OVULATION AND MENSTRUATION



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.

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.