INFLUENCE OF OVAKY ON GENEKATIVE TEACT 619 



Symptoms of the Menopause. The endocrine disturbance characteris- 

 tic of the climacteric may in some cases exert a profound effect upon the 

 entire organism, with the production of numerous and severe clinical 

 manifestations. In other cases, again, the endocrine apparatus adjusts 

 itself more smoothly and rapidly to the withdrawal of one of its cogs, so 

 that there may be scarcely a symptom produced. While there are few 

 women so fortunate as to be spared all symptoms, it is probable that the 

 significance of the menopause as a disturber of the woman's health and 

 well-being is exaggerated, especially in the minds of the laity. It is, after 

 all, one of the physiological phases of woman's life, even though many 

 women experience considerable annoyance in their passage through it. 

 The principal symptoms of the menopause may be enumerated as follows : 



1. Cessation of Menses. This symptom, which gives the menopause 

 its name, is clearly due to the cessation of the internal secretory activity 

 of the ovary a physiological agonadism which is preceded by a varying 

 period of hypogonadism. The menstrual function does not usually dis- 

 appear abruptly. Much more frequently the cessation of menstruation 

 is gradual, and in some cases many months elapse before the "dodging 

 period" of the menopause passes into a permanent amenorrhea. 



While not usually looked upon as a normal phenomenon, and while it 

 should always be regarded with suspicion, it is true that not a few patients 

 exhibit an increase in the menstrual flow during the menopausal period, 

 even in the demonstrable absence of anatomic diseases, such as cancer, 

 fibroids, etc. These cases of so-called functional climacteric bleeding are 

 probably due to a temporary hypersecretion of the ovary, as will be dis- 

 cussed under another heading. 



2. Vasomotor Symptoms. Next to the actual termination of men- 

 struation, the most striking symptoms of the menopause are those referable 

 to the vasomotor system. Most conspicuous are the hot flushes, which in- 

 volve especially the head and neck, and the lieat flashes, which affect often 

 the entire body. Among other symptoms perhaps referable to the vaso- 

 motor system are sweating, vertigo, faintness, epistaxis, vicarious bleed- 

 ing from various parts of the body, cold sensations in the hands and feet, 

 etc. Certainly these vasomotor symptoms are found in some degree in 

 about 80 per cent, of all cases. 



Cause of Vasomotor Menopausal Symptoms. As to the mechanism of 

 the production of these symptoms, various theories have been suggested. 

 Culbertson believes they "represent an instability of arterial tension." 

 He states that the ovarian deficiency occurring at the menopause produces 

 a relative oversufficiency of the pituitary and adrenals, causing thereby 

 what he terms a "vacillating hypertension." Others (Schuster, Gluzinski, 

 etc.) seek for an explanation of these symptoms in a hyperfunction of the 

 adrenals, which are intimately associated with the sympathetic nervous 

 system. 



