Gynecology: Durable, Unendurable Women

The polysyllabic title in the American College of Surgeons program was obviously designed to be provocative: “What Is Exciting in Gynecologic Endocrinology?” But his confreres suddenly sat up when Gynecologist Robert W. Kistner blurted: “We are keeping women around too long—they should all be dead soon after age 45.”

Then Dr. Kistner backtracked to explain: “Women are the only mammalian females to live beyond their reproductive usefulness. So it is by that evolutionary standard that they live too long. But since we do keep them around, we should recognize that during the menopause they are living in a state of hormonal imbalance, and we should treat it. We should give them ‘the pills’ to control the uncomfortable symptoms that women have complained about for centuries.”

Dr. Kistner suggested combinations of progestational hormones and estrogens, like those used in contraceptives such as Enovid, for women aged roughly from 40 to 50. What about those who live much longer? They are no longer in hormonal imbalance, he replied, but many of them suffer from hormonal deficiency states. These produce such symptoms as “dowager’s hump,” excessive wrinkles, and osteoporosis (brittle bones). “If a woman has these symptoms,” Dr. Kistner declared, “she should get estrogens, not every day, but in cycles. Or on the off chance that these might encourage cancer, she could have combinations, such as Enovid.”

It was not only because of female vanity that Dr. Kistner thought these aging women should have medical help. “Another common consequence of their reduced output of estrogens,” he said, “is that intercourse becomes painful. This leads to marital difficulties and is a factor in many cases of philandering by middle-aged husbands. If we can prevent or retard these changes of senescence, we can help to keep the women happier and their husbands as well.”