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To the Editor.

William H. Hunter, MD
Arch Intern Med. 1986;146(7):1448-1450. doi:10.1001/archinte.1986.00360190240041.
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—Smith and co-workers' article, "Patients with Multiple Unexplained Symptoms," was interesting and certainly worthwhile.1

The fact that the patients were mostly women, averaging 44 years of age, along with the symptoms listed, brought to mind that perhaps a goodly percentage of these patients may well be suffering from decreased endogenous estrogens. I do not believe the article mentioned this possibility.

The symptoms as listed, in view of relatively normal physical examinations, do fit into such a syndrome. In my experience, 30% to 50% of such patients respond well to estrogen therapy.

It is my opinion that, at present, we have rather poor methods to diagnose estrogen deprivation, its degrees, as well as its relative effect on certain personality types.

I sometimes think that studies such as those of Smith and his co-workers would be rather more filled out if he had included in his group a general practitioner (or


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