This change generally takes place about the forty-fifth or forty-sixth year, although it may occur several years earlier, or even later. In a very few cases it has been delayed until the age of sixty, and in a few instances even till seventy. Persons of delicate constitution, or those accustomed to sedentary habits or a high style of living, generally experience the change earlier than those of robust constitution, or accustomed to much exercise.

The change of life is one of the most important eras in a woman's existence, second only to the first appearance of the menses. This period, safely passed, and continued health and a long life are generally before her, but now her path is surrounded with danger, and she must tread it with careful footsteps. It is at this period that the seeds of much future suffering may be sown in the system, and those old predispositions to disease, perhaps long forgotten, spring up in luxuriant growth. The menses become irregular both as to time and quantity, returning once in two or three weeks, or delaying three or four months, at times the discharge scarcely perceptible, at others so profuse as to amount to a haemorrhage. Sometimes the menstrual fluid is mixed with mucus.

In most females during the progress of this change, there as more or less general disturbance of the system.

There may be great nervousness, severe attacks of headache, dizziness, flushes of heat, or paleness and debility; there may also be derangement of the urinary organs, the urine at times scanty and high-colored, at others frequent and in large quantities; the patient may also experience pain in the back, loins, and abdomen, swelling of the abdomen or extremities, piles, and violent itching of the privates, palpitation of the heart, and hysteric spasms. Sometimes the menses gradually cease without any unpleasant symptoms, and in almost all cases, where the female safely passes through this period and no after difficulties are developed, her health is more firmly established than before.

The prominent remedies are Pulsatilla and Lachesis, given in alternation three days apart. Should the discharge be frequent and very profuse, consult menor-rhagia. If attended with much pain, see dysmenorrhoea, and for the other affections which may arise, consult the respective chapters in which these diseases may be found.

Particular attention should be given to diet, exercise, clothing, etc. The room should be well ventilated, and if possible, daily exercise in the open air taken; daily bathing should also be practiced. The food should be nourishing, but easy of digestion, and articles of a highly stimulating character carefully avoided. The clothing should be warm and comfortable. Strong mental or physical excitement should be avoided and a cheerful state of mind cultivated.