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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).