Victoria Mckeithan Parrott

Estrogen: Elixir of Youth

Lauren sat at the edge of her bed, face in hands, sobbing. Her life, as she perceived it, would soon be destroyed. She felt betrayed by her own body. For years she had fought relentlessly against developing wrinkles, weight gain and other signs that tried to drag her into an unwanted maturity. She thought the efforts had paid off. She was still young, wasn't she? Then how could this "thing" have happened to her? This beckoning to age! The doctor said all the symptoms were there. When Lauren wanted physical proof, he confirmed the diagnosis through blood tests, it was menopause. Lauren remembers playing a word association game in her head, the doctor said menopause and she thought death. Recalling that, she felt the thought odd and emotional. She had been depressed and emotional for a long time. It was not so much the flaming hot flushes or drenching night sweats she experienced regularly that terrified her. It was the damnation of life without her protective female hormones, estrogen and progesterone. She had read during the decline of estrogen that her skin would become dry, thin and itchy (Gillispie 217). Bone loss would excelerate, which meant possible osteoporosis (Gillspie 6). She would experience the shrinking and drying out of her reproductive and associated organs, that meant her breasts (Tortora 959). Her blood vessels would become less flexible and hardening of the arteries might increase rapidly (Henig 6). And over time, with her hefty estrogen supply no longer present, it would only become worse. These were the "golden years" thought Lauren, with sadness and sarcasm. There seemed to be no reason to look forward to the future. She knew the joke was obviously on her, or was it? She questioned her thoughts as she reached for the pamphlet stuffed neatly inside the leather handbag. It read, in bold letters, "What About Estrogen Replacement Therapy?" Lauren wiped her face, slid to the head of the bed, eased into her pillow, opened the pamphlet and began to read.

Estrogen and progesterone's clinical use began during the end of World War II. During that time progesterone was perceived to have no value because it supplied no symptomatic relief. However, estrogen was famed for supplying prompt, unmatched relief for recognized menopausal problems. Flushes, sweats and a variety of emotional problems were considered the urgent, major symptoms that needed to be treated. Estrogen therapy became in vogue; it was distributed widely and in high doses. For a short time, women experienced relief from menopausal symptoms. Over time, problems began to appear involving the new wonder drug. Cases of thrombosis (blood clotting), excessive uterine bleeding and endometrial (lining of the uterus) cancer were reported in increasing numbers. It was clear these problems were the result of extreme and prolonged estrogen use. Estrogen treatment, by 1970, had fallen to as status of unacceptable consequences. The decade that followed brought extensive research involving the use of progesterone to diminish the persistent dangerous aspects of unopposed estrogen use (Gillspie 53-55). The findings yielded good news. Professor Clark Gillspie writes, "It was demonstrated, to almost universal agreement, that an estrogen-progesterone combination not only represented a safe menopausal treatment, but also actually appeared to protect the patient from uterine cancer, breast cancer and, perhaps, certain other problems" (55). This new combination became the modern hormone replacement therapy program.

Our great-grandmothers did not have to worry about living long enough after menopause to deal with the debilitations that come with osteoporosis, rapid loss of the bone's calcium and arteriosclerosis, hardening of the arteries (Gillespie 217). Had our great-grandmothers lived on for the additional thirty to forty years, they would have suffered the "natural" postmenopause continuum with all its risks and debilitations (Sheehy 144). Women today are not only living longer but they are living fuller lives. They demand a safe and healthy journey into maturity (Gillespie 212). The years after estrogen production has declined may be managed through diet, exercise, calcium supplements, counseling and hormone replacement therapy. The hormone dilemma is one that must be weighed carefully by each and every women, according to her medical history and needs.

It is a must to weigh the pros and cons of any medication you plan to take over a period of time. HRT (hormone replacement therapy) is certainly no different and deserves serious consideration. According to an article written by Claudia Wallis for Time magazine, likely risks of hormone replacement therapy include: a higher rate of breast cancer, abnormal clotting, weight gain, headaches and risk of gallstones (50). According to Gail Sheehy, there is a small increase in the risk of breast cancer with prolonged use of estrogen (183). Wallis also indicates increased incidences of endometrium cancer and growth of benign tumors in the uterus (51). There is also the chance that menstrual bleeding will return, along with the premenstrual type symptoms of fluid retention, breast tenderness and irritability (Wallis 50). Women who do not wish to make the choice of hormone therapy may want to try alternatives. Osteoporosis and heart disease may be fought with aerobic and weight bearing exercise. These women should refrain from smoking and eat a diet high in calcium and low in fat. There are current drugs for heart disease and promising new drugs for osteoporosis (Wallis 51). Women who choose not to replenish their body's estrogen supply will also experience atrophy (shrinking) of the breasts and vagina. Decrease of sex drive, hot flushes, emotional instability, fatigue and other general symptoms become the body's rule (Gillspie 213). The later symptoms can last up to several years, while atrophy of the reproductive organs, osteoporosis and arteriosclerosis occur in the time frame of all the years that follow menopause (Gillspie 216-217).

Dr. Clark Gillspie writes that "hormone replacement therapy is less important than insulin for a diabetic, but it is as important as any replacement therapy that you might ever be involved with" (210). In ordinary circumstances, the benefits of hormone replacement far outweigh the risks involved. A woman may begin a hormone therapy program as soon as she has experienced the first symptoms of menopause (Gillspie 211). The benefits of estrogen and progesterone therapy are many. Therapy prevents osteoporosis, decreases heart attacks and insomnia. Hormone replacement improves energy, mood, concentration, memory and sense of well being. The cessation of hot flashes and restoration of sexual interest and comfort are two benefits that have received rave reviews. Many of these benefits combined may improve longevity (Sheehy 183).

Claudia Wallis writes of gynecologist Robert A. Wilson, "He was convinced that, given early enough and continued throughout life, hormone treatment could actually prevent what he called the 'staggering catastrophe' of menopause and the 'fast and painful aging process' that attended it" (Wallis 46). Currently estrogen is the number one prescription drug in America. This fact is not surprising, "estrogen is powerful stuff, receptors for the hormone are found in some three hundred different tissues, from brain to bone to liver" (Wallis 49). With knowledge of such a fact, one might understand why the menopausal decline in hormones creates such bodily mayhem.

Finally, the decision to enter into hormone replacement therapy, or not, is a very individual one. Each woman must assess her own health in regards to cancer, heart disease and osteoporosis relative to her family history. Each woman's personal philosophy toward menopause also plays an important role (Wallis 52). "As is so often the case in modern medicine, the most a patient can ask of her doctor is to lay out the risks, the benefits and the honest fact[s]... and then let her make the choice" (Wallis 53).

Nearly a year and a half had past since Lauren began hormone replacement therapy. The first few months had been trial and error. She had tried several estrogen and progesterone dosages before she and her doctor found one adequate to her needs. The hot flashes had stopped immediately and she finally slept peacefully through the night. The mood swings and depression disappeared. She continued her exercise and diet regimes with purpose and zest. Lauren admired her reflection, as she applied finishing touches, she thought a dab of parfum would do nicely. She felt wonderful, young and energetic. It was her birthday and Patrick was taking her out for a romantic dinner. "Darling, our reservations are for eight o'clock," Patrick said as their eyes met. Lauren knew the gaze; it was one of affection and approval. Her wrap was already in hand, as she moved quickly and gracefully toward him. Patrick smiled as Lauren kissed his cheek, "Lauren, you become more beautiful and vibrant every year." They entered the doorway together; Lauren winked and smiled devilishly, "Darling, you haven't seen anything yet!"

Bibliography

Gillespie, Clark. Hormones, Hot Flashes and Mood Swings. New York : Harper, 1994.

Henig, Robin Marantz. "Myths About Menopause." Seasons Aug. 1991 : 4-6

Sheehy, Gail. Silent The Passage. New York : Pocket, 1993.

Tortora, Gerard J., and Reynold Grabowski. Principals of Anatomy and

Physiology. New York : Harper, 1993.

Wallis, Claudia. "The Estrogen Dilemma." Time 26 June, 1995 : 46-53