University of Virginia Library

CHAPTER IV.
THE ANOMALIES OF MENSTRUATION.

Menorrhagia and Metrorrhagia; Dysmenorrhea; Amenorrhea; Leuchorrhea; Pruritus Vulvae.

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.