The Menopause a Consideration of the Symptoms, Etiology, and Treatment by Means of Estrogens

Abstract

NEW YORK CITYThe treatment of menopause symptoms by ovarian extracts dates back a full generation, but therapy by means of pure hormone preparations is of very much more recent origin. Large quantities of pure estrogens have become available only during the past 5 years. This report deals with the treatment of 200 cases of menopause by means of purified or crystalline estrogenic hormones (except one). These patients have been observed over a period of not less than 6 months and, on the average, not more than 3 years years. Several patients have been observed for about 4 years.Distribution of cases. The etiological factors in the causation of the menopause have been as follows: spontaneous menopause, 160 cases; surgical menopause, 34 cases; radiation menopause, 6 cases. SYMPTOMATOLOGYIn every case an attempt was made to determine the predominant symptom that brought the patient to the Clinic. Other symptoms were also carefully noted. The symptoms were as follows.Disturbances of menstruation. Amenorrhea was one of the most common complaints. Twenty-nine patients were still menstruating, but presented other symptoms characteristic of the menopause. Of this group 18 patients reported fairly regular periods, whereas in the remaining the bleeding ranged from oligomenorrhea to hyper-polymenorrhea. It was interesting to note the effect of menstruation (or bleeding) on the symptoms. In 12 cases the symptoms definitely improved with bleeding, in 8 cases the symptoms were made worse, and in the remainder no difference was observed.Neurovascular disturbances. These were observed in almost all patients to a greater or less degree. The symptoms were hot flushes, sweats, palpitations, sleeplessness, numbness or tingling in the extremities and sensory neuroses especially of the throat. Hypertension appeared rather frequently. In view of the fact that many of the patients were not seen by us prior to treatment, it was very difficult to determine to what extent the hypertension was solely attributable to the menopause. If as a result of 4 weeks treatment there 32 The Endocrine Society. Downloaded from press.endocrine.org by [${individualUser.displayName}] on 14 July 2015. at 08:55 For personal use only. No other uses without permission. . All rights reserved.

Treatment of Intractable Depression

“…Klaiber et al (1972);Servinghaus (1933), and Wiesbader and Kuszrok (1938) found that premenopausal depressed women with regular menstrual cycles had higher levels of plasma MAO activity, and oral estrogen therapy (Premarin 125 mg daily) normalized MAO activity and the depressed mood. These results suggest that estrogen deficiency may enhance metabolism of NE.…”

The Fate of the Nontreated Postmenopausal Woman: A Plea for the Maintenance of Adequate Estrogen From Puberty to the Grave

“…The occurrence of depression in women not previously subject thereto, is fairly frequent at the menopause. In mild and moderately severe cases estrogen is almost a specific, improvement frequently ensuing in a matter of days (29, 30). We have also seen worthwhile results in mild and moderately severe involutional melancholia, but only rarely in the severe type.…”