The object of each metamorphic or developmental epoch is a critical readjustment of the organism, in order to insure the greatest possible amount of health for each subsequent period of life.  In the vast majority of cases this object is quietly effected, but sometimes the constitution only rallies after having been severely shaken for a varying period.

General Phenomena of the Menopause.—­ Borner states that while many women pass this period without noting any change in their former condition, and are conscious of the occurrence of the change of life only by reason of the absence of the menstrual flow, others suffer for years with a host of troubles.

One of the most essential changes is that of the woman s psychic condition—­ from slight vagaries, loss of interest in the daily affairs of life, to melancholia and insanity.

“Two factors are generally taken into account:  first, the sudden cessation of the menses; second, the reflections of the patient caused by her condition, meditations on the loss of youth and sexual power, and anxiety in view of the dangers of the climacteric.  It cannot be denied that there is some truth in the supposed sad thoughts about the beginning of old age, and the depression caused by them can scarcely be considered abnormal” (Borner).

Napier believes that it is extremely rare for the cessation to occur without some physical discomfort or some disturbance of the nervous system, but adds that:  “Some women, however, cease menstruating with very slight inconvenience.”  As a rule, the woman misses one, two, or more periods, then a menstruation of almost normal quantity and duration; and this is again repeated at gradually longer intervals, and with a diminished flow, until actual cessation occurs.

The periods cease owing to the degeneration and disappearance of the glandular tissues of the uterus, and secondarily to similar changes in the ovaries and other glands.  This is followed by an atrophy of all the structures of the genitalia.

An increase in the size of the uterus, from increase in the amount of blood, is frequently noticed at the beginning of the menopause; later it becomes smaller in all its dimensions.  The wall becomes thinner; the cervix becomes shorter and thinner, sometimes hard, sometimes flabby as a membrane.  But the distinguishing feature of the menopastic uterus is atrophy of its lining membrane.

The changes in the uterus and Fallopian tubes are earlier than those in the ovaries, so that ovulation, though lessened in activity, may persist for a considerable time after menstruation has ceased.  Ovarian atrophy has been referred to senile rather than menopastic changes.

Atrophy of the ovaries occurs very gradually.  Peuch found that in one case the ovaries were of normal size three years after the establishment of the menopause.  Kiwisch describes the structural change in this gland as consisting, on the one hand, of an increase of the connective-tissue stroma; and, on the other hand, the Graafian vesicles themselves undergo retrograde change.  In consequence of these microscopic changes, which take place very slowly, the entire organ becomes harder and smaller.