MENOPAUSE (CLIMACTERIC), a medical term meaning primarily the cessation of menstruation, but has come to connote the permanent cessation of the monthly periods that forms the most obvious sign that the reproductive life of a woman has come to an end. Translated into popular language it is "the change of life." The cessation of menstruation is but the outward indication of internal changes of which the primary one is the cessation of ovarian activity. Menstruation (q.v.) is determined by the periodic ripening and bursting of small sacs in the ovary contain ing the egg-cells. Associated with these cyclical changes in the ovary are internal chemical (metabolic) changes in the body, in which other glands of internal secretion, particularly the thyroid and pituitary, play a part with the ovarian secretions. The result of the withdrawal of the ovary and its secretions is that the time of adjustment is sometimes associated with disordered health.
The age at which the menopause occurs has wide variations, but is usually between 45 and 5o. The way in which the meno pause occurs is also very variable. Menstruation may end sud denly and completely and without warning or it may gradually cease by diminishing losses and lengthening intervals spread over a year or more; occasionally, but not to the extent credited by the women themselves, these irregular periods may be accom panied by profuse losses.
Normally the adjustment to these internal bodily changes is made without disturbance of health of mind or body, or at most with trifling discomforts. Such as do arise are liable to be ex aggerated in certain individuals and may require medical treat ment. The commonest psychical change is mental depression with lack of energy, sleeplessness, headaches and neuralgias and disordered sensations of various kinds. It is the time at which the childless woman may think herself pregnant and even have a phantom enlargement of the abdomen and mock labour pains.
In those exposed to mental stress at this time or hereditarily predisposed, there are increased risks of insanity, which would appear to be greater in the more educated and cultured classes. Among the nervous phenomena the most common are "heats" and "flushes" with reddening of the face and neck, sometimes accompanied by sweating, which may be momentary or last for some minutes. More commonly a later effect, but sometimes be ginning before the menopause is a tendency to adiposity.
A premature menopause may occur at any age from disease of the ovaries or other glands of internal secretion or grave nutri tional disorder, but is occasionally met with before 4o as the result of a serious illness or profound emotional stress. An artificial menopause is produced by the complete removal of both ovaries or by the destruction of their function by radium or X-rays. The earlier in a woman's life it is brought about, the more severe are the symptoms produced, the psychical and nervous disorders being specially exaggerated.
From the medical standpoint the most important feature of the menopause is concerned with the fact that as reproductive activity wanes there is a tendency to overgrowth (obesity, goitre) and new-growth (tumours) of the uterus and ovary, for which a special watch must be maintained. Irregular bleeding is usually the first sign of cancer of the womb and increased menstrual losses of fibroid tumours and both are prone to be ascribed by women to the "change of life" and their early stages to be disregarded. Also abdominal enlargement is liable to be considered as due to obesity when it may be tumour-formation. Hence it is important that a thorough investigation be made of all women in whom this time of life presents any marked deviation from the normal, particularly in the direction of excessive bleeding from the womb.