As it is widely
known, the estrogens are the most important hormonal factors responsible
for the woman's sexual maturation and the preservation of the main physical
features of femininity. Given their multiplicity of effects on the female
organism, the estrogens "shape" the woman's body. Besides their
specific trophic actions over the female sexual organs, the estrogens
are also the main factors responsible for the development and maintenance
of many of the other women's sexual characteristics. As the main sources
of estrogens in women are the ovaries, the importance of these organs
for the female sex is obviously enormous *.
however, nature did not take this into consideration when it made the
ovaries as organs that become completely depleted about the age of 50.
In fact, this depletion of the follicular population of the ovaries begins
very early even in embryonic life, continues throughout childhood, increases
at each ovarian cycle along the menacme (the menovulatory period of women's
lives), and is finished at menopause. When nature designed the female
gonads, it seems it did not give the deserved attention to their endocrine
function, being only worried with the reproductive one.
It is quite
understandable that the reproductive function of the ovaries has a limited
duration along life. Nevertheless, the same cannot be said of their endocrine
function, given the disastrous effects of the estrogenic deprivation upon
the female body. Concerning the ovarian function, nature has prepared
a very special betrayal for women: it is just the way the ovaries get
old, which differs too much from what happens to the other organs of the
body. As we have seen, the female gonads not only get old, but literally
consume and deplete themselves as a result of the gradual and inexorable
waste and disappearance of the ovarian follicles, their basic functional
structures or unities.
In the ovarian
follicles, the endocrine and reproductive functions are histologically
and functionally linked because the granulosa and the theca cells that
surround the oocytes are the main structures responsible for the estrogenic
secretion. These follicles are endocrine and reproductive unities that
possess a limited duration (those that last the most do not exceed the
age of 50), that can or cannot fulfill their entire cycle of development
and that are totally incapable of originating new follicles. Relatively
speaking, only a few follicles reach their complete development, being
able to produce high estrogenic levels, ovulate and become luteinized.
The immense majority of them is condemned to regression and disappearance
through the process of follicular death or atresia even before completing
their first or second stage of growth. The waste of follicles along women's
lives is amazing, and it is just the ovarian endocrine function that is
harmed as a result of this process. As the formation of new follicles
is impossible due to reasons linked to the embryology of the ovaries,
this fact leads to the definitive depletion of these organs about the
age of 50 and, consequently, to menopause.
the enormous anatomical and physiological overload that pregnancy and
childbirth impose on women, nature had its reasons for finishing the female
reproductive life before the age of 50. Nevertheless, it made a great
mistake by making the ovarian estrogenic production also decline and cease
from that moment on, causing a quick atrophy of the genitals, breasts
and all the other female sexual features. The main mistake of nature concerning
the female gonads lies just at the aforementioned anatomical and functional
link between the endocrine and the reproductive structures of the ovaries,
both placed in the same functional unities. With the depletion of the
follicular population of the ovaries, both their reproductive and endocrine
functions cease**. Only the ovarian stroma still maintains some capacity
of hormonal production.
the fertile period of women's lives, most of the time the ovaries are
much more important as sources of estrogens than of oocytes, since these
hormones are the main trophic factors for everything that is typically
female in women's bodies. Besides, it is a fact that the overwhelming
majority of modern women only want to become pregnant and have children,
as they really do, in a very limited time in their whole lives. Throughout
most of their fertile years, pregnancy is undesired and avoided and, if
it happens by accident or neglect, it is almost always voluntarily interrupted.
all of this, without intending to deny the obvious importance of the ovarian
reproductive function, I believe it is valid to consider the endocrine
one as the most important along the greatest part of the female existence.
Moreover, concerning the reproductive needs of most women we can say that,
in conditions of normal fertility, the ovaries satisfactorily fulfill
this function. On the other hand, the same cannot be said of their endocrine
function, which abruptly ceases about the age of 50, leaving women, from
that moment on, in serious estrogenic deficiency. The regrettable consequences
of this "physiological" event for women are widely known, due
to the quick post-menopausal atrophy of all tissues of their bodies that
depend on the estrogens, as their sexual organs and other physical features
the recent advancements on the hormonal replacement therapy seem to present
new perspectives for women at menopause and post-menopause, trying to
counterbalance, at least in part, this betrayal perpetrated by nature
against the female sex. I want to make it clear that I say "trying
to counterbalance, at least in part" because, obviously, there is
no hormonal treatment that can stop or prevent aging, and the normal menopause
is an event associated with aging. I also have to emphasize that all kinds
of hormonal therapy in menopause must be done very carefully and under
constant medical assistance. Special attention must be given to the breasts
and the endometrium.
Note 1: *Though
in embryonic life the ovaries are not the factors that determine the sexual
differentiation of the female genitals ( the feminization of the embryo
takes place spontaneously in the absence of testicles and of adequate
androgenic action ), the importance of the female gonads in postnatal
life is fundamental for the woman's sexual maturation and for the trophicity
of all typically female tissues in her body.
Note 2: **This
is a disadvantage of the female gonads when compared to the male ones.
In men, the testicular cells that produce androgens are histologically
independent from the reproductive ones, that originate the spermatozoa.
For that reason, the testicular endocrine function is autonomous in relation
to the reproductive one. The testicles do not deplete and their aging
is very slow, not only concerning their endocrine function but also the
reproductive. Therefore, the concept of "andropause" seems to
be very relative.
is a gynecologist dedicated to Clinical, Preventive and Psychosomatic
Gynecology. Graduated in 1974 by Faculdade de Medicina da Universidade
Federal do Rio de Janeiro, he is the author of several articles published
in medical journals, and of the books "Novas
Perspectivas em Ginecologia" ("New
Perspectives in Gynecology") and "Os
Órgãos Sexuais Femininos: Forma, Função, Símbolo
e Arquétipo" ("The
Female Sexual Organs: Shape, Function, Symbol and Archetype"),
published by Imago Editora, Rio de Janeiro, 1990, 1993.
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