PHASES IN THE LIFE OF THE INDIVIDUAL 715 



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 phenomenon of, the meno- 

 pause, therefore, is the permanent arrest of all the functions 

 connected with reproduction. 1 It is the inversion of the develop- 

 mental 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. 2 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 women in whom 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 neurasthenic phenomena, hysteria, and other 

 psychic disturbances sometimes occur, accompanied by neuralgia, 

 rheumatism, and various disorders. Mental instability at the 

 "change of life" is not uncommon. It is well known that the 

 menopause is followed by profound psychological changes which 

 vary in different individuals. 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 ; (b) disappearance 

 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; (b) 

 destruction of the epithelial cells. 



(3) Senile changes in the uterus : (a) Atrophy of the entire organ, 

 which may be reduced to a hard, wedge-shaped body, one-quarter 

 the size of the functional organ ; (b) in many cases closure of the 

 internal os, or of the external os, or complete obliteration of the 

 canal ; (c) consequent secretions producing pyometra or hydrometra, 



1 Cases are on record, however, of women conceiving some years after 

 the apparent menopause. 



2 For further details see Kelly, Medical Gynecology, London, 1908 ; and 

 Luciani, Human Physiology, English Edition, vol. v., London, 1921. 



