PSYCHIATRIC COMPARISON OF ARTIFICIAL MENOPAUSE AND THE EFFECTS OF HYSTERECTOMY.

MENTAL disturbances occurring in women at the menopause are commonly assumed to be due to the menopause, but the explanation of this differs according as they are mild or severe. If mild-taking the form of anxiety and depression, along with neurovascular symptoms such as flushing-endocrine changes are held responsible, and the benefits of replacement therapy with female sex hormones in most cases confirms the explanation. If severe, however-usually a psychosis with gross anxiety and depression-constitutional predisposition and psychological factors are more often invoked than endocrine ones: the illness is similar in form to those occurring in the involutional phase of life, when the menopause has perhaps for years been a closed chapter, and from this and the frequent failure of cestrogen-therapy to relieve the condition it has been inferred that the endocrine changes are of little consequence, many writers pointing rather to the causes for unhappiness and frustration which may lie in the obvious cessation ofreproductive life. It is hard to credit that a mild mental disturbance at the menopause could be due to different causes from those of a severe one of the same type at the same time of life. It seemed that one way of studying the problem would be to compare the incidence of mental disturbance in women who had suffered an artificial menopause through surgical removal of the ovaries with the incidence in women whose uterus had been removed before they had reached the menopause. In both groups of women the periods would have ceased and reproductive life would be clearly at an end: the psychological factor would therefore presumably be equally operative in both 101 coright.