THE Change of Life, by which is meant the cessation of the double function of ovulation and menstruation, does not usually occur all at once, or at any definite time. The critical age, – another of the phrases employed in this connection, – may embrace a period of several months; or extend over two years or more. While during the whole of this period the menses will occasionally make their appearance, – being in many cases as disorderly in other respects, as they are irregular in their periodical return.
Some women cease to menstruate, and consequently to be capable of fecundation, as early as their thirty-second year; while others are regularly “unwell, and even bear children when they are already fifty or even sixty years of age. But while such extreme cases are rare on either side, the possibility of their occurrence in any given instance should always be borne in mind. There is no rule absolute; and nowhere do circumstances more remarkably alter cases than in these affairs of the change of life. It is observed, however, that, other things being equal, the average duration of the period of ovulation and menstruation and consequently of the susceptibility of fecundation, is about thirty-two years. Still those who commence to menstruate early in life do not lose the function at exactly the corresponding period; since in these it continues two years longer. So those who commence to menstruate quite late in life are found to continue this function but little over twenty years. (*E.J. Tilt, M.D., Change of Life in Health and Disease, London, 1867, p. 47. The average period at which menstruation first makes its appearance being at about the age of fourteen, the general average of the period of the change of life will be found to correspond to the above statement, and to be therefore about the forty0fifth or forty-sixth year.
But there are many influences, as well in health as in disease, which accelerate or retard the change of life, in individual cases. There are persons who seem to have a sort of hereditary idiosyncrasy in this respect, – to experience the change of life at a very early period, or to menstruate to an unusually advanced age. Others, who have borne several children in rapid succession, seem to have exhausted their vital powers in this respect, and to have fallen into a sort of premature marasmus, – and consequently arrive at the change of life much sooner than in common to those in health. And very many forms of disease, especially such as induce an anaemic condition, – and all that large class of functional disorders and structural diseases of the organs of generation and of those connected with them, exert a remarkable influence in determining the change of life at an early age.
On the other hand, those who commence to menstruate late in life, as well as those who are naturally endowed with an unusual degree of vitality and longevity, may be expected to retain the function of menstruation to a much later period. Those who, – otherwise in perfect health, – menstruate for the first time at twenty, may be expected to continue this function till they are fifty, or even older. And even where we are unable to discern any such particular reason to suppose a patient is about experiencing the change of life at an earlier or later period than is usual, we ought always to be on our guard. For many cases of apparent change of life, are in reality nothing more than irregular menstruation, – which we may cure; and which we ought to cure, therefore, without first subjecting our patient unnecessarily to the imputation that she is “an old woman, – for which we should receive but little thanks; and without subjecting ourselves to the odium of lacking in judgment! For the physician who tells a patient she is having the change of life, – she afterwards entirely recovering and becoming regular and even bearing children, and such things have occurred, – commits a blunder no less palpable than that of the dentist who pulls the wrong tooth!
In proportion as women enjoy good health, and especially in proportion as the menses are normal in quantity and regular in their recurrence, may be expect them to pass through the trying season of the change of life at about the usual age, – or a little later, – and with comparatively little suffering. While in proportion as their health has been poor and their menses imperfect and irregular, shall we have reason to apprehend that for them the change of life will prove indeed a critical age, and that it will require all our care and skill to bring them out of it in safety and with health improved instead of being rendered much worse. For the change of life once well passed, the woman settles down with a new form of life, and it may be with a new lease of life, and has a right to look forward to a happy old age. While on the other hand, if this critical period is not thus successfully passed, – our patient may experience a long train of sufferings which will either render her whole life wretched and miserable in the extreme, or presently develop some rapidly fatal organic disease.
In many cases the change of life comes on so gradually that the system accommodates itself to the new order of things with no shock of the nervous system, – and without disturbing the accustomed harmony of the general circulation. In such cases the intervals between the menstrual periods become more and more prolonged, and even the menstrual discharge itself may gradually diminish in quantity. “The most frequent and least dangerous symptoms is an irregular return of the menstrual flow, every week, or every two or three weeks, or every two, three, four, or six months, and being more or less irregular as regards the quantity or quality of the menstrual blood. Serious and alarming hemorrhages frequently set in, especially among plethoric and nervous women, or such as have indulged in sexual excesses. Sometimes these hemorrhages alternate with whitish or yellowish leucorrhoea, which often has a fetid smell, is acrid and extremely copious. This leucorrhoea may continue long after the menstrual discharge has entirely ceased to appear. At this period we likewise meet not unfrequently with colic, uterine cramps, pains in the sides, weight in the loins or distressing itching of the parts. In some cases the abdomen swells as during pregnancy, with sympathetic development of the breasts, until the swelling suddenly disappearing after the expulsion of a mole, or after the emission of a quantity of gas, or after a hemorrhage, or a profuse discharge of serum. – Jahr.
Symptoms of Change of Life. – These vary in different individuals, according to their respective temperaments; for in the change of life, as well as in other conditions, women present the Plethoric, the Chlorotic, or the Nervous type. Thus in those of the plethoric type, the symptoms will resemble those of congestion; there may be flushes of heat, rush of blood to face and heat; uterine and other hemorrhages; leucorrhoea and even diarrhoea. In those of the chlorotic type, the symptoms which, at or near the proper age, would indicate the approach of the change of life, are the sallow complexion, semi-chlorotic skin, weak pulse, and various other indications of debility. In those of a nervous type, there is, as the change of life approaches, an evident disturbance of the nervous equilibrium, not unlike that which in similar cases precedes the original accession of the menstrual function. Hence the over-anxious look, the brimful eye, the terror-struck expression as if apprehensive of seeing some frightful objects, the face bedewed with perspiration, and the remarkable tendency to hysteria which are sometimes to be met with.
The unusual development of hair on the chin and upper lip generally coincides with final cessation of the menses; so does an unusual power of generating heat, indicated by the habit of throwing off the clothing and opening doors and windows. There are a large number of more or less distressing symptoms or forms of disease which in fact result from the change of life, – and which thus certainly indicate that the system is either actually undergoing that change, – or under the influence of causes which if not arrested will finally bring it about, and that too in a manner by no means safe for the patient. Among these may be mentioned the long list so admirably summed up by Jahr: “haemoptysis, bloody urine, piles, nose-bleed, and other hemorrhages; pulmonary phthisis likewise takes a fresh development and frequently terminates fatally. In other cases we meet with diarrhoea, weakness of the stomach, flatulence, vomiting and other derangements of the digestive canal, which are sometimes accompanied by consumption and profuse sweats. Some women complain at this period of attacks of rheumatism of the shoulder or thigh, or a considerable swelling of the joints; others experience attacks of hysteria, hypochondria, and even nymphomania; others again are attacked with various eruptions, such as tetter of the genital organs, acne, rosacea, or erysipelas. The most distressing maladies which break out at this period and often terminate fatally, are ulcers and polypi of the uterus, and carcinoma of this organ and of the breasts.
