Menopause and menorrhagia: a historical exploration.

Like a parallel article [1] this one also attempts to answer the question why complaints of excessive premenopausal bleeding have now virtually disappeared. Unlike the first, a review, this is a discussion paper. It explores widely, investigating the question from all aspects, even utilizing, if with caution, such unconventional sources as still unproven hypotheses or marginal theories. Presentational attitudes to, and handling of, climacteric complaints appear partially to obscure some symptoms associated with excessive menses. More importantly, however, the examination of the historical records in the light of present knowledge greatly increases our understanding of past socio-clinical events. It is then that attention is concentrated on a significant omission in these data: the fall in numbers of births per woman, first among the French and European aristocracy, then the population of France and finally that of the rest of Europe. This parallels the spread of the menopausal syndrome and complaints of excessive menstrual loss. It is suggested that limitation of the family, by design or secondarily to lifestyle, has created a unique bio-endocrinology in the West. In the past this produced a number of complications, including climacteric menorrhagia. Never redressed by preventative measures--for these had repeatedly been rejected as militating against the lifestyle chosen by Western women--they were only solved with the advent of abdominal hysterectomy. Steroidal oral contraception and hormonal treatment have, however, made this operation often unnecessary.