THE MENOPAUSE.
The menopause is the final cessation of menstruation. The age at which
it occurs is dependent upon a great variety of conditions--nationality,
climate, mode of life, constitutional and local diseases. In the
northern countries of Europe the menopause is said to appear later
than in the southern; in England, later than in America. It has been
observed that country women menstruate to a later age than city women.
The woman who bears a number of children in rapid succession and
suckles them not infrequently has a premature menopause. The menopause
may appear early in very fat women and in women who are the victims of
tuberculosis, nephritis, and diabetes. Disease of the uterus, tubes,
and ovaries may retard the menopause. In fibroid tumor of the uterus
the menopause may be delayed for several years.
In this country the menopause occurs between the fortieth and fiftieth
years--usually about the age of forty-five.
The menstrual bleeding may gradually diminish in amount until it
disappears; or it may stop abruptly and permanently; or there may occur
one or more intervals of amenorrhea of one, two, or three months’
duration, followed by normal menstrual bleedings, perhaps of diminished
amount, before the flow finally ceases.
Profuse bleeding at the time of the menopause and slight bleeding
occurring more often than monthly are, unfortunately, viewed by
most women as of no moment, and as part of the normal phenomena of
the change through which they are passing. The same may be said of
the apparent reappearance of menstruation, or of slight irregular
hemorrhages occurring after the menopause had been established and
menstruation had been absent perhaps for many months. These phenomena
are not normal. They should always excite the alarm of the woman,
and they demand immediate examination on the part of her physician.
As a rule, the bleeding is caused by some pathological condition of
the uterus--fungous growths, polypi, fibroids, or cancer. The benign
lesions may disappear spontaneously with the progressing atrophy
of the womb, and the hemorrhages may cease. Many women undoubtedly
recover without treatment, and are thus confirmed in the belief that
such irregular hemorrhages are a normal part of the menopause; and the
unfortunate women with cancer are thus encouraged to delay seeking
medical advice until the disease has progressed too far for cure.
The normal changes of the genital organs that begin at the menopause
are those of atrophy slowly progressing to the senile condition.
The ovaries atrophy; the epithelial elements gradually give place
to connective tissue; the Graafian follicles and corpora lutea are
destroyed; the tunica albuginea becomes thick and shriveled. The uterus
diminishes in size; the vaginal cervix may disappear; the utricular
glands diminish in size and number; the endometrium atrophies. The
Fallopian tubes shrink and become shortened, and the fimbriæ disappear.
Similar atrophic changes affect the vagina, the external genitals, and
the mammary glands.
If the woman is in good general health, and has no disease of the
uterus, the tubes, or the ovaries, the menopause may become established
without any marked general disturbance.
In many cases, however, very annoying general symptoms appear, and last
for one or two years before the woman becomes adapted to the altered
conditions.
There may be headache, flushes of heat, nervous depression, derangement
of the digestive apparatus, and other functional disturbance. The
woman often becomes very fat at this period. The nervous derangement
may be so severe as to result in insanity.
The vaso-motor disturbances are often the most annoying. The phenomena
of the “flushes” consist of a feeling of heat over the whole or a part
of the body, followed by sweating and the sensation of cold or a slight
chill. The flushes may occur frequently during the day, sometimes
several times during an hour.
The treatment of the menopause should be directed to the maintenance
of the general bodily and mental health. The diet should be carefully
regulated. Too much nutritious food should be forbidden. Purgatives
should be administered whenever necessary. The woman should have plenty
of fresh air and the proper amount of exercise. Mental depression
demands a change of locality and surroundings.