Pills to Keep Women Young

All over the U.S., women in their 40s and 50s are going to doctors and demanding "the pills that will keep me from growing old." Women in their 60s and over are asking for "pills to make me young again." In each case, what they are really asking for are doses of hormones to slow down or reduce the ravages of age.

Such hormone therapy is not new (TIME, Oct. 16, 1964); the current excitement has been stimulated by recent magazine articles and especially by a book, Feminine Forever, by Brooklyn Gynecologist Robert A. Wilson (M. Evans & Co., Inc., $5.95). According to the ads, Feminine Forever is the answer to the Hokinson woman's prayers --it tells "how to avoid menopause completely in your life, and stay a romantic, desirable, vibrant woman as long as you live. It shows how women who already have gone through the anguish of menopause can . . . grow visibly younger day by day." The author himself does not go quite that far, although he says his work is "one of the greatest biological revolutions in the history of civilization."

Tart Suggestion. Revolution or not, the hormone replacement program that Dr. Wilson advocates is designed to deal with a process of nature. A woman's output of sex hormones, which come mainly from her ovaries, decreases with the menopause and nears zero as she nears 80. This would cause little distress if the only function of the hormones was to preserve her monthly cycle of ovulation and menstruation--it would simply mark the end of her fertility period. But some of the hormones, especially the estrogens, fill many other biological needs. They help to keep the breasts firm and the skin supple and relatively wrinkle-free; they help keep down the level of fats in the blood and thus reduce the risk of heart attacks, and they help to keep the bones strong and hard. They have other metabolic effects as well, and some subtle influences on the emotions.

Centuries ago, the effects of hormone decline were less conspicuous because so few women lived beyond the menopause. Now modern medicine has added 30 or more years to the female life span. And still, Dr. Wilson complains, physicians generally dismiss post-menopausal changes as part of the "natural" aging process. Their attitude, he suggests tartly, stems from the fact that "most doctors, being male, are themselves immune to the disease." As he sees it, the menopause is "castration," and he asks whether his colleagues would tolerate so casually a similar fate in themselves.

Dr. Wilson compares the menopause to diabetes, arguing that both are deficiency diseases. His own efforts to correct woman's menopausal deficiency began in the 1920s. At first he had only crude hormone extracts, which had to be injected. Now there is a plethora of estrogens and of the other sex hormones, progestins and androgens. Most of them are at least partly synthetic, and they can be taken easily by mouth. A couple of years ago, a patient who had kept on taking the birth-control pill Enovid after her menopause gave Dr. Wilson a new insight: the pill--which contains both a progestin and an estrogen-seemed adequate and acceptable for alleviating the "change of life."

The Fortunate Ones. To be sure, some women suffer only minor discomfort during and after menopause; they undergo changes slowly. Dr. Wilson believes that these fortunate ones are only 15% of the total, whereas other doctors put the number as high as 40% to 50%. For the rest, whatever the percentage, Dr. Wilson is an all-out advocate of hormone replacement therapy, preferably beginning as early as age 30. With proper professional caution, he insists that a woman should take hormones only under a doctor's care, and should have a Papanicolaou smear test every year. The test serves a dual purpose: besides being a precautionary check for early cancer, the smear is read to show what percentage of the woman's vaginal cells are healthy, prime-of-life types, as compared with the cells of old age. Dr. Wilson calls this "the femininity index" and says it should be 85% .

For a woman just beginning to notice the hot flushes and sweats that are the warning signs of oncoming menopause, Dr. Wilson prescribes estrogen tablets daily for seven to 21 days a month, adjusting the dosage until her femininity index is restored to 80% or better. For a woman with more severe symptoms, he prescribes estrogens plus a ten-day course of a synthetic progesterone substitute. A woman who is clearly past the menopause gets estrogen daily for six weeks plus a progestin tablet on each of the last ten days. The effect of this treatment is to restore a pseudomenstrual cycle of about seven weeks, with some bleeding in the last week. In no case do the hormones restore fertility.

How Safe Are They? Many doctors who approve of most of Wilson's hormone therapy see no reason for an older woman to have bleeding episodes, and they feel there may be good reasons why she should not. There are others who express either skepticism or opposition to virtually any hormone replacement. The authoritative and conservative Medical Letter grudgingly concedes that for women suffering the obvious and immediate discomforts of the menopause, estrogens are "relatively harmless" if given for only a few months, or a year or two at most, and may be helpful for emotional distress. But the Letter editors are still not sure that estrogens help to preserve a youthful complexion or guard against heart attacks, dowager's hump or broken bones.

Since increasing numbers of reputable, middle-of-the-road gynecologists and other doctors have taken to prescribing estrogens, even though they may not accept Dr. Wilson's more extravagant claims, two questions are constantly reiterated: How safe are the hormones? Could they eventually cause cancer? The answers are surprisingly clear. If a woman takes only the prescribed dose--but no more--the hormones seem to be perfectly safe. The only patients for whom they emphatically should not be prescribed appear to be those who have already had cancer of the breast or uterus, those with liver disease, and (just possibly) those who have had endometriosis (abnormal growth of the lining of the uterus).

Medical Letter agrees there is no evidence that the hormones can cause cancer. In fact, there seems to be evidence that they guard against it. Harvard's Dr. Robert Kistner believes that the progestins may be useful in treating endometrial cancer. The University of Chicago's Dr. M. Edward Davis has been giving estrogens for 25 years to women who have suffered an "instant menopause" from hysterectomy, and has had not one case of genital cancer among these patients.

Though Dr. Wilson has been the most articulate, he has not been the only investigator of hormone replacement. Dr. William H. Masters, St. Louis' scholar of sexual responses (TIME, Jan. 7), has tried estrogens, progestins, and testosterone (the principal male sex hormone) in various combinations. He believes that hormone prescriptions should be tailored to the individual patient, and though his own methods differ from Wilson's, Dr. Masters welcomes Feminine Forever because he believes it will focus attention on a problem that the medical profession has too generally ignored.

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