Greer poses the following question: "What if those female bodies that fight menopause by flooding themselves with FSH and keeping up estrogen secretion, are robbing other vital functions in the process, so that the organism has to go short of endorphins and cortico-steroids?"

The use of commonly prescribed estrogen (ERT) is associated with a three to four times increased incidence of uterine cancer. However, as Germaine Greer points out, the incidence of endometrial cancer is still rare, and it rose by only ten percent in the 20 years that estrogen was taken by itself. Many other factors could have accounted for the increased rate; during the same period, the incidence of all cancers rose.

Then, as Greer says, based on the scant evidence of two small studies, all women were advised to go on synthetic progesterones or progestins. The studies showed that estrogen did not adversely affect the uterine lining in 90 percent of women, but for the ten percent of women who did develop an overgrowth of the uterine lining, adding progestin did prevent cancer. Greer feels it would make more sense to screen women for uterine changes, and then treat the ten percent who develop significant changes of the uterine lining (which is usually easily treated).

Instead, it is now recommended that all women who have not had their uteruses removed take synthetic progesterone or progestins (Provera, Norlutate or Micronor) as well as estrogens (Premarin, Estrace, Estinyl, C.E.S., Ogen, by mouth; or the Estraderm patch; which slowly releases estrogen through the skin). Most doctors advise women who have had hysterectomies that they can safely take estrogen by itself.

Overweight women, women with liver disease and women with polycystic ovarian disease are also at increased risk for uterine cancer and may be advised to consider progestin alone therapy. Progestin alone does provide some relief of menopausal symptoms, including hot flashes.

In any case, taking progestins for 10 to 14 days out of every cycle means that a woman will continue to bleed every month after menopause, although this bleeding apparently decreases in time and becomes more like spotting.

Side effects of Provera appear to be related to the dose. New ways of giving Provera are being developed, such as giving 2.5mg or 5mg of Provera along with .625mg of premarin every day of the month. The safety of these combinations has not yet been established.

After six months of hormones at this lower dose, which is often recommended for women in their 60's and 70's, bleeding should stop altogether. However, the beneficial effects of estrogen on blood lipids may be somewhat reduced by continuous Provera and cancelled by Norlutate.

A new combination estrogen-progestin skin patch is being developed and is now on the market. It is called ESTRACOMB.

The Down Side Of Synthetic Progesterone

"This would not be a problem," says Germaine Greer," if taking progestins was fun, but progestins make many women feel sicker than menopause ever did."

Not surprisingly, some women do not like to bleed every month after going through the menopause. Some women prefer to take progestin intermittently. At least every three to six months is recommended to counter the risk of uterine cancer. However, bleeding could be heavier at that point.

An acceptable alternative approved by many experts is to get a biopsy of the uterine lining done every year as an alternative to taking progestin for 10 to 14 days every month. This endometrial biopsy can be done in a gynecologist's office without a local anesthetic. This procedure can be uncomfortable even with new flexible sampling systems.

Some women come in and say they will never take progestins because of the associated mood swings and depression. In fact, the addition of progestin to estrogen is known in the medical literature to produce marked premenstrual symptoms.