216 THE INTERNAL SECRETIONS—1920 
pause. The adrenals take on increased activity at 
this time, enlarging after the menopause. It has been 
already proved there is more adrenalin in the blood 
after the menopause. 
THE INFLUENCE OF THE THYROID 
The thyroid hormone stimulates or supports the 
ovary. Menstruation cannot properly occur without 
it. If this stimulus is insufficient there is always a 
decrease or cessation of menstruation, according to 
the degree of insufficiency. Such cases are obese, lack 
energy, and are deficient sexually. 
The more marked thyroid insufficiency which pro- 
duces myxedema and is invariably associated with 
suppression of the menstrual function.?. Marked hypo- 
thyroidism almost invariably results in sterility, while 
cases of minor or variable states of this disease im- 
proved notably when pregnancy occurred. 
“Both the minor and the major states of thyroid 
insufficiency are readily amenable to thyroid treat- 
ment, with one reservation—if the girl has suffered 
from thyroid insufficiency for some years past the 
period of puberty, and has never menstruated, it may 
be impossible to relieve her genital condition, and the 
uterus may remain undeveloped. If the insufficiency 
has arisen after the subject has possessed full genital 
activity, then the uterus may, even after a long period 
of inactivity, resume its normal functions.” ° 
With ovarian insufficiency hypothyroidism is much 
more frequent in young women, while hyperthyroidism 
seems to be more common in adults. Ovarian disturb- 
ances are almost always found accompanying hyper- 
thyroidism. Osborne states that the ovaries are al- 
ways over-stimulated when the thyroid is too active.* 
Early in these cases menorrhagia is common. Later 
amenorrhea is usual, but probably is due to a disturb- 
ance of the general metabolism. During the meno- 
