The periodic discharge of blood from the uterus usually ceases between the ages of forty and fifty years. Raciborski3 concludes, from the observation of a large number of cases, that the average date of cessation is the forty-sixth year. This estimate is confirmed by the observations of Brierre de Boismont, Guy, and Tilt. The average date of cessation in 1082 cases,4 collected by these three observers, was forty-five years and nine months.
3 Traité de la Menstruation, Paris, 1868.
4 Tilt, The Change of Life, 4th ed., 1882, p. 22.
Climate, race, and the various accidental circumstances which exercise such potent influence upon the establishment of the functions of ovulation and menstruation have measurably less effect upon their cessation. Mayer5 attaches some importance to social condition as determining the date of cessation. From the observation of a large number of cases belonging to the higher classes he determines the average age to be 47.138 years. It is a popular belief that the period of menstrual life is a constant number of years, usually from thirty to thirty-five; that is to say, if a woman commences to menstruate when very young, cessation will occur at an earlier age than in a woman who begins to menstruate later in life. Cazeaux, Raciborski, Frank, Dusourd, and Tilt, supported by Guy's6 analysis of 1500 cases, are of the opinion, on the contrary, that the duration of menstruation is longest in women who have menstruated earliest. In the words of Négrier,7 "It seems well proved that the ovarian function, creative of germs, is prolonged in life in direct ratio of the volume of the ovaries and of the precocity of ovulation; thus the girl nubile at twelve will continue menstruating until fifty or even fifty-five; whilst the girl who did not menstruate until eighteen or twenty—a fact which reveals feeble development and small energy of the organs—will cease to menstruate at forty, an early age."8 Cessation occurs later in women who have passed through repeated normal pregnancies than in virgins or sterile females. Cohnstein9 observed the longest duration of menstruation in women who had menstruated early, married, and borne more than three children, suckled their offspring, and were normally confined for the last time between the ages of thirty-eight and forty-two years. An interesting opinion with reference to the relation between longevity and the date of cessation was expressed by Robert Cowie at the Paris Medical Congress in 1867. According to Cowie, there is a direct and constant relation between longevity and protracted menstruation. A woman who menstruates up to an advanced period of life has more chances of attaining extreme old age than one whose menstrual function has ceased earlier. Cowie derives this opinion from the observation of numerous cases of longevity and coincident protracted menstruation which occurred in the Shetland Islands.
5 Schroeder, Handbuch der Krankheiten der Weiblichen Geschlechtsorgane, 1881, p. 321.
6 Medical Times and Gazette, 1845.
7 Barnes, Diseases of Women, 1878, p. 194.
8 T. Gallard, Pathologie des Ovaires, Paris, 1885, p. 114.
9 Deutsche Klinik, 1873, No. 5.
Among the pathological factors which determine the early occurrence of cessation, puerperal atrophy of the uterus, syphilis—especially the graver forms—and chronic alcoholism deserve particular attention (Lancereaux).