Gail Sheehy, puts it this way: "Is it even conceivable that millions of men over 50, those at the highest levels of the power structure, would be herded by physicians toward chemical dependence on powerful hormones at suspicion for causing testicular cancer?"

She goes on to quote public health expert, Dr. Lewis Kuller, who says that HRT is the largest uncontrolled clinical trial in the history of medicine.

Fifty Something In The Nineties

Every woman will have to decide for herself whether the risks outweigh the benefits. As Dr. John Collins, Professor of Obstetrics and Gynecology at McMaster University in Hamilton, says: "You must make the choice that suits you. There are numerous issues and no outsider can tailor these to the way you live your life."

FIFTY SOMETHING IN THE NINETIES is the title of a thoughtful article by Dr. Collins on the whole question of HRT. Dr. Collins says that at age 50 a woman faces a 32 percent lifetime risk of a spinal fracture. Estrogen use might decrease this to a 26 percent risk and for hip fractures, from a 16 percent lifetime risk to a 13 percent risk. At age 50 there is a 31 percent risk of dying from coronary heart disease. Estrogen would reduce this risk by 20 to 25 percent. Breast cancer risk would rise slightly from 2.8 percent to 3.3 percent. Risk of uterine cancer would also rise from .7 percent to .8 percent (see chart).

Concludes Dr. Collins: "Estrogen forever was a theme in the 1940's and again in the 1960's and it is now frequently recommended in the 1990's. Women who are fifty something in the 1990's face an interesting challenge. Given the promise of longer life and taller stature, women who take risks will want to take estrogen; more cautious women may prefer to wait for better evidence."

At the University of California, Dr. Deborah Grady and her colleagues did an extensive review of all relevant research on HRT published since 1970. They summarized risks and benefits of hormone therapy for healthy post-menopausal women considering long-term therapy to prevent disease or to prolong life. Women with a uterus on hormone replacement therapy increased their life expectancy by only one year. For women without a uterus, the increased life expectancy was 1.1 years (see chart).

The authors concluded that, "There is evidence that estrogen therapy decreases the risk for heart disease and for hip fracture, but long-term estrogen therapy increases the risk for endometrial cancer and may be associated with a small increase in risk for breast cancer. The increase in endometrial cancer risk can probably be avoided by adding a progestin to the estrogen regimen for women who have a uterus, but the effects of combination hormones on risks for other diseases has not been adequately studied."

They conclude that "HRT should probably be recommended for women who have had a hysterectomy and those with coronary heart disease or at high risk for coronary heart disease. For other women, the best course of action is unclear."

A New Way Of Looking At Menopause

Menopause is better viewed as the gateway to a second adulthood. Gail Sheehy suggests that, "If 45 is the old age of youth, 50 is the youth of this second adulthood... The life expectancy of a woman fortunate enough to live to age 50 is now 81. So from the time she reaches peri-menopause, the average woman has 33 more years."

She proposes four demarcations of this second adulthood:

PERI-MENOPAUSE: The start of the transition (40's).

MENOPAUSE: The completion of the ovarian transition (50's).

COALESCENCE: In which women can tap into new vitality (60's).

MATURESCENCE: The passage to full maturity in the seventies (70's).