Innumerable varieties and combinations of interglandular action supply us with the limitless types of adolescent girls. Some endocrine cooperatives that make one girl stable and settled, will make others unstable and unsettled. Alicia may be hyperthyroid, and so excitable, nervous, restless, and subject to palpitation of heart and sleeplessness. Bettina may have too much post-pituitary, and so will menstruate early, tend to be short, blush easily, be sentimentally suggestive and sexually accessible. Christina may be adrenal cortex centred and so masculinoid: courageous, sporty, mannish in her tastes, aggressive toward her companions. Dorothea may have a balanced thyroid and pituitary and so lead the class as good-looking, studious, bright, serene and mature. Florence, who has rather more thyroid than her pituitary can balance, will be bright but flighty, gay but moody, energetic, but not as persevering. And so on and so on.
Environment, habit-formation, training, education serve only to bring out the internal secretion make-up of the girl, or to suppress and distort and so spoil her. Adolescence will be peaceful, calm, semi-conscious, or disturbing, revolutionary and obsessive according to the reaction of the other endocrines to the rise of the ovaries. Harmony, and so continued happiness of the mind and body, means that they have been welcomed into the fold. Disharmony, ailments, unhappiness, difficulties, mean that they are being treated as intruders, or are acting as marauders. The after life, sexually the period of maturity, barring accidents, diseases, and shocks, will bear the same character. The kind of adolescence provides the clue to the kind of maturity, for both are effects of the same endocrine factors.
THE SEX GLAND CHAIN
Furthermore, the activities of a normal woman involve a series of sex glands. Since there function, in addition to the ovaries, the glands of the uterus, the breasts or mammary glands, and the placental gland (the secreting cells of the tissue which comes out as the after-birth). Each of these contributes directly to the reproductive life of the individual. To call the ova the sex glands is to confer upon them a name which really belongs to a chain of glands.
All of the members of the sex chain, including those of the thyroid, the adrenal and the pituitary, are necessary to the functions of menstruation, impregnation, settlement of fertilized ovum in the wall of the uterus, labor and lactation. A disturbance of one of them will set up disturbances all along the line, and a resonance of distress or compensation upon the part of all of them. As an interlocking directorate over the sexual functions of the female, they are members one of the other. So what helps or hurts one, helps or hurts all.
THE CYCLE OF MENSTRUATION
Essentially, the ovary is a collection of follicles, nests of cells, acting as safe deposit vaults for the ova that are to become candidates for fertilization. At birth, there are some 30,000 to 200,000 of these, of which a good many atrophy during childhood so that there are no more than about 30,000 left at puberty. Of the 30,000, only an élite 400 actually mature between the ages of fifteen and forty-five. About every twenty-eight days, one of the follicles swells, becomes filled with liquid, pushes or is pushed to the surface of the ovary, there to rupture and expel into the abdominal cavity the tiny ripe ovum. The rest of the torn follicle makes itself over into a peculiar yellowish body, the true corpus luteum, should pregnancy occur. If pregnancy and the consequent placenta do not occur, it shrinks and turns into a scar, the false corpus luteum. The true corpus luteum resembles closely the adrenal cortex in make-up and staining reactions. It seems as if, once successful impregnation has been achieved, the feminine organism adrenalizes itself, makes itself more masculine and less feminine, inhibiting the posterior pituitary and the adrenal medulla, as well as the ovaries. Besides, the corpus luteum stimulates the thyroid to prepare for the heavy demands to be made upon it during pregnancy.
Before menstruation, there is a stage of preparation, a stir and twittering of the endocrines, the premenstrual state. Currents of communication flow between the different glands, messages and replies pass to and fro. When these are properly balanced, so that all goes well, the consciousness of the woman will be disturbed by no knowledge of them. In some women abnormal sensations appear, a sense of fullness in the breasts, or of weight in the back or pelvis, or pain in the head. The last is probably due to swelling of the pituitary beyond the capacity of its bony container. In a good many women, nervous and mental phenomena herald the expected menstruation because of a complete upset of the balance between the internal secretions, with resulting disturbance of the nervous system. Irritability, depression, excitability, melancholia, exaltations, restlessness, hysteria, loss of self-control, or even more marked mental aberrations may appear. Following them, and roughly paralleling them, may come various abnormalities of menstruation itself. The character, extent and duration of these furnish us the best clues to the endocrine stability or instability of the particular feminine organism.
Menstruation is simply the uterus saying: well, not this time. As the destined ovum within its nest, the follicle, grows, its fluid affects the interstitial cells to send their specific stuff into the blood. There it circulates, hits this gland and that, makes some more active, others less, transforms the chemistry of the cells, and engorges the mucous membranes, most of all those of the nose and of the uterus. It is all to welcome the mature ovum and its possible impregnation, to prepare a site for its landing and settlement, blood and food for its nutrition, safety for its development. But it is not to be. No sperm at hand, or effective enough to penetrate that wandering ovum. Love's labour's lost. All must return to the so-called normal, really the intermenstrual state. The womb must surrender some of that blood, the glands return to their routine, and a sex diastole of the whole organism succeeds. Until again, another follicle swells, another ovum matures, and the premenstrual state of sex high tide cycles back.
Seven to ten days before menstruation we know that sex high tide is beginning for that is when the blood pressure goes up. As this rise of blood pressure is probably controlled by the posterior pituitary, we have a clue to the reason for the rhythmic variations in the rate of production of its secretion by the ovary. For, since menstruation is so closely connected with the phases of the moon and the tides, the rhythmicity of the posterior pituitary may be traced to the days when the pineal was an eye at the top of the head, and in direct relation with the pituitary.