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. 7 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." e 



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- 



