All authors are in agreement in considering as very undeterminable the limit and epoch of the normal and pathological crisis in this phase of feminine life, if we take into account the gradual involution of the ovarian function always compensated by very complex glandular and nervous reactions.

Before beginning to point out which are the remedies more frequently indicated during the climacteric (critical age) in woman, it is necessary to clear up the clinical concept and the terminology relating to it and to the menopause, which are markedly different conditions.

Properly speaking, the menopause is a normal and isolated phenomenon which is manifested by cessation of the menstrual fluid and the critical age or climacteric in woman is of some duration, a period characterized by a group of complex symptoms in which the main accident is constituted by menstrual cessation.

These phenomena have been recognized and studied since the times of Hippocrates; they have been subject to various interpretations and a great number of theories more or less justified have been written determining the pathogenic and clinical concept of these conditions.

The works of Adler, Bauer, Curschmann, Falta, Halban, Herz, Kraus, Neumann, Zondek, Franz, Werner, Maranon, Pende, Berman, etc., etc., constitute the most valuable modern investigations, which teach us the multiple elements which enter into this biological problem of womans life.

In order to shorten this extended matter, I begin according to Dr. Maranon, by dividing the periods of the climacteric and the normal menopause into three parts:

1. Pre-menopausic or pre-climacteric. period,

2. Menopausic or climacteric period and

3. Post-menopausic or post-climacteric period.

This schematic division permits us to form an easy appreciation of the whole matter, which comprehends since the symptomatical beginning which announces the menstrual declination, till the very end, with or without functional alterations.

Nevertheless this division, one must remember that the menopausic phenomena as those of the climacteric or critical age, are submitted to a well determined evolutive cycle, showing these in our race and climate between the age of from 40 to 50 years, but they can appear precociously or too late, according to the different factors which affected directly or indirectly the ovarian function.

Among these factors we should mention surgical interventions upon the ovaries and their adjuncts, uterine fibromas, ovarian cysts, x-ray application, endocrine dysfunctions, diabetes, gout, rheumatism, heart diseases, malaria, cancer, etc., such as the temperament and constitution of each patient, all of which allows us to establish the clinical criterion between the normal menopause and the pathological climacteric.

All authors are in agreement in considering as very undeterminable the limit and epoch of the normal and pathological crisis in this phase of feminine life, if we take into account the gradual involution of the ovarian function always compensated by very complex glandular and nervous reactions.

Notwithstanding the symptomatic variety among the different types of menopause and climacteric states that we found in practice, it is necessary to remember most especially that authentically menopause symptoms or those belonging to the changes suffered by women in this epoch, are of endocrinic- vegetative order and revealed by the most complete and diverse glandular and nervous troubles.

Precocious climacteric, tardy climacteric, the surgical one, the climacteric as a result of the x-rays, the pathological one, etc., have as many symptomatic manifestations as the female human organism apparatus has, upon which the phenomena of this change of age may operate.

For a better clinical understanding it is necessary to divide into eight the more frequent symptomatic phases as founded on climacteric conditions:

1.Genital symptoms.

2.Circulatory symptoms.

3.Nervous symptoms.

4.Metabolic troubles and symptoms.

5.Endocrinal symptoms.

6.Digestive symptoms.

7.Cutaneous symptoms.

8.Symptoms from other organs and apparatus in connection with menopause and climacteric respectively.

1.To the genital symptoms which can be counted on as a pre- climacteric, belong the irregular retirement or cessation of the menstrual fluid, the metrorrhagia, the hemophilic states (Kintsi), vicarious menstruation, inflammatory and neoplastic lesions of the genitals (myomas and fibromyomas of the uterus), haemorrhoidal haemorrhages, epistaxis, malenas, haematemesis, haemoptysis, mammary hypertrophy or atrophy and mammary tumors.

2.The symptoms of the circulatory apparatus comprehend: arterial hypertension, vasomotor phenomena with blushing, suffocating and profuse perspiration, urticarias, essential and paroxysmal tachycardia, cardiac insufficiency, arrhythmias, anginous phenomena, arteriosclerosis, Raynauds disease, phlebitis, varices, varicose ulcers and climacteric apoplexy.

3.To the climacteric nervous symptoms belong diverse neuralgias which are localized in different regions, where are often observed those of the trigeminus, dentals, cervicals, intercostals, etc. Headache and cephalea due to the hypertension is very frequent. Asthenia, paresthesias, generalized and vulvar pruritus are very annoying symptoms.

Climacteric states are very often accompanied by dizziness,insomnia and obstinate somnolency symptoms. In the same way we must dwell upon the psychical symptoms which are invariably associated with this condition, and being so multiple, varied and important that it is impossible to pass them by even though superficially on account of their characteristics, well known in the clinic, and to make use of them as guide in every homoeopathic prescription, if we take into account that the founder of homoeopathy, in paragraph 211 of the Organon or Exposition of the Homoeopathic Medical Doctrine, says as follows:

This holds good to such an extent, that the state of the disposition of the patient often chiefly determines the selection of the homoeopathic remedy, as being a decidedly characteristic symptom which can least of all remain concealed from the accurately observing physician.

Therefore psychical troubles in this phase of feminine life have been classified into general symptoms that influence sexuality and the habitual alterations in climacteric psychology.

Both of them are very closely related to the functions and dysfunctions of the organs of internal secretion, modifying the affectivity, the intellectual activity, properly speaking the sexual characteristics giving origin to emotional instability, impatience, psychical serenity, decrease or increase of sexual feelings, dislike of the opposite sex, sadness, anguish, tardy romanticism, sexual inversion (exhibitionism), eroticism, mysticism, religious delirium, melancholy manic-depressive states, suicide, hysteria, neurasthenia and epilepsy.

4. The metabolic troubles are characterized by obesity in its different types (adiposis and lipemia of the limbs, Dercums syndrome, Barraquers disease, Quinkes disease) and climacteric slenderness; the latter is due to hyperthyroidism and hypophyseal cachexia. Diabetes, gout, chronic rheumatism and tardy osteomalacia are the most important metabolic troubles in the climacteric.

5.The endocrine symptoms are of remarkable value and being well known, I will mention them only in the following order, but I have to remember that is every climacteric state there exists an endocrine symptomatology that serves as a basis for most of the symptomatic manifestations which appear at this age of woman, but we have to mention that IN THIS CHANGE OF FEMININE LIFE THE ENDOCRINE STATES DO NOT CAUSE ALL THE CLIMACTERIC TROUBLES (Maranon).

Hyperthyroidism, acute strumitis, myxoedema, thyroid insufficiency with obesity and thyroid instability are very frequent.

The suprarenal and hypophyseal syndromes, bronzed virilism (sexual inversion), pluriglandular sclerosis and precocious senility are the most characteristic endocrine troubles.

6. The digestive symptoms are of a very different kind, prevailing the dyspepsias of flatulent type or hyperchlorhydria, bulimia and obstinate constipation, hypochlorhydria, chronic colitis and enterocolitis are less frequent, but as a rule spasms of the pharynx and oesophagus are associated with these states; cholecystitis, cholelithiasis and climacteric jaundice are very common.

Intestinal or suppletory haemorrhages are seldom present. The Mickuliz disease is a very interesting and frequent syndrome in the climacteric epoch.

7.The skin and pilous system symptoms comprehend the acne rosacea, eczema, furunculosis, herpes, hyperhydrosis, erythemas oedemas, pruritus, melanoderma, whiteness of the hair, hyperhydrosis and baldness.

8. The symptoms of other organs and apparatus are shown by different manifestations which have as a starting point the sudden or gradual cessation of the menstrual fluid, which is accompanied by asthmatic and cystitic phenomena, urethral, cystalgias, ectopy kidney and uremia. Iritis, iridochoroiditis, cataract, glaucoma, etc.

Clinically the artificial menopause (surgical) is the manifestation of the complete and sudden ovarian insufficiency and the spontaneous one is a pluriglandular and complex crisis in which the gradual insufficiency of the ovary forms the most outstanding symptom and very often is accompanied by neuro- endocrine symptomatic manifestations.

Hilario Luna Castro