The Menopause





While the phase of feminine sexual life which involves the cessation

of menstruation is physiological and not morbid, it is so commonly

associated with physical and mental symptoms difficult to bear that,

practically always, it sends the woman to a physician. This is as true

of the artificial menopause induced by removal of ovaries as it is of

the normal process by which, in the course of time, ovarian function

comes to an end and changes are brought about in the system consequent

upon the absence of ovarian secretion. The ovaries, like many other

organs, have two functions. One, that of ovulation, is so prominent

that the other, the internal secretion, has been too much neglected.

How important this is, however, may be judged from the change that

comes over feminine nature after its cessation. Much of the

emotionality of woman disappears, not a few of her special sex

qualities are modified and even masculine physical peculiarities may

assert themselves. The physical effects of the ovarian internal

secretion may be inferred from the definite tendency to grow stout

which results from its suppression by the menopause. Certain changes

in the organism are inevitable then, and the only hope of therapy is

to keep them from disturbing life processes.





Neutralizing Unfavorable Mental Attitude.--Psychotherapy can do more

for the troubles of the menopause than any other treatment. The

symptoms of the change of life in the long ago, if we can trust

traditions, were not so troublesome as they are now. Only rarely did

women suffer from it as they are supposed to suffer at the present

time. Women are so persuaded that there is to be much suffering, or at

least prolonged physical discomfort, as to make it difficult for them

to be quite themselves. They are prone to think that their physical

symptoms are noted, and that their condition is a subject of remark.

This adds to the difficulty of bearing in patience whatever symptoms

are present. The introspective attitude of our time has reacted upon

such affections as occur in the menopause, and, by creating an

abnormal susceptibility of mind, has added much not only to its

possibility but also to its actuality of suffering. Drugs or other

remedial measures will modify the conditions only partially and

temporarily. The mental prophylaxis of suggestion must alter the state

of mind both before and during the progress of the condition.





Favorable Suggestion.--After the menopause women are less disturbed by

emotional strains and troubles of any kind than before. They settle

down into more placid, easy-going lives. They are not subjected to the

monthly interruption of their routine of work or amusement, everything

comes a little easier to them, and they are not, to use the word in

its physiological sense, so irritable--that is, so responsive in

reaction. They are not so likely to respond to slight irritations, and

are often physically and mentally more content with life. This must be

insisted upon, for, at the present time, unfavorable suggestion with

regard to the menopause is the universal rule. Women look for the

worst from it, and their expectation makes conditions less tolerable

than they really are. Most women dread it as if it were the beginning

of the end of life, the first descent into old age, while it is often

the dawn of a larger and broader life free from sexual and other

irritations, and with better possibilities of accomplishment.





Definite Prescriptions.--These patients are best reassured by being

told that every woman who has lived to the age of fifty has gone

through a similar experience and that they have all, with rare

exceptions, revived with health of both body and mind. It is more

important to insist on the patients cultivating a certain gaiety of

disposition, to plan for regular diversions two or three times a week,

to see that they are not too much alone and that they find abundant

occupation of mind and body, than to try to combat their manifold

symptoms by drugs or local measures. Of course, their physical

functions must be kept normal. It is surprising, however, how much

improvement can be brought about in the menopause symptoms by definite

prescriptions as to the time to be spent in the open air--at least two

or three hours a day--with regard to having a definite diversion of

some kind in mind two or three days ahead to which they look forward

with pleasure, and by convincing them that whenever they allow

themselves to dwell much on their condition, their symptoms of

discomfort will become so severe as to be intolerable, while when they

are occupied with other things they will find them quite easy to bear.



As a rule, mothers of families with many cares and diversions of mind,

with little time to think of themselves, do not suffer much at this

period, or at least not nearly so much as do those who are without

these diversions. The more time a woman has to think about herself at

this period, the worse for her. Her irritability of mind will be

reflected upon her physical condition and make it worse. In the olden

time mothers of families went through it and no one knew about it, or

even noticed that there was anything the matter with them except

possibly a little increased irritability at certain periods. Neither

menstruation nor the menopause is necessarily connected with more than

passing discomfort, if the patient is in good health. This is

perfectly true if symptoms are not brooded over, if there is not too

much expectancy of evils, and the feelings and manifestations which do

not deserve the name of symptoms are taken as a matter of course. Best

of all, let the woman keep her mind well occupied with many

duties--with care for others, the helpless, the ailing, around her,

instead of with herself and her passing ills.





Dread of Insanity.--There are few women who go through this period

without the hideous thought that possibly they may go crazy. This is

especially likely if, as a consequence of the exaggerated desire for

seclusion that many women have at this time, they do not get out into

the air nor exercise as much as they should. As a consequence, they

suffer from constipation, from lack of appetite, and capriciousness of

taste for food, and they may have a series of symptoms that, when

dwelt on during the hours of solitude, very seriously disturb the good

feeling that is so important for the normal accomplishment of

physiological functions.





Diversion of Mind.--This tendency to withdraw from social relations

with their friends and from the occupations that take them out of

doors and which are often a helpful diversion of mind is one of the

worst symptoms of this time and must be strenuously combated. It

superinduces a series of physical symptoms which are attributed to the

menopause but are really due to lack of air, to inactivity, to absence

of interest and the consequent opportunity provided for unfortunate

auto-suggestion and introspection. These superadded physical symptoms

can be readily relieved by directions for rational living and then the

genuine menopause symptoms may be so diminished as to be scarcely

noticeable. It is impossible for the ordinary human being to stay much

in the house, to lie down a large part of the time, eat irregularly

and let the bowels become sluggish without having many symptoms of

depression.





Summary of Treatment.--The treatment, not of the menopause but of the

patients passing through the menopause, then, must consist, first, in

putting them in as good physical condition as possible and keeping

them in it; second, in maintaining such normal natural habits of life

as will enable them to keep up this physical condition without

disturbance; thirdly, in putting off solicitude with regard to the

menopause and realizing that it is a normal natural process with a

definite place in human life and not at all representing a terminal

stage of human existence. Nature meant that the mature woman, formed

by precious experience, with sympathies broadened by years, should be

able to devote herself without sexual irritation to the many things

that naturally come to her at this period. There is a place in life

for the grandmother and even for the grandaunt, though a French

visitor recently declared that he thought there must be no

grandmothers in America since all the women seemed to dress in the

fashion of the young girl. If this submission to natural conditions is

recognized and accepted there are long years of happiness and

helpfulness in store for the woman of middle age and the menopause may

be welcomed as an important step towards a larger development of life.





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