The "physiology" of the climacterium.

The climacteric represents both a time of declining gonadal function and general aging with subsequent alterations in those organs responsive to sex hormones. Men and women differ in that in women sex hormone production is intimately linked to the presence of gametes. As the number of oocytes is fixed at birth and oocytes are lost at a relatively constant rate, gonadal failure is the inevitable result. When the human life expectancy did not exceed the age of the climacteric, this was not a clinical problem for our species. With our rapidly lengthening life span, however, the medical impact of an extended life span without reproductive hormones becomes significant. In order to address these clinical problems in a humane and cost-effective manner to improve the quality of life for our increasingly aging population, a thorough understanding of the climacteric is mandatory for any physician treating women. Like most concepts in medicine, this one is not new. Borner stated in 1887: The climacteric, or so-called change of life in women, presents, without question, one of the most interesting subjects offered to the physician, and especially to the gynecologist, in the practice of his profession. The phenomena of this period are so varied and changeable, that he must certainly have had a wide experience who has observed and learned to estimate them all....it is desirable in the interest of our patients of the other sex, that the greatest possible light should be thrown upon this question. The modern practitioner will need to apply all the skills and resources available to adequately deal with the multitude of interrelated problems that beset women beyond the climacteric.