The subject of menstruation seems to be troubling several of you. I am sorry that you did not all have the advantage of having this explained at an early age. You might have been saved a great deal of suffering and causeless worry.

By menstruation, or "the monthlies" as it sometimes is called, is meant the monthly hemorrhage that takes place in the uterus or womb during the child-bearing period of the normal woman except during pregnancy and lactation, when it nearly always is suspended. The child-bearing period commences at the age of puberty and ends with the menopause (change of life).

Puberty is the period of maturing of the sexual organs. It occurs about the age of twelve, although there may be considerable variation as to this. It extends over a period of several years. As a rule, girls mature earlier in warm climates than in cold and in cities than in country districts. The signs of the approach of this period are the growth of hair on the pubes and other parts of the body, the enlargement of the breasts, a general rounding and increased grace of the body, the development of the pelvis so that the hips become more prominent, and a change in the mental qualities of the child, the girl naturally becoming more retiring. The menstrual function usually is not established at once, there being premonitory symptoms of a vague nature. There may be, at first, only a slight discharge of mucus tinged with blood, later the normal menstrual flow will be established.

During this period of puberty there are great changes taking place in the girl's internal organs. This change and development requires considerable of the girl's strength and naturally influences her nervous system. It is for this reason that a girl at this period of her life should not be subjected to any great exertion, either physical or mental. She should have plenty of light, healthful exercise in the open air, but should not indulge in any very violent exercise. A little care at this time often will save her years of suffering. As the nervous system is greatly affected at this period there should be no great mental strain. In fact, if the girl shows many nervous symptoms, it may be wise to take her out of school for a year so that her strength may be used as Nature requires it. As a rule, too much work is required in school at this age. The school duties should be lessened and the girl allowed to rest a day or two during her menstrual period. The girl at this age should not attempt to accomplish as much work or study as the boy does. Her time at this period might better be occupied in learning the rudiments of housekeeping and home-making. Then, when her body has become developed, her strength can be spared and can be well used in the development of her mind. If the nervous strain too common at this age could be relieved we would have fewer nervous women and a healthier and happier posterity.

As puberty approaches, a mother should give her daughter adequate information so that she should not be frightened at the first appearance of the menstrual flow, nor take any risks at this period. Menstruation is the sign of the possibility of motherhood. If properly taught this fact, every girl will be glad she menstruates and will want to be careful during the period. On account of lack of early instruction, many a girl obtains wrong ideas regarding this function and it produces in her a feeling of repugnance. She should be taught the reasons for observing prudence during the menstrual period. The possible lifelong invalidism that may result should be pointed out. A woman owes it to herself to take good care of herself during her menstrual periods. For two or three days at least she should avoid any unnecessary strain, lie down and rest as much as possible and not worry over school or other duties. Especial attention should be paid to cleanliness during this period. A sponge bath taken in a warm room is not injurious and unpleasant odors can be avoided by sponging the parts with a warm antiseptic solution upon changing the cloth. Every woman should be provided with a circular girdle cut upon the bias so it may be elastic, and provided with tabs to which to pin the folded cloth. She also should have a supply of sanitary cloths made of absorbent cotton-fabric, or pads made of absorbent cotton enclosed in gauze. The latter especially are convenient for the girl who is obliged to room away from home, for they may be burned and the cost of new ones is no greater than the laundry of cloths. These pads or cloths should be changed at least twice a day. It also is necessary that one should bathe the parts in warm water with each change, as unpleasant odors can thereby be avoided. At the close of each period she should take a bath and change all clothing. One cannot be too careful about these matters so essential to cleanliness. It is surprising how many women neglect these important matters. The erroneous idea that bathing of any sort at this time may have disastrous results accounts for much of this neglect. If proper care is taken warm sponge baths cannot be injurious.

A woman in normal health should not suffer at the menstrual period. She normally will have a feeling of lassitude and disinclination for any great mental or physical work, perhaps accompanied by a slight feeling of uneasiness in the pelvic region. Because so many women do suffer at these periods it often is considered as "natural" and allowed to continue.

The phenomena often noted at the menstrual period are,—pains in various parts of the body, hot flashes, chilliness and various hysterical symptoms. A few days before menstruation commences there may be various nervous symptoms, as irritability and a disinclination for any exertion. Dark circles often appear under the eyes and the breasts become enlarged and painful. A sense of fullness and oppression may be felt in the head.

Any severe pain or profuse flow during the period or a discharge between periods indicates a weakened or diseased condition and should not be neglected, for it sooner or later will affect the whole system. A woman suffering from female diseases not only is unable to perform her work in a normal manner but the pale skin, dark circles under the eyes and drawn haggard look which accompany these conditions rob her of her charm of physical excellence.

The menstrual flow appears, as a rule, every twenty-eight days, although the length of time varies with the individual. The average duration is five days, but varies from three to seven. The flow consists of blood from the uterine mucosa (lining of the womb) together with small quantities of mucus. The color generally is dark at first while later it becomes more pale. Women in poor health often have a pale discharge. There always is a faint odor to the menstrual flow, which has been likened to the odor of marigolds. The quantity varies with the individual. Usually fleshy girls flow more than thin ones and dark complexioned ones than light ones. The average quantity is four to six fluid ounces. The time between the periods is required by the uterus or womb to first restore the lining and then prepare it for the reception of the ovum. Every month one or more ova (eggs) leave the ovary, pass to the uterus and, if not impregnated, pass off with the menstrual flow. The material prepared for the reception of the ovum is used to nourish the new life if pregnancy occurs, but when it does not, this surplus passes off in the form of the menstrual flow.

The menopause or change of life is the end of the child-bearing period of a woman's life. The average age at which it occurs is forty-six, although there is a great difference as to this. In some women it has been known to occur as early as the thirtieth year, while in others it does not come until the fifty-fifth year. As a rule, a woman who commences to menstruate at an early age continues to do so until a late age, while with a woman who commences to menstruate late, the change comes early. At this period of a woman's life, there are numerous changes taking place in the body. The ovaries and uterus atrophy or shrink in size, and cease to functionate. The nervous system is being readjusted to meet the changed conditions. One symptom of the approach of this period is irregularity in menstruation; sometimes several periods are missed, then the menstrual flow appears normally for several months and then disappears again. Often the woman complains of hot flashes, cramps in the limbs and other parts of the body. These are caused by the attempts to readjust the nervous system to the altered conditions. A great many women worry unnecessarily, for there is no especial danger at this time unless the body has been neglected previously and a diseased condition is present. But the body needs a little extra care, just as it did at puberty. So many women break down their health by worrying at this period over what might happen. The best plan for every woman, as soon as she perceives the approach of this period, is to go to a reliable physician and have a thorough examination. Then if there are any neglected tears or chronic inflammations they can be corrected and danger removed. If a person were to cross a deep lake and had any doubts regarding the worthiness of the vessel provided for his use, he would be very foolish if he did not have a trained boat-builder examine his vessel and repair any weak places. It is just as important for a woman about to cross this period of her life to go to a trained repairer of bodies and have him correct any weak places.

The various changes taking place consume so much of the woman's strength that she requires an extra amount of rest and cannot use up as much energy in working as at other periods of her life. The ordinary woman does not realize the need of extra rest during this period and so continues her usual work. Then the extra drain on her nervous system shows itself in various forms. The disturbances sometimes are productive of so much discomfort and so often are exaggerated beyond physiological limits that the patient is impelled to seek relief and often requires a physician's attention. Puberty or the period of development extends over several years, so the menopause or period of atrophy extends over a period of from three to five years. If a woman relaxes and allows the changes to proceed naturally she need have no cause to worry, but she must remember that rest from continual strain is necessary during this period. Freedom from care, relaxation of physical and mental effort, regular periods of complete rest once or twice a day, a reduction of the diet and regulation of the bowels should be the first principles of treatment. Then—do not worry but occupy the mind with happy thoughts.