Although menstruation usually ceases from the forty-fifth to the fiftieth year, cases are on record in which “change of life” occurred at much earlier, as well as later periods. Dr. T. J. Patchen relates a remarkable case where a girl ceased menstruation at twenty-two, accompanied by all the physical changes of the organism as well as attended by the usual symptoms of that period. Cases are recorded where menstruation continued with regularity until the seventieth year, and the reproductive function remained unimpaired. In a state of health the meno-pause should be attended by no unpleasant symptom, by no change from the normal condition. Ordinarily all the sufferings and ailments incident to this period can be accounted for from some ovarian or uterine disease, dyspepsia, or other deviation from health. Irritation or congestion in the ovaries, more than any other cause, decides the numerous symptoms of the climacteric. Uterine inflammation or derangement also causes many of the distressing ailments of the meno-pause. _Irregularity_ in menstruation may be looked for about the forty-fourth year in temperate climates. In the torrid zone, where girls menstruate as early as the tenth or twelfth year, it may occur much earlier. But in this country it is often delayed even far beyond the fiftieth year. There may be occasional absence of the menses, or it may first be indicated by frequent and profuse menstruation. In rare cases the menses cease suddenly, without any warning or any special derangement. Women often feel alarmed at the sudden suspension of this discharge, but their fears are groundless if all other functions are normal. With some women the flow is alternately scanty and profuse for months. The length of time in which these symptoms occur is extremely variable. It may be only a few months or it may be several years. In extreme cases the symptoms have continued nearly twenty years. The average period, however, is about three years. These changes are accompanied by various pathological symptoms. _Hot flashes_ or “flushings” are especially peculiar to this period. First one feels a decided glow or heat, as if suddenly transported to a hot room; this is soon followed by a perspiration which may terminate in a chill. They are often accompanied with a sense of suffocation or violent throbbing. The phenomenon is precisely the same as blushing, and indeed this may be said to be a sort of pathological blushing.