Ovarian failure and ageing

Abstract

Summary It is difficult to separate the true symptoms of oestrogen deficiency from symptoms of ageing and the effects of social and domestic problems of the middle-aged woman, but a careful history eliciting vasomotor symptoms or atrophic vaginitis, or a recent onset of psychogenic symptoms, identifies the patient who might benefit from the only specific treatment of oestrogen deficiency — namely oestrogen. Response is usually dramatic and gratifying, and the good health regained rapidly becomes addictive, with patients unwilling to accept drenching night sweats, disturbed sleep and ensuing tiredness, lethargy, irritability, loss of concentration and depression, and relieved that they can once more function normally. The physician can also be reassured that there is no evidence in the medical literature that low-dose oestrogen therapy with additional cyclical progestogens, if the patient has a uterus, increased the incidence of endometrial cancer in climacteric patients; it may indeed reduce the incidence of cardiovascular problems, hypertension, osteoporosis and fractures. There remains a desperate need for well-controlled studies on the aged geriatric population to determine whether oestrogen therapy is of long-term benefit to the wellbeing of women, and to establish whether any protection from skeletal or cardiovascular pathology will reduce the duration of pitiful ‘pre-death dependency’ in this population.