672 THE PHYSIOLOGY OF REPRODUCTION 



THE MENOPAUSE 



In the male sex (as already mentioned) there is no definite 

 age at which the reproductive functions cease. In the female, 

 on the other hand, the close of the reproductive period is far 

 more definite, and it is this change in the human female which 

 constitutes the menopause or climacteric. The essential pheno- 

 menon of the menopause, therefore, is the permanent arrest of 

 all the functions connected with reproduction. It is the in- 

 version of the developmental process of puberty, and marks 

 the termination of active sexual life. In temperate climates 

 it almost always takes place between the ages of forty and 

 fifty, and most usually at about the age of forty-five. 1 In 

 warm countries it has a tendency to be earlier, and in colder 

 ones later. It is usually earlier among the labouring classes, 

 and also in cases in which puberty was early. The actual 

 duration of the period when menopause symptoms occur varies 

 from about three to five years. 



The symptoms of the menopause may be referred to two 

 stages (1) a stage of menstrual irregularity, and (2) a post- 

 cessation stage, during which various systemic disturbances are 

 wont to occur. During the latter period especially the organic 

 functions are irregular. Palpitation, dyspepsia, sweating, and 

 vasomotor changes are not infrequent, and hysteria and other 

 psychic disturbances sometimes occur, accompanied by neuralgia, 

 rheumatism, and various disorders. The changes which take 

 place in the lower Mammals have not been studied, but they 

 can hardly be so great as those which occur in women. 



The anatomical and physiological basis of the menopause 

 is, as already indicated, the atrophy of the reproductive organs. 

 The following are the changes which take place in women : 



(1) Senile changes in the ovary : (a) Atrophy, induration, 

 and shrinkage to the size of the rudimentary ovary; (6) disappear- 

 ance of Graafian follicles and cessation of ovarian functions. 



(2) Senile changes in the Fallopian tubes : (a) shortening 

 and narrowing, often accompanied by obliteration of the lumen ; 

 (6) destruction of the epithelial cells. 



1 For further details see Kelly, Medical Gynecology, London, 1908. 



