THE ANOMALIES OF MENSTRUATION.
Menorrhagia and Metrorrhagia; Dysmenorrhea; Amenorrhea; Leuchorrhea;
Pruritus Vulvae.
"Defer not till to-morrow to be wise,
To-morrow's sun on thee may never rise."
-- CONGREVE
Menorrhagia and Metrorrhagia.-- By menorrhagia is meant an excessive
or too profuse menstrual flow; by metrorrhagia, a flow of blood
between the menstrual periods. Neither one constitutes a disease by
itself, but is a symptom of some pathologic condition.
It has already been stated that the excretory organs, by constantly
eliminating from the system the worn-out material, keep the machine
healthy and in good working order. Kept within natural limits, this
elimination is the source of strength and health; beyond these limits,
the menstrual flow becomes an actual hemorrhage that, by draining away
the life, becomes the source of weakness and disease.
No physician would dare to bleed a man or woman once a month, year in
and year out for thirty years; but, through ignorance or folly, this
is what many girls do for themselves.
This excessive flow, aside from actual local disease, is brought about
by excessive muscular exercise during menstruation; by the use of all
stimulants, whether alcoholic beverages or quinin; as well as by the
thinness of the blood.
When the flow is excessive, it must be considered a pathologic
condition, which needs the physician's attention. Rest in the
recumbent position is the first essential; the diet must be plain and
unstimulating, and attention must be paid to the condition of the
blood.
The general diseases which generally cause this condition are anemia,
Bright's disease, malaria, the early stages of tuberculosis, and heart
disease.
The local causes may be reflex, as powerful emotions; or due to local
disease of the uterus and its appendages, as the various inflammations
and displacements of the uterus, fibroid tumors, polypi, and cancer.
Dysmenorrhea is painful menstruation. The most frequent forms are due
to uterine congestion; to mechanical causes, as a narrowing of the
cervical canal, particularly at its internal opening, or to a
constriction caused by the bending over of the uterus at the junction
of the body and the neck; or to ovarian irritation.
The pain varies in intensity from slight discomfort to the most
intense uterine colic, which is experienced in the lower part of the
abdomen. In severe cases the general health becomes undermined, the
nervous system gives way, and hysteria and other disorders of the
nervous system result.
The congestive variety usually occurs in patients who have previously
menstruated painlessly. The pain comes on suddenly with the flow and
ceases when the flow stops; it is very severe and is generally
accompanied by a diminution or a cessation of the flow. There is
severe headache, marked diminution in the secretion of the kidneys,
and general restlessness. The patient frequently experiences pain in
walking, is easily fatigued, has leucorrhea and an irritable bladder.
In ovarian dysmenorrhea the pain precedes the flow for several days
and ceases when a free flow is established. The pain is of a dull
aching character, and may be felt on one or both sides of the abdomen,
according as one or both ovaries are involved.
Amenorrhea.-- In amenorrhea the menstrual flow may not appear for some
years after it is normally due; or the flow may cease after some
months or years of continuance; or the flow may be abnormally scanty
or even absent.
The menstrual flow is much later in appearing in some families than in
others, so that this may be considered as a family idiosyncrasy; and
if the girl's health is good, it need cause no anxiety. If, on the
contrary, the girl has severe headaches, or suffers in any way, the
physician should be summoned at once, as the absence of menstruation
may be indicative of some serious pathologic condition,
A scanty flow is often indicative of thinness of the blood; on the
other hand, serious anemias often lead to profuse menorrhagias or
metrorrhagias, as has already been stated. The cause of the profound
anemia itself may be insufficient nutrition, overwork, or lack of
exercise.
Scanty menstruation is often seen to occur in fevers, in the later
stages of consumption, in advanced Bright's disease, in malaria, or in
any other very serious disease. In these cases it seems to be a
conservative process on the part of nature in the run-down state of
the system. As consumption progresses menstruation generally ceases
absolutely, never to return again; and in this case nothing should be
done to try to induce a return of the flow.
Great shock sometimes causes a sudden cessation of the flow; and
sometimes a sea-voyage, followed by the change of habitat, will cause
an obstinate form of amenorrhea.
But it cannot be too well understood that, after the menstrual flow
has been regularly established, it continues with the greatest
regularity throughout the child-bearing period, unless the exposure to
wet or cold has been sufficiently severe to cause great indisposition
on the part of the woman. In this case it is possible that, if the
exposure took place just previous to the time of the expected flow,
one period may remain out. But except in case of serious illness,-- as
for example, typhoid fever,-- two or more periods do not fail to
appear except in the case of pregnancy.
Leucorrhea.-- Leuchorrhea, or "whites," is a mucous or mucopurulent
discharge from the vagina; it may be a symptom of uterine or vaginal
disease.
Immediately after the menstrual flow there is a well-marked vaginal
secretion which is whitish in appearance; it may be transparent or of
a milky color, and is sometimes very acrid. This secretion may also
precede the flow, and there is nothing abnormal in this. But any
discharge occurring between the periods sufficient to stain the
clothing-- the so-called whites or leucorrhea-- is abnormal, and is
caused by an inflammation of the vagina or the neighboring parts. In
addition to the discharge there is heat and swelling of the parts,
more or less local distress, and generally intense nervousness.
If the disease is not cured, it may become chronic. The pain, heat,
and scalding disappear, but a copious discharge continues, and in this
stage the disease may be very obstinate and greatly reduces the
strength. The constant drain breaks down the system, producing pallor,
debility, pain in the back, palpitation, indigestion, and so forth.
The character of the discharge in leucorrhea varies considerably, from
a whitish or mucous secretion, to a yellowish or mucopurulent
secretion, and is debilitating in proportion as it is profuse. It is
to be remembered that this is not in itself a disease, but indicates a
disease of some of the pelvic organs; and that all such inflammations
left to themselves incline to grow worse.
A severe leucorrhea is generally attended with frequent and finally
painful micturition; pain in walking in the lower part of the abdomen,
which may become so severe as to compel the patient to go to bed.
Pruritus Vulva.-- This is an intense and persistent itching of the
vulva, and is a symptom rather than a disease. It is not an infrequent
result of leucorrhea, the acrid discharge of the latter leading to an
irritation of the parts; this causes rubbing of the parts until a
veritable inflammation is produced.
Other causes of pruritus vulvae are: The local congestion, such as
occurs at the menstrual period, or in certain cases of pelvic
inflammations, or in early pregnancy; constipation; sedentary habits;
congestion of the liver; incontinence of urine, and diabetes. When
dependent on the latter, the malady is most obstinate in yielding to
treatment. Indigestible foods or drinks, the rubbing of the clothes,
the friction of walking, and the heat of the bed act as exciting
causes in those predisposed to it.
The essential treatment here is to at once ascertain and remove the
cause; aids in the treatment are vaginal douches and cooling lotions.