While the phase of feminine sexual life which involves the cessation of menstruation is physiological and not morbid, it is so commonly associated with physical and mental symptoms difficult to bear that, practically always, it sends the woman to a physician. This is as true of the artificial menopause induced by removal of ovaries as it is of the normal process by which, in the course of time, ovarian function comes to an end and changes are brought about in the system consequent upon the absence of ovarian secretion. The ovaries, like many other organs, have two functions. One, that of ovulation, is so prominent that the other, the internal secretion, has been too much neglected. How important this is, however, may be judged from the change that comes over feminine nature after its cessation. Much of the emotionality of woman disappears, not a few of her special sex qualities are modified and even masculine physical peculiarities may assert themselves. The physical effects of the ovarian internal secretion may be inferred from the definite tendency to grow stout which results from its suppression by the menopause. Certain changes in the organism are inevitable then, and the only hope of therapy is to keep them from disturbing life processes.

Neutralizing Unfavorable Mental Attitude.—Psychotherapy can do more {451} for the troubles of the menopause than any other treatment. The symptoms of the change of life in the long ago, if we can trust traditions, were not so troublesome as they are now. Only rarely did women suffer from it as they are supposed to suffer at the present time. Women are so persuaded that there is to be much suffering, or at least prolonged physical discomfort, as to make it difficult for them to be quite themselves. They are prone to think that their physical symptoms are noted, and that their condition is a subject of remark. This adds to the difficulty of bearing in patience whatever symptoms are present. The introspective attitude of our time has reacted upon such affections as occur in the menopause, and, by creating an abnormal susceptibility of mind, has added much not only to its possibility but also to its actuality of suffering. Drugs or other remedial measures will modify the conditions only partially and temporarily. The mental prophylaxis of suggestion must alter the state of mind both before and during the progress of the condition.

Favorable Suggestion.—After the menopause women are less disturbed by emotional strains and troubles of any kind than before. They settle down into more placid, easy-going lives. They are not subjected to the monthly interruption of their routine of work or amusement, everything comes a little easier to them, and they are not, to use the word in its physiological sense, so irritable—that is, so responsive in reaction. They are not so likely to respond to slight irritations, and are often physically and mentally more content with life. This must be insisted upon, for, at the present time, unfavorable suggestion with regard to the menopause is the universal rule. Women look for the worst from it, and their expectation makes conditions less tolerable than they really are. Most women dread it as if it were the beginning of the end of life, the first descent into old age, while it is often the dawn of a larger and broader life free from sexual and other irritations, and with better possibilities of accomplishment.

Definite Prescriptions.—These patients are best reassured by being told that every woman who has lived to the age of fifty has gone through a similar experience and that they have all, with rare exceptions, revived with health of both body and mind. It is more important to insist on the patients cultivating a certain gaiety of disposition, to plan for regular diversions two or three times a week, to see that they are not too much alone and that they find abundant occupation of mind and body, than to try to combat their manifold symptoms by drugs or local measures. Of course, their physical functions must be kept normal. It is surprising, however, how much improvement can be brought about in the menopause symptoms by definite prescriptions as to the time to be spent in the open air—at least two or three hours a day—with regard to having a definite diversion of some kind in mind two or three days ahead to which they look forward with pleasure, and by convincing them that whenever they allow themselves to dwell much on their condition, their symptoms of discomfort will become so severe as to be intolerable, while when they are occupied with other things they will find them quite easy to bear.

As a rule, mothers of families with many cares and diversions of mind, with little time to think of themselves, do not suffer much at this period, or at least not nearly so much as do those who are without these diversions. The more time a woman has to think about herself at this period, the worse for {452} her. Her irritability of mind will be reflected upon her physical condition and make it worse. In the olden time mothers of families went through it and no one knew about it, or even noticed that there was anything the matter with them except possibly a little increased irritability at certain periods. Neither menstruation nor the menopause is necessarily connected with more than passing discomfort, if the patient is in good health. This is perfectly true if symptoms are not brooded over, if there is not too much expectancy of evils, and the feelings and manifestations which do not deserve the name of symptoms are taken as a matter of course. Best of all, let the woman keep her mind well occupied with many duties—with care for others, the helpless, the ailing, around her, instead of with herself and her passing ills.

Dread of Insanity.—There are few women who go through this period without the hideous thought that possibly they may go crazy. This is especially likely if, as a consequence of the exaggerated desire for seclusion that many women have at this time, they do not get out into the air nor exercise as much as they should. As a consequence, they suffer from constipation, from lack of appetite, and capriciousness of taste for food, and they may have a series of symptoms that, when dwelt on during the hours of solitude, very seriously disturb the good feeling that is so important for the normal accomplishment of physiological functions.

Diversion of Mind.—This tendency to withdraw from social relations with their friends and from the occupations that take them out of doors and which are often a helpful diversion of mind is one of the worst symptoms of this time and must be strenuously combated. It superinduces a series of physical symptoms which are attributed to the menopause but are really due to lack of air, to inactivity, to absence of interest and the consequent opportunity provided for unfortunate auto-suggestion and introspection. These superadded physical symptoms can be readily relieved by directions for rational living and then the genuine menopause symptoms may be so diminished as to be scarcely noticeable. It is impossible for the ordinary human being to stay much in the house, to lie down a large part of the time, eat irregularly and let the bowels become sluggish without having many symptoms of depression.

Summary of Treatment.—The treatment, not of the menopause but of the patients passing through the menopause, then, must consist, first, in putting them in as good physical condition as possible and keeping them in it; second, in maintaining such normal natural habits of life as will enable them to keep up this physical condition without disturbance; thirdly, in putting off solicitude with regard to the menopause and realizing that it is a normal natural process with a definite place in human life and not at all representing a terminal stage of human existence. Nature meant that the mature woman, formed by precious experience, with sympathies broadened by years, should be able to devote herself without sexual irritation to the many things that naturally come to her at this period. There is a place in life for the grandmother and even for the grandaunt, though a French visitor recently declared that he thought there must be no grandmothers in America since all the women seemed to dress in the fashion of the young girl. If this submission to natural conditions is recognized and accepted there are long years of happiness and helpfulness in store for the woman of middle age and the menopause may be welcomed as an important step towards a larger development of life.{453}