Chapter XX: Menstrual Diseases

Menstruation is a periodic discharge of blood from the uterus and the Fallopian tubes. It occurs every twenty-eight or thirty days, and it lasts from puberty to the menopause, or the cessation of the menses,--about the forty-fifth year of age.

There is a connection between menstruation and the production of the human ovum. During the first stage of menstruation the mucous membrane lining the uterus swells to twice or thrice its normal thickness, and this growth is a preparation for the reception of the ovum, which, as a rule, is given off by one of the ovaries at this time and passes out into the uterus. Menstruation and ovulation ordinarily occur simultaneously, but they may be independent and take place at different times. If, during this stage, the ovum is impregnated, pregnancy begins, and menstruation ceases until some time after childbirth. In married women conception is more likely to be effected during the first stage of menstruation than during the interval of quiescence; the contrary is almost the exception. Impregnation, however, is likely to occur in the spring more than at other seasons, and this fact coincides with the advent of spring in various latitudes.

If the ovum is not impregnated, the material that made the uterine mucous membrane thick during the first week of menstruation degenerates and passes off, constituting the menstrual flow. This stage lasts about five days. A reparative period of about four days follows, and then a period of quiescence until the next menstruation commences.

Menstruation is first observed about the fourteenth year, but it may start earlier or later. In general, it comes on {241} earlier in warm climates, and later in the extreme north. The menstruation, too, is likely to show sooner in the labouring classes than in girls who do not work.

Even in normal menstruation there is often a marked physiological excitation which affects the entire person. Very commonly a nervous disturbance and sensitiveness are observed, and in women that are not robust there may be mental depression and irritability. The temperature will rise a half degree, and drop to the normal height on the day preceding the flow.

There are derangements of menstruation which are symptoms of various diseases. Amenorrhoea is an absence of menstruation in conditions other than pregnancy or lactation. Absolute amenorrhoea is a complete absence of menstruation for several months; relative amenorrhoea is delayed, scant menstruation.

Amenorrhoea is common during convalescence from acute diseases; it is also a result of chronic diseases of the liver, stomach, intestines, kidneys, and especially of the lungs; it complicates anaemia, malaria, rheumatism, and other general pathological conditions. Fright, grief, great anxiety, mental shock cause amenorrhoea; so do homesickness and many forms of insanity.

There are also local causes of this condition: imperfect development of the uterus or the organs connected therewith, and inflammations of these organs or of the pelvic wall.

Opposed to amenorrhoea is menorrhagia, or an excessive menstrual flow. Metrorrhagia, or hemorrhage from the uterus at any time, is a term confounded with menorrhagia, which is an inordinate menstrual loss of uterine blood, but the distinction is not important. Menorrhagia and metrorrhagia commonly have an identical cause and they frequently coexist. They are found in chronic diseases of the heart, lungs, liver, and other organs; they are an outcome of prolonged lactation, and of local affections of the uterus and its appendages. Any condition also that deranges the blood may cause menorrhagia or metrorrhagia; so do malignant tumours of the uterus, uterine displacements, lacerations that {242} occur in childbirth, and psychical influences, as fright, anxiety, and other strong emotions.

Dysmenorrhoea, difficult or obstructed menstruation, is a term used for menstruation accompanied by pain. This is a common menstrual derangement, and it may be neuralgic or inflammatory in origin, or it may be caused by obstruction to the menstrual flow. There is another variety of dysmenorrhoea, called membranous, in which the superficial layer of the uterine lining is cast off partly or wholly.

In the neuralgic form the uterus and its appendages are normal in appearance, but the pain recurs monthly, and it may have degrees from mere discomfort to agony. This form is characterised by reflex headache, sympathetic nausea or vomiting; and the pain may not be confined to the uterus and its appendages. The irritation often brings out latent hysterical phenomena, spinal irritation, and neurasthenia. Rheumatism and gout are predisposing causes, so are indolence, lack of physical exercise, light clothing in cold weather, forced school work and similar depressing agents.

In the neurotic variety of dysmenorrhoea pain often persists after the menstrual flow has set in, but in inflammatory dysmenorrhoea the flow relieves the pain or removes it. Marriage commonly removes the neurotic form of dismenorrhoea.

In obstructive dysmenorrhoea the menstrual fluid is retained by narrow or tortuous outlets, flexions of the uterus, and similar causes. The prognosis is good in all forms of dysmenorrhoea, but frequently long and skilful treatment is required to cure such conditions, especially the membranous form. Inflammatory, obstructive, and membranous dysmenorrhoea are commonly made worse by marriage.

At the end of the childbearing period menstruation gradually ceases. In temperate climates this menopause occurs about the forty-fifth year, but it may come earlier or considerably later. Work that keeps a woman in a heated atmosphere, as cooking, washing, and baking, disturbs menstruation and tends to advance the menopause. Workers in chemical factories, in badly ventilated rooms, or women that do heavy labour in the open air, are apt to age prematurely, and have {243} an early menopause or "change of life." This premature climacteric is found also in women that bear many children in rapid succession.

At the menopause there may be various physical or mental disturbances which are probably due more to the somewhat abrupt advent of old age, at the cessation of the childbearing part of life, rather than to the menopause itself. It is a fact, however, that often profound disturbances coincide with the climacteric, and we know no sufficient cause for them if the menopause itself may not be deemed such.

There are numerous disorders of the nervous system in women which are dependent directly or indirectly upon a derangement of the pelvic organs. Distant parts of the body are affected pathologically through sympathetic irritation when the primary disease is in the pelvic organs, and direct treatment of the pelvic trouble alone cures these reflex conditions. The very common disorders of pregnancy, the marked physiological changes in women at the beginning of menstruation with puberty, and its cessation with the menopause, are among the first proofs of this assertion that occur. Menstruation may aggravate goitre, uterine fibroid tumours, skin diseases, and affections of the blood vessels. Disordered menstruation causes sleeplessness, melancholy, dementia, and mania, by affecting the brain; it may bring on local paralysis; start up latent epilepsy; excite reflex cough and difficulty in breathing; make the heart irritable; cause nausea, vomiting, dyspepsia, flatulence, diarrhoea, skin-inflammations, pain in the joints, and many other symptomatic phenomena.

Chorea ("St. Vitus's Dance") is caused by various irritatations, and dysmenorrhoea can be such a cause. If a person is disposed to hysteria by neurotic inheritance, idleness, sedentary habits, vicious practices, excessive development of the emotions, any affection of the uterus or its appendages will greatly aggravate the outbreaks. The same is true in neurasthenia; and uterine disorders can directly cause neurasthenia, a condition described in another chapter. Migraine is an extremely severe form of headache which arises from various excitations, and uterine disturbances are among the causes.

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Insanity frequently appears in women at puberty, soon after marriage, during pregnancy or lactation, and at the menopause; at these periods disposed women are especially prone to outbreaks of insanity. Irritation and exhaustion from diseases of the pelvic organs are potent factors in bringing on insanity, although these conditions may coexist independently of each other. Symptoms should not be mistaken for causes, but pelvic diseases at least aggravate a tendency toward mental unbalance.

In an article like this it is not expedient to speak of treatment, but the conditions are described in outline so that the spiritual adviser may recognise the need of medical aid and suggest its employment. A woman suffering from pelvic disorders should be relieved from a labourious or responsible office until she has been cured of her disease, in her own interest and especially in the interest of those affected by her condition.

AUSTIN OMALLEY.

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