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In forty-four cases of my own, all women past the menopause, the average age of the first menstruation was fourteen years and four months; and the average age of the actual cessation of the menstrual flow was forty-eight years and five and two-thirds months.
That single women suffer less than married women would suggest that excessive coitus and the occurrence of abortions, frequent child-bearing, and lesions as the result of pregnancies, many of which lesions could have been prevented or cured by the timely aid of the physician, are the combined sources of much of the suffering at the time of the menopause.
It has been a grave question in the mind of the medical profession whether the dangers that certainly do attend the menopause are natural or acquired; that is, could these dangers be averted by any precautions or hygienic measures on the part of women, or are these dangers a necessary accompaniment of this period of life?
At the present day there is an increased sexual vitality, which shows itself in the fact that the duration of menstrual life has been increased three to four years during the past generation. The inference can be fairly deduced that vigorous vitality causes prolongation of the menstrual process and the actual age. Duration of Menopause.
For they mimic and prophesy the events of the last crisis of feminine sex life, the cessation of ovulation which goes by the name of menopause, gonadopause, or change of sex life. The premenstrual phenomena provide a positive film, so to speak, of the latent negative picture of the endocrine system of the girl or woman.
The Lancet quotes a rather fabulous account of a lady over sixty-two years of age who gave birth to triplets, making her total number of children 13. Montgomery, Colomb, and Knehel, each, have recorded the birth of twins in women beyond the usual age of the menopause, and there is a case recorded of a woman of fifty-two who was delivered of twins.
This is another reason why every woman at the menopause should undergo a thorough examination and have any defect repaired, thus avoiding much of the possibility of trouble. A frequent symptom of carcinoma of the uterus is hemorrhage at irregular times after the menopause.
Tilt's cases showed that women who suffered much at the menopause had previously suffered at puberty and at the menstrual periods. And among thirty-nine cases where there was no suffering at the menopause, there was the same immunity from suffering at puberty and at the menstrual epochs. Tilt's statistics were, or course, taken from English women.
Not only should any excessive and prolonged bleeding at the time of the menopause be a source of great anxiety to the woman, but even the irregular appearance of a slight show of blood just sufficient to keep the clothing stained, or a slight bleeding following coition; since all of these are symptoms of very great gravity, and demand an immediate local examination and appropriate treatment.
And Robinson believes that this is the explanation of the many pathologic manifestations of every viscus at the menopause; that is, "the irritation which arises by trying to pass more nervous impulses over plexuses than normal gives origin to what is unfortunately known as functional disease. It is just as organic as any disease, only we are unable to detect it."
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