CHAPTER XXII.
CHANGE OF LIFE.
Change of life is one of the scape-goats of physicians and bugbears of patients. If any lady from thirty-five to fifty-five years of age is afflicted with dyspepsia, neuralgia, rheumatism, consumption or any other ailment, the doctor, not being able to cure her, pronounces it the meno-pause, or “change of life,” and that time alone can bring relief. Most women plan and expect to give up from eight to ten years of the best part of their lives to this climacteric period. They consider themselves of little account for business or social duties. They must be petted and nursed, and have every passing whim gratified.
The meno-pause is simply a cessation of ovulation. It is the exhaustion of the germ-making power. If a woman menstruates because of the monthly ovulation and deposit, she will cease to menstruate because ovulation has ceased to be a physiological operation.
At puberty the ovaries enlarge. When fully developed they begin casting off each month perfected ovula, which are taken up by the fimbriated extremities of the oviducts and conveyed to the uterus. This function of the uterus continues on an average thirty-two years. After the meno-pause begins the ovaries become small and shriveled, resembling a peach stone in shape and appearance.
“At the same time that the ovaries are undergoing this remarkable degenerative change, a similar change is taking place in the other organs of generation. The uterus diminishes in size, as does also the vagina. The mouth of the womb becomes contracted and after a time entirely closed. The upper part of the vagina is often contracted to such a degree as to produce folds closely resembling those which result from serious inflammation about the uterus. The breasts usually diminish in size. These changes indicate unmistakably the decline of the function of reproduction, preparatory to its entire suspension.
“As a rule, the capability of procreation ceases with the cessation of menstruation; but this is not universally the case. Instances are on record in which pregnancy has occurred before the appearance of menstruation. This seeming anomaly is due to the fact that ovulation and menstruation are really two distinct acts, although usually coincident.”
Although menstruation usually ceases from the forty-fifth to the fiftieth year, cases are on record in which “change of life” occurred at much earlier, as well as later periods. Dr. T. J. Patchen relates a remarkable case where a girl ceased menstruation at twenty-two, accompanied by all the physical changes of the organism as well as attended by the usual symptoms of that period. Cases are recorded where menstruation continued with regularity until the seventieth year, and the reproductive function remained unimpaired.
In a state of health the meno-pause should be attended by no unpleasant symptom, by no change from the normal condition. Ordinarily all the sufferings and ailments incident to this period can be accounted for from some ovarian or uterine disease, dyspepsia, or other deviation from health. Irritation or congestion in the ovaries, more than any other cause, decides the numerous symptoms of the climacteric. Uterine inflammation or derangement also causes many of the distressing ailments of the meno-pause.
Irregularity in menstruation may be looked for about the forty-fourth year in temperate climates. In the torrid zone, where girls menstruate as early as the tenth or twelfth year, it may occur much earlier. But in this country it is often delayed even far beyond the fiftieth year.
There may be occasional absence of the menses, or it may first be indicated by frequent and profuse menstruation. In rare cases the menses cease suddenly, without any warning or any special derangement. Women often feel alarmed at the sudden suspension of this discharge, but their fears are groundless if all other functions are normal. With some women the flow is alternately scanty and profuse for months.