The menopause and its treatment in perspective

• menopause
• hormone replacement therapy
• postreproductive gynaecology

The menopause, the last menstrual period, marks the end of a continuum of declining physiological fertility. Decreased fertility in relative or absolute terms antedates the menopause by 10–15 years. The climacteric is the period of time (about 4–5 years) around the menopause during which ovarian function is gradually compromised. By the turn of the 20th century life expectancy in women of the Western world was about 58 years, at present it is about 82, but as the mean age of the menopause, 51 years, has not changed more than one third of a woman's life is expected beyond the menopause. This is the first time in human history where long postmenopause existence is witnessed on such a scale. More importantly, the disability-free life expectancy, between the ages of 50 and 60, for the whole population, largely due to cardiovascular disease and arthritis, has not changed over the last 30 years.1 For either gender, ageing is the primary factor influencing disabilities related to cardiovascular disease, arthritis, Alzheimer's disease, visual and hearing problems. As far as women are concerned it is expected that more such disabled women will live after the menopause, which is increasingly found to be a confounding variable and the treatment of which may profoundly influence the clinical progress of such disabilities. With the expected increase in postmenopausal population over the next 30 years, the health issues modulated by the menopause have moved from a peripheral medical interest into a central health care programme that commands a different strategy for resource allocation and for service delivery.