Schiefeling M
Munich Reinsurance Company.
J Insur Med. 1996;28(1):27-34.
The increasing proportion of the aged in the population is posing significant new challenges to politics, society and medicine as well. Gerontology and geriatrics are playing a role in all areas of preventive and curative medicine. Since the life expectancy of women is approximately eight years longer than that of men, gynecology draws special significance from the fact that the greater part of an aging society will primarily be comprise of women. The medical treatment and care of women in climacteric and postmenopause in the past is seriously inadequate by today's standards. The attitude in earlier years of not making any great investment of cost or personnel in patients over 75 can, in view of the vitality of modern-day senior citizens, no longer be justified or maintained. The necessity of establishing old-age gynecology becomes more and more clear and urgent. The decrease of ovarian function in menopause is without doubt an important turning point in the life of a woman. The first signs of aging are inescapable. Following these years a woman still has more than one third of life expectancy ahead of her which she would like to and should spend in good mental, spiritual and physical health. The principle of postmenopausal hormone replacement has shown itself to be amazingly successful in treating climacteric disorders and their effects on the entire organism. Treatment over many years with as board a spectrum as possible of preventive hormones to combat the long-term consequences of hormone deficiency, like osteoporosis-related fractures, heart attacks, or strokes, is one of the great medical advances of our time. Furthermore, the significance of preventing a number of genital concern manifestations through hormone replacement therapy cannot be overestimated. Gynecology has taken a remarkable step toward its goal of enabling aging women to spend the third part of their lives free of unnecessary diseases and suffering. In 1994, after consultation with representatives of European countries during the World Congress of the International Menopause Society, a statement was published by the menopause society of German-speaking countries. In this consensus paper, a stand was taken on hormone replacement therapy in postmenopause. The purpose of this paper was to serve as an aid in formulating and interpreting the text in the package inserts that are enclosed with hormone preparations. The most important passages were to once again summarize the present status of knowledge on hormone replacement therapy and its risks and benefits: (Estradiol is the estrogen normally produced by a woman's ovaries that exercises all functions of the natural follicle hormone. It is used to treat all symptoms of estrogen deficiency). Estrogen eliminates, or mitigates, all typical symptoms of estrogen deficiency in menopause, including hot flashes, night sweats and other complaints frequently observed like nervousness, sleep disturbance and depression, with great reliability. Estrogen stimulates the cell division of an aging organism, of mucous membranes, of supportive and connective tissue. It improves the blood circulation and the salt and water content. Furthermore, estrogen prevents or eliminates deterioration in the urogenital area and the disorders that result from such deterioration. Estrogen prevents or retards bone deterioration, osteoporosis and spinal, lower arm and femur fractures. By positively influencing HDL- and LDL-cholesterol, blood vessels and circulation, long-term estrogen replacement inhibits the development of arteriosclerosis and nearly halves the frequency of heart attacks and strokes. The mortality rate of women over 50 is therefore decreased significantly and life expectancy increased. (Benefits to the blood vessels of such preventive treatment can already be seen after five years of estrogen therapy and their benefits continue for several years after treatment is stopped.
人口老龄化比例的不断上升给政治、社会以及医学领域都带来了重大的新挑战。老年学和老年医学在预防医学和治疗医学的各个领域都发挥着作用。由于女性的预期寿命比男性大约长8年,鉴于老龄化社会的大部分人群将主要由女性构成,妇科医学便具有了特殊的重要意义。按照如今的标准来看,过去针对处于更年期和绝经后期女性的医疗和护理严重不足。鉴于现代老年人的活力,早年那种不在75岁以上患者身上投入过多成本或人力的态度已不再合理,也无法维持。建立老年妇科的必要性变得越来越清晰和紧迫。绝经过程中卵巢功能的衰退无疑是女性生命中的一个重要转折点。衰老的最初迹象不可避免。在经历这些岁月之后,女性仍有超过三分之一的预期寿命,她们希望并且应该在良好的心理、精神和身体健康状态下度过这段时光。绝经后激素替代疗法的原则已被证明在治疗更年期紊乱及其对整个机体的影响方面极为成功。多年来使用尽可能广泛的预防性激素进行治疗,以对抗激素缺乏的长期后果,如与骨质疏松相关的骨折、心脏病发作或中风,这是我们这个时代重大的医学进步之一。此外,通过激素替代疗法预防多种生殖系统相关问题表现的重要性再怎么强调也不为过。妇科医学在实现让老年女性在生命的第三阶段免受不必要疾病和痛苦这一目标上迈出了显著的一步。1994年,在国际绝经学会世界大会期间与欧洲国家代表协商后,德语国家绝经学会发表了一份声明。在这份共识文件中,对绝经后激素替代疗法表明了立场。本文的目的是辅助制定和解读激素制剂附带的药品说明书中的文字内容。最重要的段落再次总结了激素替代疗法的现有知识状况及其风险和益处:(雌二醇是女性卵巢正常产生的雌激素,它行使天然卵泡激素的所有功能。它用于治疗雌激素缺乏的所有症状)。雌激素能够消除或减轻绝经后雌激素缺乏的所有典型症状,包括潮热、盗汗以及其他常见症状,如紧张、睡眠障碍和抑郁,且可靠性极高。雌激素能刺激衰老机体、黏膜、支持性和结缔组织的细胞分裂。它能改善血液循环以及盐和水的含量。此外,雌激素可预防或消除泌尿生殖区域的退化以及由此退化导致的紊乱。雌激素可预防或延缓骨质退化、骨质疏松以及脊柱、上臂和股骨骨折。通过对高密度脂蛋白和低密度脂蛋白胆固醇、血管和血液循环产生积极影响,长期雌激素替代可抑制动脉硬化的发展,并使心脏病发作和中风的发生率几乎减半。因此,50岁以上女性的死亡率显著降低,预期寿命增加。(这种预防性治疗对血管的益处,在雌激素治疗五年后即可显现,且在治疗停止后其益处还会持续数年。