OVULATION AND MENSTRUATION


The most useful homeopathy remedies for Ovulation And Menstruation symptoms from the book The diseases peculiar to women and young children by H.N.Guernsey. …


THE ovaries constitute the central head of the female sexual system. This is true of all grades of animal life; throughout the entire scale of creation the ovaries form the ultima ratio of the generation. The uterus derives its stimulus from the excitation of the external organs of generation; but the final cause, the true physiological and vital reason of its existence and action, is to be found in the ovaries. It has been amply shown by the successful experiments of modern observers, that the ovaria are the essential organs of reproduction, and that in them originate the greater proportion of those sympathies which have been so long generalized as uterine; and furthermore that the development of the pelvis, of the uterine system and of the mammae, the function of menstruation and all the peculiarities of the human female, depend upon the ovaries. These supply the ova or seminal vesicles, which, by the stimulus of the seminal virus of the male, may be developed into an individual similar to its progenitors. In fulfilling their appropriate and primary function of ovulation, the ovaries determine also that of menstruation, which is secondary and consequent.

The ovaries have already been described as containing at puberty the seminal vesicles in different states of development. But these ova are discoverable long before the accession of the period of puberty. They may be seen in the ovaries of the new- born babe, and even in those of the foetus in utero. They form therefore an integral part of the ovarian tissue. The ante- pubertal life of the female is one of preparation, of growth in stature and in strength, with especial reference to the perfect fulfilment of the function of the ovaries. Many of the lower orders of the animal creation arrive at maturity much earlier than man. The human female is longer in arriving at the full measure of her development, as her being and destiny are higher. And the same general principle of greater length of preparation and greater results, is seen in the more particular instances of those individuals who commence to menstruate at a period later than the average. Those later in assuming the evidences of maturity are said to be more steadfastly regular in menstruation, and to continue it longer. And the converse is still more evidently true. For as in general all those whose precocious growth, even of the intellectual faculties, attracts so much attention, are seen to become exhausted, almost before they enter upon the race of life; so in the particular instance under consideration of premature development of the sexual system, the earlier young people arrive at puberty, so much the earlier do they grow old. And this is as manifestly true of nations as if individuals. Those races in which, like the Hindoo, the women arrive at sexual maturity at the earlier periods, as in the twelfth, year, are effete, emasculate, and doomed to be conquered by those in which the period of puberty is longer delayed. And this is true independently of those influences of climate or temperature, which may apparently seem to have conduced to much premature development. Thus the female, after a preparatory period of constitutional incubation, becomes so highly developed in her entire system in general, especially in her sexual organization, and more particularly still in her ovaries, that these minute seminal vesicles, these ova or eggs, mature and begin to burst through the outer covering of the ovary itself. Previous to the final accession of the period of puberty, the ova have been but imperfectly developed; and have in consequence remained comparatively dormant. But at this time a new life a new life and vigor spring up in the ovaries, which rapidly develop the external form of the female herself in general, and all the organs of her sexual system in particular. For, as the soul animates the body, so by the interior, vital change and new life and vigor of the ovaries, the lank and lean, homely, awkward and boyish form of the school girl is transformed into that full development of neck and bust, that rounded contour of the hips and perfect loveliness of the features, which the poet so aptly terms “beautiful exceedingly. And with advancing years, the beauty of “sweet sixteen” is still further developed under the unconscious influence of the higher life, which still more abundantly flows into and animates her whole system throughout the perfect action of her ovaries. For all the wondrous beauty of the woman, inward beauty, which may light up the plainest features with a most surpassing loveliness, all that fascinating influence which the purest-minded young woman most powerfully and unconsciously exerts upon all of the opposite sex around her, making them admire and even love her, is but the natural and inevitable expression of her capacity for receiving and reciprocating the highest affections of the human nature and of fulfilling, in the reproduction of the species, the highest uses of her being.

The period of the accession of puberty varies, according to climate and race hereditary and social circumstances, from the thirteenth to the sixteenth year. But if we take the fourteenth year for the average, as is probably the case in this country, half as many more years must be spent before the young woman’s constitution and sexual organization will have acquired its fullest development, that is, become capable of bearing the most healthy children, in the easiest and most healthy manner. Some young women indeed arrive earlier at their highest maturity; as some also do at a still later period; but in general the average age of the first ovulation being at fourteen, we may assume the period of the most perfect and complete development of this function to be at about the twenty-first year.

OVULATION, or the functional action of the ovaries, consists in the maturation of the ova and in their extrusion through the ovarian surfaces. This functional activity occurs in the normal state, at regularly recurring periods, usually once in twenty eight days. And in many women this period returns with great exactness, at the same day of the week, or even in some instances at the same time of the day. This increased activity of the ovaries is not far removed from a congestion of these organs; and in many cases the entire system sympathizes in this disturbances of the ordinary sanguineous and nervous circulations. And this disturbance of the whole system is no less intimately connected with the other function of menstruation, as it is seen to be very greatly and immediately relieved by the accession of the menstrual flux.

The manner in which the process of ovulation takes place is so admirably described by Dalton, physiology, p. 567, that we quote it in full, and copy the accompanying very elegant illustrations. In the earlier periods of life, in man and the higher animals, the egg is contained ion a Graafian follicle which closely embraces its exterior, and is consequently hardly larger than the egg itself. As puberty approaches, those follicles which are situated near the free surface of the ovary become enlarged by the accumulation of a colorless, serous fluid in their cavity. We then find that the ovary, when cut open, shows a considerable number of globular, transparent vesicles, readily perceptible by the eye, the smaller of which are deep-seated, but which increase in size as they approach the free surface of the organ. These vesicles are the Graafian follicles, which, in consequence of the advancing maturity of the eggs contained in them,. gradually enlarge as the period of generation approaches.

The Graafian follicle at this time consists of a closed globular sac or vesicle, the external wall of the which, though quite translucent, has a fibrous texture under the microscope, and is well supplied with blood-vessels. This fibrous and vascular wall is distinguished by the name of the “membrane of the vesicle”. It is not very firm in texture, and if roughly handles is easily ruptured.

The membrane of the vesicle is lines throughout by a thin layer of minute granular cells, which form for it a kind of epithelium, similar to the epithelium of the pleura, pericardium and other serous membranes. This layer is termed the membrana granulosa. It adheres but slightly to the membranes of the vesicle, and may easily be detached by careless manipulation before the vesicle is opened, being then mingled in the form of light and shreds, with the serous fluid contained in the vesicle.

At the most superficial part of the Graafian follicle, or that which is nearest the surface of the ovary, the membrana granulosa is thicker than elsewhere. Its cells are here accumulated in a king of mound or “heap, which has received the name cumulus proligerus. It is sometimes called the discus proligerus, because the thickened mass, when viewed from above, has a somewhat circular or disk-like form. In the centre of this thickened portion of the membrana granulosa the egg is embedded. It is accordingly always situated at the most superficial portion of the follicle, and advances in this way toward the surface of the ovary.

As the period approaches at which the egg is destined to be discharged, the Graafian follicle becomes more vascular, and enlarges by an increased exudation of serum into its cavity. It then begins to project from the surface of the ovary, still covered by the albugineous tunic and the peritoneum. The constant accumulation of fluid, however, in the follicle, exerts such a steady and increasing pressure from within outward, that the albugineous tunic and the peritoneum successively yield before it; until the Graafian follicle protrudes from the ovary as a tense, rounded translucent vesicle, in which the sense of fluctuation can be readily perceived on applying the fingers to its surface. Finally, the process of effusion and distention still going on, the wall of the vesicle yields at its most prominent portion, and the contained fluid is driven out with a gush by the reaction and elasticity of the neighboring ovarian tissues, carrying with it the egg, still entangled in the cells of the proliferous disk.

During the earlier life of the female, the ova, or rather their rudimentary and incompletely developed germs, are formed ion the ovaries, and perhaps discharged from them time to time. But at the full constitutional and sexual development called puberty, with each return of the menstrual period, or ovarian nisus, one or more of the complete ovules bursts through the enveloping membranes of each ovary, in the manner just described, and is received into the upper portion of one of the oviducts called the Fallopian tubes. The fimbriated extremities of these tubes are applied to the ovaries, not, as is supposed by some, under the stimulus of sexual intercourse, but under the wonderful reflex influence of the process of ovulation itself, by which these extremities are led to apply themselves firmly over the exact portion of the ovaries from which the ova are about making their appearance. This must necessarily be the case, since the ova are conveyed to the uterus whether impregnated or not.

At each menstrual period, it is believed that one ovum is transmitted through the Fallopian tubes; the passes off and is lost. At the same time those remaining in the ovaries are advanced in their development. Of the particular manner and time of the transmission of the impregnated ova, we shall speak in treating of conception. Suffice it to say here in general, that the ripening and discharge of the ovum is menstruation is called oestruation, which is analogous to the orgasm of sexual intercourse although more protracted.

MENSTRUATION requires to be particularly studied in this connection, since it usually forms an important attendant and consequent portion of the process of ovulation, although it is not always present, even in apparently perfect health.

Ovulation we have found to consist in the maturation of the ova, and in their extrusion from the ovaries. By the Fallopian tubes these ova are taken up and transmitted to the womb. The uterus becomes then immediately and directly connected with the ovarian nisus; and at the same time it partakes in a most remarkable manner in the ovarian congestion. And, in fact, all the other parts of the generative apparatus, the vagina and the external organs, and even the entire sanguineous and nervous circulations, sympathize in this congestion and excitement. But although thus involving the whole system, the menstrual orgasm is entirely dependent upon the ovarian nisus. Where there are no ovaries, there are neither sexual desires nor menstrual periods. And in a remarkable case, in which both ovaries were extirpated in removing a painful tumor from each groin, a woman who before had always menstruated with great regularity, immediately and permanently ceased to menstruate. While in some other cases in which the womb was either wanting naturally or had been removed on account of disease, the mammary development and sexual desires remained unabated, and the menstrual discharges took place from the vagina. As long as the ovaries remain intact the woman is a woman still, in external form and inward desires; although from absence of the uterus or vagina, she may be incapable of conception or even of sexual intercourse. But let the ovaries be removed, and the woman loses at once all the distinguishing traits of the female character; her breasts diminish in size and she becomes masculine in features, form and voice.

Relation of Menstruation to Ovulation. Thus far we have shown that menstruation is essentially dependent upon the functional action of the ovaries; that it is not an original action of the uterus, since it always fails where the ovaries are wanting; but does not necessarily fail where the uterus is absent; and that although there can be no menstruation except in connection with ovulation, there may be ovulation without menstruation. This may be the result of imperfect development of the uterus and its inferior appendages; or it may occur without any such structural cause, as many cases are recorded of persons who have repeatedly conceived and become mothers, but who have never once menstruated. Let us now examine the physiological relation which menstruation or the quasi function of the womb bears to ovulation or the primary function of the ovaries.

The orgasm of the ovaries at the period of maturation and extrusion of the ova, and the consequent congestion of the womb and other dependent parts of the sexual apparatus, have already been described as very intense and as involving the entire system. This intense orgasm having accomplished its primary purpose in the maturation and extrusion of the riper ova, and having at the same time also advance others to a proportionate degree of development, requires a larger basis for its own critical ultimation. The intense congestion of the blood-vessels and the no less intense excitement of the nervous centres must be relieved; and the relief is obtained through the menstrual discharge.

The first menstruation usually makes its appearance about the fourteenth year. In some individual cases it comes earlier; and in others much later. Delicate and luxurious habits of living, especially in large cities, and to render the menstrual period earlier in its first occurrence, but less constant and regular in its subsequent appearance. Hereditary constitution exerts a powerful influence in determining the time of the first menstruation. For while in Calcutta, india, the native females begin to menstruate between the twelfth and thirteenth years, the children of British residents, although born in the city, average about the sixteenth year. And different conditions in life, and residence in the country rather than in the city, exert an important influence in determining the period of first menstruation. Thus in Denmark, in the women born in the country, the average period of first menstruation will be found to be at sixteen years and five moths; those in larger towns, fifteen years and four months; those in Copenhagen, the largest city, fifteen years and seven months. So in Russia, in fifty-three cases of the noble and rich, the average was found by De Boismouth, to be thirteen years and eight months. In one hundred and thirty-five women of the well-to-do classes, the average was fourteen years and five months. And in one hundred and seventy-one of the poor, the average was set down at fourteen years and ten months. In London, of sixty-seven women of the opulent class, the average was thirteen years and about six months; while in even hundred and seventy five women of the well-to-do working class, the average was fourteen years and four months.

The cessation of the menses usually takes place between the fortieth and the fiftieth years; at about forty five, being considered to be the average time of the change of life. But this may and often does vary in individual cases to a considerable extent. Some women cease to menstruate soon after thirty, especially those who began early; while others have borne children after they were fifty years of age, and regularly menstruated to their sixty-second year. Others again cease to menstruate at the usual period, but experience a return of the periodic flow after some years. In some instances this protracted menstruation or return of the flow may be dependent upon ulceration or other disease of the womb. But in most cases late menstruation, especially if unattended with much suffering or other morbid symptoms, may usually be regarded as evidence of remarkable constitutional strength and longevity. Since, in general, life is longest and the health most assured in those females who commence to menstruate later, and who continue in the exercise of this function later than the ordinary term. In many cases the cessation of the menses does not occur at once, but is arrived at gradually through from one two three or even more years of menstrual irregularities, called by some, “the dodging time. And the cessation may be by a gradual diminution of the flow; by alternate copious and scanty menstruation, or by changes in the character of the discharge itself. The general average duration of the function of menstruation may be stated at about thirty two years. For the morbid conditions which occur in connection with cessation of the menses, see subsequent chapter on the Change of Life.

Symptoms. “The menstrual discharge consists of an abundant secretion of mucus mingled with blood. When the expected period is about to come on, the female is affected with a certain degree of discomfort and lassitude, and sense of weight in the pelvis and more or less disinclination to society. These symptoms are in some instances slightly pronounced, in others more troublesome. An unusual discharge of vaginal mucus then begins to take place, which seen becomes yellowish or nearly brown in color, from the admixture of a certain proportion of blood; and by the second or third day the discharge has the appearance of nearly pure blood. The unpleasant sensations which were at first manifested, then usually subside; and the discharge, after continuing for na certain period, begins to grow more scanty. Its color changes from a pure red to a brownish or rusty tinge, until it finally disappears altogether, and the female returns to her ordinary condition..–Dalton.

The original menstruation flux, as it issues from the uterus, is nearly pure blood; but in its passage through the vagina it becomes mingled with the acid, mucous secretion from the vaginal surface, which changes its quality and appearance. The menstrual discharge returns with great regularity in perfectly healthy females; but varies in quantity in different individuals, being quite free in some and scanty in others. Each menstrual period occupies from two or three to five or six days; and the whole amount of the flow may vary from three ounces to eight, according to the temperament and idiosyncrasy of the individual. Some plethoric persons having a very scanty flow; while in others, who seem to have no blood to spare, the discharge in much more free. And in some exceptional cases of persons apparently enjoying good health, the catamenia may differ from the normal standard in every respect. Those irregularities which are properly termed morbid will be considered in a separate chapter. During utero- gestation and lactation the menses are usually wanting; there are however exceptions, some women menstruation with their usual regularity, and while nursing; in many others, the menses return after the first few moments of lactation.

The causes of menstruation, must be identical with those of ovulation–from the intimate connection of these two functions, and from the essential dependence of the former upon the latter. The causes of ovulation must be found in the nerves which supply the ovaries. These form part of the ganglionic system, and are immediately derived from the solar plexus, which is the great centre of vegetative life.

All the actions of the human body may be considered as voluntary, as involuntary, or as partaking of the nature of both these conditions. Thus the bodily actions may be distinctly referred either to the cerebral or voluntary nervous system, to the ganglionic or involuntary nervous system, or to the spinal nervous centre, which is more or less influenced and controlled by each of the others. The involuntary functions, with which alone we are at present concerned, may all be classified as belonging either to the nutrition of the individual, or to reproduction of the species. Thus the ante-pubertal period is almost exclusively devoted to the nutrition of the individual, but not without reference to future reproduction, as is seen in the existence and even extrusion of the premature ova during all this period. During the child-bearing period, the nutrition of the individual is rendered unusually active and vigorous in order that it may subserve the reproduction of the species; and when both cannot be at the same time provided for, it is the former which gives way to the latter. This is seen in case of consumptive women who become enciente; the child flourishes at the expense of the mother, and is born comparatively healthy, while the mother dies from inanition.

H.N. Guernsey
Henry Newell Guernsey (1817-1885) was born in Rochester, Vermont in 1817. He earned his medical degree from New York University in 1842, and in 1856 moved to Philadelphia and subsequently became professor of Obstetrics at the Homeopathic Medical College of Pennsylvania (which merged with the Hahnemann Medical College in 1869). His writings include The Application of the Principles and Practice of Homoeopathy to Obstetrics, and Keynotes to the Materia Medica.