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The Flushings of the Menopause adapted (mainly by reformatting) from CHANGE OF LIFE IN MEN AND WOMEN by MARIE CARMICHAEL STOPES |
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Menopause "neglected field" | In private practice the patient at the menopause, unless gynecological symptoms are present, must rely entirely upon her family physician for advice; in hospital practice pressure of time does not permit accurate observations to be made with sufficient regularity to justify conclusions being drawn from this source. These factors, in part, possibly account for the scanty reference to the subject under consideration in text books, and the even more scanty instruction in the conduct of the menopause which the medical man receives as a student.”Dr. Hannan investigated one problem only of the menopause; he describes the subject as “a somewhat neglected field.” Showing how little is even yet known about the menopause in comparison with its importance (for every healthy woman can reasonably anticipate passing through the change of life and living on for very many years afterwards), Dr. Hannan drew his conclusions from very small numbers of cases. In spite of this his work has the great virtue that its facts and views are not merely copied from the publications of others. |
How many? | He observed his cases himself
and says:
“Of 131 women whom I questioned at the time of the menopause, I found that |
Where? | The nature of the flushing
varies with individual women.
Dr. Hannan continues: " Of 45 women questioned |
How long? | The head and neck are generally recognised as being particularly susceptible to flushing. Most of the women who suffer from “flushes,” feel the flush as a burning sense of heat, passing swiftly, and sometimes relieved by local perspiration. A brief second or two generally suffices for all the phases of the flush. Dr. Hannan reports that the longest attack complained of in any of his patients was about half an hour |
Variations | The description of the flush
is given with more accuracy by Dr. Hannan than in other text books, and
he describes the variations in his 45 cases.
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Three stages | In all the 45 cases some
other feelings occurred with the flushing, leading Dr. Hannan to consider
the flushing to be part of a series of symptoms that he calls a vasomotor
crisis. This crisis he describes as consisting of three stages;
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Dearth of subjects | As very many women have experienced such unpleasant, though not serious sensations at the time of the menopause, it is natural to ask whether a detailed study of these flushings has been made. But apparently although individual women have often experienced them, there is little systematic knowledge about them. Dr. Hannan's book is the most careful study and yet even he says: “In the first place, patients had to be found who were willing to co-operate with the tedious procedures necessary to obtain accurate results. I have succeeded in obtaining four patients who were willing to assist me in this investigation.” One is astonished to think that after waiting until the year 1927 for an investigation of such a common experience of women only four patients were available for a medical research into this matter. Though it has been repeatedly described by medicals as a “universal” feature of the menopause! |
Study results | Dr. Hannan describes carefully how each of the four patients was under his observation for at least three consecutive hours. He made ten attempts to obtain data. Six of these failed because the patient had no attack of flushing during the time he was observing. Three of the women had one attack of flushing during their three hours' observation, and one woman had two attacks. The flushings were momentary in four, and lasted thirty_five seconds in one attack. The blood pressure and the pulse rate go up during the flushing, and the blood pressure goes down again directly the flushing ceases. |
Why flushes? | Dr. Hannan's work was original,
yet how meagre! So far as I can trace no adequate research has yet been
done on the subject.
What is the meaning of these flushings? That is a question which every intelligent person must ask. Dr. Hannan points out that what he describes as vasomotor crises or flushings, and their associated discomforts do not occur in women who have no menstrual flow because of severe anemia or acute illness; consequently he is satisfied that these crises are due to the loss or insufficiency of the internal secretions of the ovaries. |
Calcium's role | My own personal view
is that a contributory cause is also the accumulation of calcium, either
in the blood, or in the blood and lymph, or both.
In severe anemia and in other acute illness, the calcium salts in the blood are below what are normally required for health, so that there is not that excess of calcium salts in the blood which stimulates the vaso-motor, or what we may more simply call the circulatory system. Now, contrariwise, consider the case of the woman at the menopause. Up till that time at each menstrual flow she has been eliminating calcium salts from her system. We know this because it has been proved by analysis that menstrual blood is particularly rich in calcium salts. (See p. 150.) I have myself observed in several cases that the post-menstrual depression and signs of weakness and weariness which are common after a menstrual period can be checked and compensated much more rapidly than they are by nature. Nature takes three days to ten days according to the strength and vitality of the woman to restore to her her full vitality after the lowering process of the menstrual flow, whereas if the right organic compound of calcium (see p. 253) is taken for two or three days following the menstrual flow, the vitality returns much more rapidly.The explanation of this that I offer is that the blood has been depleted of its calcium and tension and with it the sense of the vitality is lowered. On the other hand the menopausal woman who just before the time when the menstrual flow would have taken place is prepared for it to take place, but the calcium not being eliminated because the menstrual flow does not occur, experiences the effects of a rather sudden accumulation of released calcium salts in the blood. This appears to me to be contributory to if not mainly the origin of the palpitations and the flushings experienced by some women at those times which would have been the menstrual period had not the menopause set in and the menstrual flow ceased. |
Use of calcium suggested | I conclude, therefore, and
I believe I make this suggestion for the first time, that a rational control
of the calcium content could be made one of the most ameliorating considerations
for women who are passing through the complications of the menopause.
This conclusion of mine is based not merely on what I think is sound theory, but is supported by practical results. Fortunately there are simple forms of organic calcium which can be utilised effectively to keep the balance of the system. Thus we may preserve the useful amount in the vascular system, and also prevent that accumulation of excreted inorganic calcium which deposited inthe blood vessels and muscles of women after the menopause causes arthritis, various “rheumatics” and other troubles of the kind. |
Need for more attention to calcium's role | There is no doubt that the
control of the internal secretions or hormones from the various ductless
glands and organs is supremely important. Wonderful have been the advances
made by the knowledge of these secretions and the ameliorating power of
organotherapy, but the results obtained have been so spectacular, that
the quieter, though also extremely complicated part played by calcium in
the system, has been somewhat overlooked. I think calcium is almost as
important as the hormones of the gonads.
Much more attention should be paid to the calcium in the system, to supplementing the necessary organic calcium compounds, to controlling and eliminating during the climacteric, calcium compounds which are not required. In short, to assist in warding off “flushes” I suggest that the right form of soluble organic calcium should be swallowed (see also p. 253), when it will be circulated by the blood to those tissues which will know what to do with it. |