Menstrual cycle

“ For some centuries, at least, inquisitive observers here and there have thought they found reason to believe that men, as well as women, present various signs of a menstrual physiological cycle. It would be possible to collect a number of opinions in favor of such a monthly physiological periodicity in men. ”

“ The purpose of menstruation is to keep the uterus in suitable condition for the reception of this product of conception at any time. It is now known that the menstrual flow is not the whole of menstruation, and that the changes going on in the uterus are almost as continuous as the process of digestion. The whole of the reproductive life of woman has been divided into cycles of twenty-eight days each ”

“ DATE OF CESSATION OF MENSTRUATION, AND DURATION OF THE CHANGE OF LIFE.—The function of ovulation, as far as we know, ceases with the discontinuance of menstruation, although immature ova still exist in the ovaries. The date of natural cessation of menstruation and ovulation is variable in different women. It is difficult to determine an average date, because the menopause may be gradually ushered in, and then women are apt to interpret any genital hemorrhage as menstruation. In certain cases the menstrual flow may cease between the ages of thirty and forty years, or even at an earlier period. ”

“ 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. ”

“ Were there no other condition to bring about the cessation of menstruation, the diagnosis of pregnancy would be greatly simplified. But any one can appreciate the fact that diseases of the womb may interfere with the menstrual process. Menstruation is influenced, also, by the ovaries. As a result of age, for example, the ovaries undergo changes which invariably bring about the permanent cessation of menstruation, called the menopause. ”

“ If the ovum remains unfertilized, which is usually the case, it does not attach itself to this elaborately prepared lining, but passes out with the uterine discharges and all of this preparation not only goes for naught but must be undone.
The second stage, therefore, which lasts about five days, is the destructive stage and is the period we speak of as menstruation. During this period the extra tissue which has been formed in the uterus is broken down; it mixes with the blood that oozes from the congested lining and together they pour from the vagina as the menstrual flow. ”

“ But even the gradual cessation of menstruation causes notable disturbance of the woman’s mental and physical equilibrium, if the irregularities in the menstrual process are very great and spread over a very long period—more especially when the loss of blood is extensive. ”

“ These physical disturbances accompanying menstruation vary so widely in different women, and in the same women at different times and under different conditions, that it is not possible to draw a classical picture of the condition. But all of the symptoms above described will persist with more or less severity throughout the entire menstrual life of one woman, while perhaps only one or two of them will occasionally disturb another. Whatever discomfort there may be usually begins from one day to a week before the discharge appears ”

“ There ripens in one of these bodies each month a human baby-seed,9 which finds its way to the uterus through the little fallopian tube and is apparently lost in the debris of cells and mucus which, with the accompanying hemorrhage go to make up the menstrual flow. This continues from puberty to menopause, each gland alternatingly ripening its ovum, only to lose it in the periodical phenomenon of menstruation, which is seldom interrupted save by that still more wonderful phenomenon of conception. ”

“ The undulatory movement of the vital processes in woman is apparently in some way dependent on ovulation, though the nature of the connection has not hitherto been fully elucidated. This view is confirmed by the fact that no such rhythmic variation in the bodily functions can be detected either in girls under thirteen years of age, or in women from fifty-eight to eighty years of age in whom menstrual activity has entirely disappeared. The menstrual rhythm begins at puberty and ends when ovulation ceases. ”

“ Neglect during menstruation, especially in the young girl, is a frequent cause of subsequent suffering. The effect of menstruation upon the whole system is remarkable. The nervous, vascular, and digestive systems all share in the menstrual function. The usual work of the girl at school or other employment should be altered to suit the altered conditions of her body at the menstrual period. Long school hours and close mental application or active exercise are too often continued at this time. ”

“ Just as the beginning of menstruation may set in without any trouble of any kind, and just as some women have not the slightest unpleasant symptoms during the entire period of their menstrual life, so [129] the menopause occurs in some women without any trouble, physical or psychic. The periods between the menses become perhaps a little longer, or a little irregular, the menstrual flow becomes more and more scanty, then one or several periods may be skipped altogether, and the menopause is permanently established. ”

“ And as there are thirteen lunar months a year, a woman menstruates not twelve but thirteen times a year.
Where does the menstrual blood come from? The menstrual blood comes from the inside of the womb. Every month, for a few days prior to menstruation, the inside lining of the womb (what we call the mucous membrane or endometrium) becomes congested and its bloodvessels become distended with blood. ”

“ In different women the menstrual intervals are from 2 to 6 weeks, or longer; but when strictly regular, or the woman not pregnant, every lunar month. The first periods of menstruation, and the final cessation by age, are two very important epochs in female life, on which much of their succeeding health and longevity will{328} hinge. But, without entailing diseases, many women are liable to some menstrual irregularity, with respect to the periods, duration, and quantity. ”

“ If latent dispositions to disease, either in the uterus or other parts, become active about this period of life, it is not because the declining menses excite them; but because the disease is slow in developing itself, and is, perhaps, kept in check for a long time, by the menstrual discharge serving as an important evacuation; especially when the uterus may be the seat of the complaint. In such instances, the foundation of the disease was laid, perhaps, at the time when the menses were the most perfect, as regards period and quantity ”

“ Knowing as we do that generally speaking an intimate connexion subsists between menstruation and ovulation, we are indeed able to assert that regular menstruation and fertility in women run a parallel course, and further, that the greater the irregularity of the menstrual function, the greater the tendency to sterility. ”

“ It appears, therefore, that the periodical revolution of the menstrual blood has great influence on delivery, and that it is the cause why the times of delivery in women vary so much more than in every other female who is not subject to the periodical evacuation, and which always bring forth at the same times. ”

“ It has long been known that menstruation presents a group of phenomena closely allied to fecundity. The first eruption of the menses is an unequivocal sign of the awakening of the faculty of reproduction. The cessation of the menstrual epochs is a sign equally certain of the loss of the faculty of reproduction. ”

“ The woman should reckon from the time when she had her last regular menstruation.
PARTURITION. Natural labor. The uterine functions are characterized by periodicity. If an abortion occurs that is not the result of an accident, it is generally at what would have been, but for conception, a monthly period, and even injuries are more likely to produce their bad effects at that particular time. So the normal period for parturition corresponds to a menstrual period, and generally labor may be looked for at about the tenth period after the last appearance of the catamenia. ”

“ Premature cessation of menstrual activity, in the third or the fourth decennium of life—very rarely indeed before the third decade—depends in part upon disturbances of metabolism and of haematopoiesis, and in part upon diseases of the female reproductive organs ”

“ In these cases, bicycling, lawn tennis, and suitable gymnastics are often of value; also baths, in the form of warm general baths, hot sitz baths, and hot foot baths.
Vicarious Menstruation. In cases in which, in consequence of morbid conditions of the uterus, the ovaries, or the organism as a whole, the menstrual flow has at the time of the menarche either failed entirely to appear or 165been exceedingly scanty, hæmorrhages from other organs have since ancient times been witnessed, and these hæmorrhages have been regarded as vicarious menstruation. ”

“ The menstrual periods often exist, at least, in the commencement, and so the alteration in health cannot be attributed to their derangement or suppression. It is not uncommon to see the shape impaired. ”

“ From my own observations on this matter it appears, that in women who are healthy and of powerful constitution, whose reproductive organs have been sufficiently exercised, who have given birth to several children and have suckled these children themselves, the duration of menstrual activity is in general notably longer than in women whose circumstances have been just the opposite in these respects. ”

“ The menstrual function, as we have already seen, often becomes obstructed from 100other causes than pregnancy. Conception may take place without the woman being regular. Thus, it may occur some months, even, after the menses have ceased from other causes. If, then, the reckoning should be made to commence at the time when cessation occurred, it would be found very fallacious in many cases. On the other hand, menstruation may occur one or more times after conception has taken place. ”

“ I have had patients who for months would have a perfectly normal menstrual flow of three to five days to whom a serious mental disturbance always brings a profuse menstruation. The arrest of a woman by mistake just before or at the beginning of her menstrual period will often cause a greatly increased flow and great weakness will follow. Women approaching the menopause already have a tendency to an increased flow though not beyond the bounds of what might be considered normal, and at this time almost any shock will produce profuse menstruation and lead to prostration. ”

“ The fashionable system of spending married life, such as late hours, close rooms, excitement, rounds of visiting, luxurious living, is quite enough to account for its prevalence. The menstrual functions in a case of this kind are not duly performed; she is either too much or too little “unwell;” menstruation occurs either too soon, or too late, or at irregular periods. ”

“ The favorite practice, in cases of scanty menstruation, of taking hot foot-baths is to be rejected. At the conclusion of each menstrual period, however, a tepid bath should be taken. The knowledge we have now acquired of the rhythmical “menstrual wave” process (see p. 19 et seq.) points to the practical conclusion that the physician should not direct his attention to the actual menstrual period only, but also, and more than has hitherto been customary, to the premenstrual period, in which temperature, blood-pressure, and excretion of urea attain their acme ”

“ This menstrual rise in blood-pressure is accompanied by a rise in temperature and an increase in metabolic activity. The influence of menstruation on the heart is most powerfully displayed in cases in which for some reason a disturbance occurs of the normal appearance or normal course of menstruation. ”

“ To the circulatory disturbances consequent upon the menopause we must also refer ardor fugax, fugitive heat, the sudden rushes of blood to which women are prone at this period of life.
The cardiac troubles of the menopause are seen especially in women in whom the cessation of menstruation occurs quite suddenly, and in those in whom menstrual activity ceases at an exceptionally early age. ”

“ Menstruation ceases temporarily during pregnancy, in normal cases, and often also ceases during the period of lactation or nursing. The menstrual period lasts on an average for four or five days, the flow increasing for the first half of the period, and decreasing during the last half. At the beginning of the period there is often manifested a general congestion of all of the sexual organs of the woman, and often of the breasts as well. There is also usually found a sense of physical discomfort, from which more or less irritable feeling arises. ”

“ Amenorrhœa at the time of the menarche may depend on complete aplasia of the ovaries, associated with a rudimentary and imperfect development of the uterus. In such girls, the development of whose reproductive system is thus imperfect, the continually expected menstrual flow fails to appear, in spite of the fact that a recurrent menstrual discomfort, evoked by the congestion of the genital organs, recurs at intervals of four weeks; as, for instance, colicky pains in the abdomen, irritable, nervous states, and mental disturbances. ”

“ Of the vicarious haemorrhages which are apt to ensue upon such a sudden menopause, we have already spoken.
Generally speaking, women in middle life, in whom the whole organism is accustomed to the onset and decline of the menstrual hyperaemia, endure the functional disturbances induced by a sudden and complete cessation of menstruation much more easily than women who have already entered upon the climacteric age, or have nearly attained that age. ”