Wann ist „Schluss mit lustig“? – gynäkologische Sicht

Aging can be medically defined by terms such as frailty, decreasing muscle strength (sarcopenia), or brain atrophic changes (Alzheimer’s disease). An essential aspect of the ageing process is characterized by a decreasing energy supply to body cells by mitochondria. Glucose metabolism also becomes less efficient. This limits lifespan and the quality of life. The degradation can be slowed by adopting the most positive lifestyle behavior. Medication approaches are of limited effect. Estrogens can influence glucose metabolism in women. Insulin sensitivity is maintained. The energy substrate supply is stabilized. Estrogen effects are dependent on sufficient expression of the estradiol receptors. Expression decreases with increasing age. Estradiol may therefore lose its positive effect in old age. Metformin for treatment of type 2 diabetes mellitus is effective and therapeutically safe in the elderly. It maximally increases mitochondrial energy performance. In old age, however, mitochondria are already at their performance limits. Therefore, here too should the effect be monitored closely with increasing age. The combination of prophylactic metformin with physical exercise is counterproductive. Glucagon-like peptide (GLP) receptor agonists are also highly effective in the treatment of diabetes mellitus. As an anorectic, however, their effect in old age is critical, as it can increase sarcopenia and thus frailty. The ageing process is fateful. It can be delayed with a healthy lifestyle and drug therapies. However, age-related changes in drug effects must be taken into account.