That time in a woman’s life at which her sexual activities come to their
natural termination, marked by the cessation of menstruation, is known
as the menopause, climax, or climacteric period.
This “change of life,” from a condition of sexual maturity to a
condition of quiescence of sexual functions, is not a sudden one, the
symptoms of sexual retrogression making their appearance gradually,
until the cessation of the monthly recurring menstrual flow indicates
that the termination of sexual activity has arrived, and that sexual
death is taking place.
The influence of this period of life is not manifested by the sexual
organs alone—in these latter indeed various changes may be detected
already before the cessation of menstruation, whilst after that
cessation, the atrophic changes characteristic of old age proceed in
these organs with a slow but continuous advance,—but the disturbances
evoked by the climacteric involve the entire organism and affect the
functions of numerous organs, giving rise to a true storm of irritant
phenomena, and to manifestations of decay of manifold nature.
The stormy manifestations, the occurrence of which led the ancients to
denote this period as the “critical age” of a woman’s life, are in the
first place due to changes in the ovaries; the tissue changes in these
organs give rise to a powerful ovarian stimulus, which, by irradiation
and reflex action, leads to the occurrence of a number of nervous
disturbances, vasomotor manifestations, and circulatory disorders;
whilst owing to the cessation of the internal secretions of the ovaries,
numerous and intense pathological disorders of metabolism arise. These
various symptoms become apparent at the very outset of the menopause,
when the oncoming entire cessation of menstruation is already
foreshadowed by irregularity in the periods, gradual diminution in the
quantity of the flow, and variations in the number of days during which
the flow on each occasion persists.
The manifestations of the menopause are in fact so striking, that from
ancient times down to the present day a widespread belief has prevailed
that especial danger to a woman’s life is threatened by the climacteric
age. The statistics available on this subject are, however, of dubious
significance. Although it cannot be denied that the changes in the
entire organism which attend the extinction of sexual activity, bring
numerous dangerous influences into play, yet I feel bound to maintain
that these dangers are by no means so great as those which are involved
by the sexual life in its ripest period of development—the dangers of
pregnancy, parturition, and the puerperium.
It is often asserted that in this “critical period” of the menopause,
the mortality of the female sex is notably increased. The data available
are somewhat conflicting, but a careful examination leads us to believe
that, if due allowance is made for the natural increase in mortality
with advancing years, no important increase in the mortality of women
can be traced as due to the troubles and disturbances of the climacteric
period.
The age at which a woman’s last sexual epoch begins is a very variable
one. The duration of the “change of life,” the length of time during
which the occurrence of the “change” is manifested by local and general
disturbances, also varies greatly. Not less variable are the intensity
and the general distribution of the symptoms which mark the climacteric.
The external configuration of woman at the climacteric age is usually
characterized by signs of over-ripeness, and these changes appear to
exercise upon certain men—more especially very young men—a peculiar kind
of erotic stimulus. Many women remain long at this period quite fresh
looking, with a vivid, youthful colouring; others, however, early
manifest alterations in their finer feminine characteristics, hairs, for
instance sprouting on the chin, and the voice becoming deeper in tone.
The outward characters of senescence, with withering of the tissues, are
not commonly manifested at this time, but first make their appearance in
later years, after the completion of the menopause.
A tendency to the excessive accumulation of fatty tissue is one of the
most distinctive characteristics of the menopause, varying, however,
greatly in degree according to race, family predisposition, and
nutritive conditions. The dominant tone is thus given to the physical
configuration by the deposit of fat. The face comes to have a rounded,
spherical appearance, the eyes looking smaller in proportion, whilst the
furrows and folds which form the natural boundaries between the features
become indistinct. The formation of the “double chin,” and the abundant
deposit of fatty tissue in the supraclavicular region, gives to these
extremely obese women an appearance of such a shortening of the neck,
that head and thorax seem to be connected as it were by a great mass of
fat, marked by furrows in the thyroid and sub-hyoid regions. The breasts
sometimes attain an enormous size, hanging down to the gastric and even
to the umbilical region. The abdomen is greatly enlarged, the fat in the
anterior abdominal wall projecting more especially in the hypogastric
region, hanging down in two or three horizontal rolls over the tops of
the thighs, and pushing the mons veneris downwards, so that this latter
itself projects over the genital fissure. The posterior projection of
the buttocks is also greatly increased, until they form a huge elastic
cushion, of which the sensual orientals, who regard obesity in women as
a beauty, poetically write: “Her face is like the full moon, and her
buttocks are like two pillows.” Occasionally, so huge a mass of fat
forms beneath the tuberosity of the ischium, that the configuration of
the nates reminds us of the well-known _steatopyga_ or fat-rump of the
Hottentot and Bosjesman women. In the genital organs, as already
mentioned, the genital fissure is hidden by the projection of the mons
veneris. The labia majora are also greatly enlarged by the deposit of
fat, so that they look like two great cylinders lying side by side.
Another way in which the characteristic sexual beauty is often lost in
extremely obese women, is by the falling out of the pubic hair.
_Moreau_, in his work on _The Natural History of Woman_, describes the
changes occurring in a woman at the climacteric in similar terms, and
concludes: “The only elements of a woman’s beauty that may sometimes be
saved from the wreck, to persist for a shorter or longer time after the
climacteric, are, the abundance of her hair, the vivacity of her glance,
and sometimes also the amiable expression of her countenance; gradually,
however, even these last remnants of beauty disappear, and old age takes
possession with its irresistible force.”
None the less, some women may preserve substantial elements of beauty
for a long time after the menopause. A classical example of this fact is
furnished by _Ninon de l’Enclos_. When she died, at the age of 90, she
was still beautiful. At the age of 65 she aroused the passionate love of
a young man, who, unfortunately, was her own son. When informed of this,
he committed suicide. A young abbé fell in love with her when she was 75
years old.
The psychical life of woman is profoundly affected by the stormy
physical changes of the climacteric. Not merely does a woman entertain
the disturbing thought that the critical age has begun, bringing in its
train certain dreaded dangers to her health and even her life, but she
is further depressed by the consciousness that she is about to lose her
feminine attractions, and to decline in sexual esteem, and that her
reproductive capacity is now to be extinguished. She realizes vividly
that the beautiful past, the loving and beloved womanhood, is now to be
left behind for ever, and by this an intelligent and sensitive woman
cannot fail to be profoundly affected. Her feelings at this time were
never more characteristically expressed than by the Frenchwoman who said
“Autrefois quand j’étais femme.” If, indeed, a woman has been so
fortunate as to have made a happy marriage, to have borne healthy
children, and to be living a satisfactory family life, she will be
enabled to bear with comparative equanimity the disappearance of her
sexual life; but it is different with the childless wife and with the
unmarried woman, who, at the onset of the climacteric, must bury all
their sexual aspirations, and who see the remainder of their lives
stretch before them without hopes for the future. The psychical
predisposition and the intellectual education of the woman concerned,
will now determine whether she will bear the onset of the menopause with
composure and resignation, or whether she will become a prey to
melancholia. Women of the former kind will seek to find employment for
the powers set free by their sexual non-activity, in services of
neighbourly affection, in works of benevolence, and in the performance
of social duties; women less happily endowed will display their
hostility to the world in ill-nature, scandal-mongering, and intrigue,
thus giving vent to their inward bitterness; whilst those, finally, with
hereditary predisposition to nervous degeneration, will become the prey
of veritable psychoses.
A by no means rare result of the excited fantasy and of the eager desire
not to grow old, is displayed at the climacteric in the form of
self-deception. The women thus affected cannot understand, and cannot be
made to believe, that the cessation of menstruation is the natural sign
of their sexual decadence, they trick themselves into believing that in
their case it is a sign that they have become pregnant. We must not
indeed forget that the enlargement of the abdomen, so common at the
commencement of the climacteric, in association with the unexpected
failure of the menstrual flow to appear, the frequent dyspeptic
troubles, and the enlargement of the breasts in consequence of the
deposit of fat in these organs, often enough lead to appearance which
have a deceptive resemblance to the clinical picture of early pregnancy.
The mistake is the more readily made because the breasts sometimes
secrete a serous fluid, whilst sacrache is not infrequent, and
peristaltic movements of the intestines are mistaken for the movements
of the foetus. Cases of this kind, in which all the objective signs of
pregnancy appear to be present, and in which it is impossible to
convince the woman that she has been deceiving herself, and that all the
signs and symptoms are due to the menopause, are mentioned already by
very early writers, and have been frequently reported by modern
gynecologists. (An example of spurious pregnancy especially familiar to
English readers is that of Mary I, Queen of England. Transl.)
Sexual desire in woman by no means reaches its physiological term with
the climacteric and the cessation of menstruation. On the contrary, we
have observed it to be the rule that shortly before and at the
commencement of the climacteric, there is a considerable increase in the
libido sexualis, and at the same time an increase in sexual sensibility
during coitus. This sexual erethism makes its appearance in a manner
often extremely surprising to the husband—and especially surprising in
the case of women who have previously been characterized by a certain
frigidity in sexual matters, and who have, perhaps, always needed strong
persuasion before they would consent to perform their marital duties. It
is by no means rare for the increased sexual impulse to manifest itself
in some pathological form. Even some time after the menopause, when
senile changes in the genital organs are far advanced, the sexual
impulse may still be remarkably active. There is an interesting analogy
in the fact that _Glaevecke_ observed that the sexual impulse was
persistent in women in whom an artificial menopause had been induced by
oophorectomy; and that _Lawson Tait_ and _L. Smith_ have reported cases
in which dyspareunia, which had existed prior to the operation, passed
away after the removal of the ovaries, so that after the artificial
menopause, voluptas coeundi for the first time made its appearance.
Other authors, _Goodell_, for instance, report that libido sexualis is
retained only for a short time after oophorectomy, but subsequently
disappears, as in the course of the physiological menopause, and that at
the same time the voluptas coeundi is entirely extinguished.
When the menopause is fully established, and the processes of involution
in the reproductive organs have taken place in a normal manner, the
woman has had time to acquiesce in the inevitableness of the changes
that have occurred, and she often attains a state of emotional repose
which was quite unknown to her in the earlier phases of her sexual life.
More particularly, those women who hitherto during menstruation, and for
some days before and after the flow, have been the prey of numerous
nervous symptoms and troubles, rejoice, after the menopause, at their
new-won freedom from these pains and disquiets, at their delivery from
the excitements of the reproductive system, at their now uninterrupted
state of well-being.
I once saw a group of statuary by _Pietro Balestra_, entitled “Time
carries off Beauty.” A beautiful woman was striving in vain to resist
the overwhelming might of Chronos, whilst Cupid, about to be abandoned,
was standing sorrowfully by. Here we have a symbolic representation of
the sexual epoch of the menopause.
In a recently published romance, “_Les Demi-Vieilles_,” _Yvette
Guilbert_ has described in a manner most true to nature the feelings of
the “Half-Old,” the mental condition of women at the climacteric, “They
endeavour to remain young, to hide their defects, they seek once again
the intoxication of love. But that which aforetime in hours of
depression they have foreseen, now becomes a dreadful reality. When the
lemon has been squeezed dry, the skin is thrown away.”
Sooner or later after the completion of the menopause, the signs of
senile marasmus become apparent. The soft, feminine configuration of the
face disappears, the features become coarser, approaching the masculine
type, hairs appear on the upper lip and on the chin. The voice becomes
deeper and harsher. As decrepitude begins, the breasts wither, a change
that occurs sooner in proportion to the degree in which their functions
have been in previous years exercised by suckling; but also sometimes
after a life of complete sexual inactivity. Even in cases in which the
loss of substance of the breasts is apparently small, the glandular
tissue of the organs has really disappeared, and has been replaced by
fat. In advanced age, the breasts become quite small, wrinkled, flaccid,
and dependent, and sometimes atrophied to become mere cutaneous folds.
The nipples project more prominently, they are darker in colour, and
their surface is wrinkled. In the genital organs, the fat disappears
from the mons veneris, which becomes flattened, whilst the pubic hair
ceases to be curly, and much or all of it is ultimately shed. The labia
majora become thin and flaccid, until they are mere empty folds of skin;
they are widely separated, so that the vaginal orifice is closed only by
the withered nymphæ, until these latter are themselves ultimately
indicated by mere traces.
Where the menopause has been artificially induced, the signs of
senescence do not appear immediately after the removal of the ovaries;
their development is a very gradual one. The sexually mature woman, from
whom these tokens of femininity have been removed, experiences at first
little change in external configuration, beyond a somewhat exaggerated
tendency to the deposit of fat; the other changes described do not
usually set in until the physiological climacteric age is attained. A
few cases only have been observed in which after oophorectomy a rapid
change to the masculine configuration has been observed.
Seldom if ever does it happen that menstruation suddenly ceases without
any notable constitutional disturbance, so that in a moment, as it were,
the menopause is effected, without any period of transition. Rarely,
even, do we meet with cases in which the peculiar manifestations
foreshadowing or accompanying the cessation of menstruation last for no
more than a few weeks. Most commonly the irregularities of the menstrual
function (of which the most noteworthy characteristic has hitherto been
its extreme regularity), and the associated symptoms of the climacteric
period, endure for months, and occasionally for years. According to my
own observations, the mean duration of the climacteric manifestations is
from two to three years, the limits of variation in individual cases
being, however, exceedingly wide.
The manifestations which accompany the cessation of menstruation are as
a rule the following: The woman is for some months in an irritable
condition, complains of digestive disturbances, constipation, meteorism,
epistaxis, haemorrhoidal flux, congestions of the head, increasing
fugitive sensations of heat (Ger. _fliegende Hitze_), and a tendency to
profuse perspiration.
The length of the intermenstrual interval commonly increases, to as much
as six or eight weeks; the flow itself becomes scantier. In other cases,
however, the flow becomes much more abundant, and the intermenstrual
intervals much shorter than normal. In some cases, the regularity of the
flow is altogether lost, it appears now soon, now late, and is now
scanty, now profuse. Sometimes the intervals are several months, it may
be 6, 8, and even 10 months, then again the flow will occur every two or
three weeks; in exceptional cases, a scanty flow persists right through
what should be the interval, so that menstruation becomes continuous,
with periodic increases in the flow. Not infrequently, after a sudden
cessation of the flow lasting for many months, menstruation recurs, and
continues at regular intervals for a long time, until the final
cessation of menstrual activity.
The mode of cessation which is most favourable to a woman’s general
health, is for the duration of the intermenstrual interval gradually to
increase, whilst pari passu with this increase, the amount of the flow
progressively decreases, until it ceases altogether. In such cases, the
general constitutional disturbance is reduced to a minimum. On the other
hand, the _sudden_ cessation of menstruation gives rise to profound
disturbance of the domestic economy of the feminine organism, and causes
violent changes therein. But even the gradual cessation of menstruation
causes notable disturbance of the woman’s mental and physical
equilibrium, if the irregularities in the menstrual process are very
great and spread over a very long period—more especially when the loss
of blood is extensive.
Even after the menopause, after the final termination of the flow, there
persists a more or less regular recurrence of certain symptoms referable
to the continuance of ovulation. Sacrache, a sense of abdominal tension,
a feeling of heat and fullness in the pelvis, dragging pain in the
hypogastrium, and general irritability, occur at intervals, so that the
woman thus affected sometimes describes herself as suffering from the
continuance of a “bloodless menstruation.”
_Tilt_ made observations in 637 women, in order to ascertain the various
modes in which the menopause occurs, and obtained the following results.
The menopause occurred:
By gradual diminution of the amount of
the flow in 171 women, or 26.84 per cent.
By sudden interruption of the flow in 94 women, or 14.76 per cent.
By sudden interruption and a terminal
attack of metrorrhagia in 43 women, or 6.75 per cent.
By a terminal attack of metrorrhagia in 82 women, or 12.87 per cent.
By a series of attacks of metrorrhagia in 56 women, or 8.79 per cent.
By alternations of very profuse and
very scanty menstruation in 36 women, or 5.65 per cent.
By irregular recurrence of
menstruation, at intervals exceeding
21 days in 99 women, or 15.54 per cent.
By irregular recurrence of
menstruation, at intervals of less
than 21 days in 33 women, or 5.18 per cent.
By irregular recurrence of
menstruation, the intervals being
sometimes longer and sometimes
shorter than 21 days in 23 women, or 3.61 per cent.
——— —————
Totals 637 99.99
The two principal dangers of the climacteric period in women are, first,
the great tendency to profuse uterine haemorrhages, and, secondly, the
liability to the occurrence of malignant tumours, more especially to
carcinomatous disease of the ovaries, the uterus, and the mammae.
With regard to the question whether, in any particular individual, the
course of the menopause is likely to be favourable or unfavourable,
there are, in my experience, four considerations of principal prognostic
significance: the condition of the woman during the menarche, the state
of the general health at the time of commencement of the menopause, the
degree to which the sexual functions have been and are being exercised,
and the manner in which the cessation of menstruation takes place.
As a rule, the disturbances and pathological states of the climacteric
period will be especially frequent and severe in women whose sexual
development at the time of the menarche was accompanied by severe
disturbances of the general condition. In every individual, there
appears to be a certain connexion between the manifestations attending
the menarche and those attending the menopause, of such a nature that
according as puberty has been passed through with little or with much
disturbance of the general condition, a similar favourable or
unfavourable course of the menopause may be prognosticated. If, at the
time of the menarche, there were severe nervous manifestations, or heart
troubles of a serious kind, the passage of the menopause may be expected
to give rise to neuropathic affections and to cardiac disturbances in a
similar manner.
The woman’s state of general health is likewise of importance in
determining whether the course of the menopause will be favourable or
unfavourable. Perfectly healthy women, with a quiescent temperament, and
in favourable circumstances of life, will pass most easily through the
climacteric period without disturbance of their general condition. Every
departure from normal health has an unfavourable influence upon the
course of the climacteric. In women of a plethoric habit of body, there
is an especial tendency at this time to the occurrence of symptoms of
stasis and hyperaemia. Chlorotic and anæmic women are more prone than
others to suffer at the time of the menopause from uterine haemorrhages.
Women of a sanguino-erethistic constitutional disposition often manifest
at this epoch a tendency to neuroses and psychoses. Those women have the
best prospect of a smooth and undisturbed passage through the
climacteric age, who enter upon it in a state of perfect health. Less
favourable is the prognosis in the case of those women who already some
time before the climax, at the outset of the fourth decade of their
lives, have begun to complain of severe haemorrhages and various other
pathological states.
Regarding the influence which the sexual activity of a woman during the
menacme exercises upon the course of the climacteric, it may be said,
generally speaking, that a previous free exercise of the sexual
functions in normal conditions has a favourable influence upon the state
of health during the menopause. Women who have been married for many
years, who have had many children, and who have suckled these children,
pass through the changes of the climacteric much more easily than old
maids, than women who have lived for many years in continent widowhood,
or than women who have had very few children or none at all. The
practice of prohibitive coitus, i. e., the use during intercourse of
methods of preventing the occurrence of conception, a form of sexual
immorality which has become extraordinarily common during the last few
decades, has an unfavourable influence upon the course of the
climacteric. Unfavourable, also, is the effect of great sexual activity
during the four or five years immediately preceding the menopause. Women
who marry shortly before the commencement of the climacteric, and those
who have given birth to a child shortly before this time, commonly
experience very severe disturbances during the menopause. Prostitutes
who continue the active pursuit of their profession until the
climacteric age, have at this time much to suffer. Women who have had
difficult deliveries, or several miscarriages, or severe puerperal
illnesses—and indeed, speaking generally, those women who have been
subject to any kind of disease of the reproductive organs—are apt to
suffer from serious disturbances of the general health during the
climacteric period.
The mode in which the cessation of menstruation takes place, is also
causally connected with the easy or difficult course of the menopause.
Premature cessation of menstruation, or very sudden interruption of this
function, has a deleterious effect, manifesting itself both by local
disorders of the reproductive organs, and by general disturbances in the
nervous system and in the circulatory organs. On the other hand, a late
menopause and a gradual cessation of menstruation, are both usually
accompanied by a favourable course of the climacteric phenomena.
The influence of sexual activity upon the course of the climacteric is
described by _Busch_ in the following terms: “Women who have led an
exhausting mode of life, who have had intercourse too frequently, those
who have been given to onanism or to some other sexual irregularity, and
who therefore enter upon the menopause with flaccid and deteriorated
reproductive organs, are liable to haemorrhagic and mucous fluxes, to
prolapse, carcinoma, dropsies, enlargements, and suppurative processes.
Women, on the other hand, who have lived a life of strict isolation, and
who have forcibly repressed all sexual inclinations, frequently suffer
from ossifications, indurations, and atrophic conditions of the
reproductive organs, and also from neoplasmata.”
After an artificial menopause, induced by the operative removal of the
ovaries, similar manifestations occur to those witnessed during the
natural menopause. Similar disturbances and troubles occur in both
cases, but in the artificial menopause they are commonly more severe
than in the natural; they last also for a longer time, varying usually
from three to six years; moreover, in the artificial menopause, as in
the natural, the disturbance of health is more severe and lasts longer
in proportion to the youth of the individual. Further, in the artificial
menopause also, the intensity and the duration of the climacteric
manifestations are influenced by the constitutional state and by the
condition of the genital organs at the time when the operation is
performed. We note, moreover, that, just as in the physiological
menopause, the attendant troubles are most violent in the initial
period, and then gradually subside, so also after the induction of an
artificial menopause by the removal of the ovaries, the resultant
disturbances rapidly increase in severity, to attain their maximum in
from three to six months, and then, after lasting for a year or so, they
gradually become less severe, until they are ultimately extinguished.
The extensive process of transformation which goes on in a woman’s
system during this period of the sexual life, from the very first
diminution in ovarian activity to the complete extinction of the
reproductive functions, manifests itself throughout the organism by
means of a series of changes which can for the most part be referred
either to states of blood-stasis and their consequences—congestion of
various organs, haemorrhages, and disorders of secretion—or else to
perversions of nervous function.
The most manifold symptoms of disordered circulation may occur:
hyperaemic states of the central nervous system, flushings of the face,
the so-called fugitive heats (Ger. _fliegende Hitze_), a tendency to
epistaxis, to haemorrhoidal flux, and to profuse perspiration. The
changes which take place in the reproductive organs at the time of the
menopause give rise to venous engorgement and to collateral congestions.
Such a condition of venous hyperaemia may occur in the gastric and the
intestinal mucous membrane, giving rise to various dyspeptic
manifestations, and at times, when severe, even to actual gastric and
intestinal catarrh. Hyperaemia of the liver may also arise. In this
case, the pressure of the distended bloodvessels on the biliary ducts
may interfere with the outflow of the bile, and thus give rise to a
slight icterus. Further, the intra-abdominal venous congestion leads to
overfilling of the haemorrhoidal veins, and hence to bleeding piles.
When the congestion is long-lasting, various further morbid changes may
arise, pulmonary hyperaemia may eventuate in bronchitis, hyperaemia of
the cerebral meninges may cause very severe headache, there may be
syncopal attacks, tinnitus aurium, choroidal congestion, impaired
vision, etc.
Congestion of a more active nature arises from an increased and usually
accelerated flow of blood through the vessels of a part in which the
resistance to the blood stream has been lowered proportionately to its
propulsive force. In this way arises that characteristic symptom of the
menopause known as ardor fugax—fugitive heat—one link in the long chain
of vasomotor manifestations occurring at this period of life. Fugitive
heats are commonly most clearly marked in the face, head, and neck, in
which region there suddenly occurs a reddening of the skin, with diffuse
and increasing subjective sensation of heat. At the same time there is
often a sense of tension, as if the part were about to burst. Actual
slight swelling may be noticed, the eyes sparkle and are somewhat
prominent, the head feels heavy, stupid, and dizzy. Sometimes these
symptoms last for a considerable time; at other times they terminate
speedily and suddenly with a local perspiration or with an attack of
epistaxis. Not infrequently, after lasting a short time in one region,
they pass away as rapidly as they came, but are immediately succeeded by
a similar attack in some other part of the body, or by vasomotor
phenomena of a slightly different kind. Thus, such a flushing and heat
of the face may be replaced by a sudden sense of heat in the small of
the back or in the sacral region, by pruritus of the extremities, by
palpitation of heart, or by an attack of pseud-angina.
A further consequence of active hyperaemia is the onset of those
confused states, so common in the climacteric age, of mental and bodily
disquiet, which find expression, now in states of excitement, and now in
states of depression. So we often observe change of disposition,
associated with incapacity for regular work, whilst sleep is restless,
and much disturbed by dreams; and again states of dizziness, a sense of
mental uneasiness and confusion, and even actual delirium.
In the skin, in addition to the fugitive heats, we often have a peculiar
pricking, itching, or stabbing sensation, and various kinds of
hyperaesthesia, frequently associated with disturbances of tactile
sensation. We observe also muscular twitchings, and general weakness of
the organs of locomotion.
In association with the passive and active hyperaemias of the menopause,
we frequently see increase or some qualitative change in the various
secretions. Above all, these changes affect the various secretions of
the different reproductive organs, but we have also increased intestinal
secretion, leading to diarrhoea, increased excretion of urinary
deposits, and increased secretion by the skin. Symptoms which are common
at the menarche, and frequently recurs at the menopause, are: headache,
migraine, a state of pseudo-narcotism, slight hysterical attacks,
indications of moral insanity, lumbo-abdominal neuralgias, neuralgia of
the breasts, leucorrhoea, and various skin eruptions.
According to _Tilt_, the changes occurring in the organism at the
climacteric period may be summarized under the following heads: