimer's disease, heart attack, stroke, as well as breast, endometrial, ovarial and colon cancer. For insurance medicine, these aspects are of paramount significance. Quantification with regard to morbidity and mortality statistics is a challenge that will have to be faced in the years to come.