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third or one-quarter of its earlier output. By the time she gets into the sixties and
onwards it will have fallen to one-sixth. During the menopause her gonadotrophins
will be increased to try to stimulate her ovaries to keep up the supply of oestrogen with
inevitable failure; so she may suffer the unpleasant hot flushes and possibly the drenching
night sweats. We may notice a change in her emotional stability; she may be
depressed, tearful, anxious, crying for no reason, rather negative, and tending to flare
up into angry or catty outbursts for little reason. Her hair, formerly bright, glossy,
and pretty, is becoming dull and lifeless, and is made still worse by her own neglect.
She may have morbid fears about the future, about growing older, about the children
leaving home, about the extent and nature of her husband's outside activities. Her
physical strength has declined from what it used to be.
Somewhere between 60 and 70 she has passed the stage of emotional instability,
but the years are catching up. By degrees she will acquire the drooping eyelids, crow's
feet, mouth creases, sagging cheeks, wrinkles in her face, and vertical skinfolds in her
neck; on the back of her hands the skin will gradually lose its elasticity, become thin
and the veins prominent; her nails may become ridged. Her stature is starting to shrink,
she has the beginnings of a buffalo hump at the base of her neck, her lower jaw is
slightly shrunken. Her figure has lost its former contour. Her axillary and pubic hair
is sparse; the vaginal secretions are drying up; the vulva is becoming atrophic and thin;
libido is diminished, and the vaginal cytology shows the changes of old age. Her blood
cholesterol is rising, as is possibly also her blood pressure, and arterial disease is advancing.
In her seventies and onwards she will turn into the little frail old woman, deeply
lined and pigmented, with the pale face, sunken eyes, eyebrows almost gone, thin dry
hair, dense rings round her corneae, hairs on her chin and upper lip. Her body is thin
and malnourished; there is little muscle substance in her arms and legs; her grip and
her strength are feeble; her bones are thin and brittle. She may have obstinate constipation,
probably a cystocele. Her temperature is low, her pulse slow, her haemoglobin
down and her blood cells abnormal. She has deformities of the feet so that she can
only shuffle along, and she has the typical flexed stance of old age. She is miserable,
forgetful, querulous; she is often dependent on her relatives and neighbours for her
shopping and housework, and is a nuisance to them. She cannot see to read well because
her glasses are unsuitable, and she has partial cataracts; she is rather deaf.
At this stage of her life she probably has protein malnutrition, nutritional anaemia,
deficiency of iron, manganese, copper, vitamin C, vitamin B12 and folic acid. She has
deficiency of calcium, magnesium, vitamin D and fluorine. She is deficient in vitamins
A, Bj, B2, Bd, and E. She has hypothyroidism, and deficiency of anabolic steroids and
oestrogen. She has advanced artery disease affecting her heart and brain.
Oestrogen deficiency
Much of this deterioration can be traced to deficiency of oestrogen — the effects
becoming progressively more noticeable as life goes on. For some time we have been
trying to prevent the progress of this deterioration and if possible ameliorate part of
the disability. In one experiment, we set out to see the effect of replacement therapy
in women just past the menopause, and if possible to find easily observed indications
of oestrogen deficiency. We selected 10 women volunteers for the trial; they were all
healthy, aged between 49 and 55, and had ceased menstruating for at least a year.
They came to the clinic seven times in all at intervals of a fortnight. This covered two
cycles of six weeks with three periods of a fortnight in each cycle. They were given
tablets thus:
First cycle
Visit A—beginning : 0.1 mg. ethinyloestradiol daily for a fortnight.
Visit B—middle: 0.1 mg. ethinyloestradiol and 4.0 mg. megestrol daily for a
fortnight.
Visit C—end: nothing for a fortnight.
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