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Menopause, Or The Change Of Life

( Originally Published 1918 )

THE establishment of menstruation at the beginning of the adolescent period is something of a physical crisis for the young girl; so, also, is the cessation of this function for the adult woman. The sex organs continue their activity from about thirteen or fourteen years of age to somewhere between forty-five and fifty years of age. This is called the childbearing period, because it is during this time that the woman is capable of fulfilling her function as a mother. The exact time for the end of this period cannot be definitely placed, because it varies with different individuals. The change of life, as it is called, may come, in some instances, as early as forty years of age; in others it may be delayed until after fifty, but the average seems to be somewhere between these two limits.

In all probability, just as the menstrual function itself was not intended to be a cause of physical weakness to woman, so was its cessation not intended to be productive of physical ailments. If women were able to live an absolutely normal, healthy existence, it is most likely that they would experience but little inconvenience in the readjustment of the body which takes place at this time.

There is great variation in the amount of inconvenience suffered by different individuals. The causes of these differences are not always apparent. It would seem, however, that if the physical condition has been kept at the highest point, the transition should be made easily and without any marked physical disturbance. There are, however, physical and nervous adjustments to be made which should be expected and properly provided for.

The process that now begins is the reverse of that which took place at the beginning of the adolescent period. As at that time, the ovaries were quickened into activity, so now they begin to lessen their functioning and slowly to atrophy. As the production of ova gradually ceases, so also does the functioning of menstruation cease. Normally, the first indication of the approaching change should, in all probability, be a gradual lengthening of the time between menstrual periods. This is not always the case, however. Various forms of irregularity may make themselves manifest. For example, at one time the flow may be very profuse; the next month, the menstruation may be suppressed. The following month it may be very scanty, and then, again, very profuse. The periods may lose their regularity, so that it becomes very difficult for the individual to know when to provide against the contingency. During the profuse period, it is very important for the woman to remain in bed in order that a serious flooding may not result.

Where this natural precaution is neglected, the period of change may be unnecessarily pro-longed, and its nervous symptoms may reappear after the lapse of some years.

As the ovaries gradually atrophy, so also do the uterus and the breasts,—all organs of the reproductive system.

The process of change is, as a rule, a gradual one, taking sometimes as much as three years for its completion. As the vital powers are now relieved of the extra burden of providing for this reproduction process, there naturally comes about, in many instances, a tendency for fat to be distributed somewhat generally throughout the body, except about the breasts which usually de-crease somewhat in size and become flattened in form. The fact that there is a real increase in vitality at this time is shown by mortality tables, which indicate that the death rate among women between the ages of forty and fifty is lower than at any other period after puberty. It is lower than the death rate of men between those same ages. This should go far to relieving women of the serious apprehensions which many of them are inclined to feel at this period. If they will exercise an ordinary amount of common sense in the care of themselves, there is nothing in this experience which they seriously need to dread.

This does not mean that care is not needed to enable them to pass successfully through this necessary adjustment. There usually is a variety of nervous symptoms which accompany this change, such as headache, irritability, flushing of face and body, capricious appetite and other disturbances of the digestive apparatus. Congestions and aberrations of the blood and nerves cause the various disagreeable symptoms from which women suffer at this time. Not only is there a tendency to flooding, which itself is a usual phenomenon of the circulatory system, but there are apt to be hemorrhages from other parts. Nose bleeding is a common form of hemorrhage, and may be a welcome relief unless unduly severe.

Another distressing irregularity which may take place at this time is palpitation following some exertion or emotion; or, it may be, for no apparent, reason the heart begins to throb, causing the greatest discomfort. There is a rush of blood to the head, which is hot, with severe head-ache ; the cheeks burn ; there is a feeling of faintness or a choking sensation, a buzzing sound in the ears and a dancing blackness before the eyes. Such an experience may leave a woman with the dread that she is going to be visited by a stroke, or she may think that she is about to become a victim of heart disease. She should put aside all such morbid fears, however, as the change of life never causes heart disease, although it may produce a sudden attack of palpitation which only indicates a disturbance of the normal course of her life.

When the adjustment of her system is finally made, she will have no further trouble of this kind. She should, however, give strict attention to rules of simple, hygienic living and should carefully avoid all stimulants.

The more serious abnormal conditions which may develop are, in the first place, excessive hemorrhages. These should not be allowed to go on under the fallacious notion that they are the natural accompaniment of the menopause. If they continue for an undue length of time, a physician should be called in that they may be carefully checked. There is the possibility of the development of tumors. If special pain is felt, or nodules appear in the breast, or if pains in the pelvis endure or are persistent, it is wise to consult a physician at once. The probability is that the cause will not require much treatment, but the possibility that it may be serious and need attention makes it imperative to call for expert assistance without delay. Should a malignant growth be in the process of development its early discovery will insure the adoption of treatment for its removal before any serious consequences can follow, whereas delay may be most dangerous.

The nervous system at this time becomes as unreliable as does the circulatory system. Changes in the sensibility of the skin become frequent. Tender spots appear and vanish. Back-ache, neuralgia, pain over the heart and over the stomach are apt to be present, and show the general instability of the nerves. Irritability of temper is unfortunately common. Women also are apt to lose their power of judgment and their power to think clearly; they become restless, hesitating, indecisive, moody and depressed. They sleep badly, are troubled with distressing dreams and may evidence fear that they are going insane.

All of this calls for a sympathetic understanding on the part of those around them, who should help them to have patience with their own distressing symptoms and to await with confidence the day when adjustment will have been completed and they will once more find themselves competent to fill a useful place in life.

The use of hot water in various forms at this time will be found most efficacious. Wherever there may be pain in the back, the bowels, or else-where, the heat will be beneficial. Hot applications throughout the entire length of the spine will be helpful in quieting the nerves. The hot vaginal douche will relieve tenderness and congestions of uterus and ovaries and tend to control excessive flow, but it must be hot—110 or 115 degrees Fahrenheit. Warm sitz baths will relieve the head. For flushings, the affected parts will be relieved by sponging with hot water. For profuse sweating, sponging with hot salt water will be found efficacious.

As a rule, the desire for sexual intercourse gradually decreases and finally dies with the cessation of ovulation and menstruation. It some-times happens, at this time of life, that because of local congestion and disturbed nerves excessive sexual desire is felt. This is a morbid condition which is generally increased by the effort to gratify it. If it is so recognized by the individual and the proper use made of hot vaginal douches and careful exercising, the condition may gradually be overcome.

With many women at this period, there is a strong tendency to gloomy forebodings. Their thoughts center about themselves and every pain is aggravated by their apprehensive imaginings. Thus they make their own lives a much greater burden than is at all necessary. Often a complete change of scene and occupation is the most effective treatment. It is important to establish an absorbing interest in something outside of self, thereby preventing introspection.

There is no reason for women to dread this time as so many of them do, nor to feel that it is an indication of the end of their period of use-fulness. While it is true that they can no longer bring children into the world, that does not mean that they cease to be mothers in the truest and most comprehensive meaning of the word. Motherhood is more than simply a physical function. In its essence it is purely spiritual. As the physical mother nourishes and sustains the body of her offspring, so does the spiritual mother inspire and develop the highest and best in all with whom she comes in contact.

Instead of looking upon the change of life as a lessening of her usefulness rather should the woman consider it an extension of her field of activity.

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