Nelson Soucasaux

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 *. Regrettably 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. Considering 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. Even during 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. Considering 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 of femininity. Fortunately, 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. MORE INFO: http://www.nelsonginecologia.med.br