Amenorrhea

“ Inanition Amenorrhea.—Sometimes indigestion, or what is supposed to be indigestion, may be at the root of the amenorrhea. In many cases it really is not true indigestion that is present, but a disinclination for food which has increased to such a degree as to bring about a lowered state of nutrition. In nervous young women and, above all, in nervous spinsters beyond forty, disturbances of menstruation consequent upon lack of nutrition are not infrequent. ”

“ The best testimony to the value of psychotherapy in amenorrhea is found in the success of many of the remedies used for the condition, which, in the successive phases of medical development, have included all sorts of home treatments, many types of quack medicines, and innumerable proprietary combinations. ”

“ When the menses are skipped, or when they are so scanty that you can hardly notice any blood, we use the term amenorrhea. In a few rare cases the menstruation instead of coming normally from the uterus, comes from some other part of the body, for instance, the nose. Some women have a hemorrhage from the nose every month. In some a bloody discharge may come from the breasts. To such a substitute menstruation we apply the term vicarious menstruation. ”

“ If a woman is accustomed to connect certain physical incidents with disturbances of menstruation, then those disturbances are almost sure to recur. As a rule, many an incident said to be disturbing to the function would probably have no influence upon it but for the dread connected with it and the anticipation of some interference. In all cases of amenorrhea, then, the patient's mind must be put into a favorable state and suggestions must be made that will lead to the expectancy of menstruation at the next regular period. ”

“ The renal apparatus may become affected and its activity arrested, or, as is more often the case in the milder forms of psychopathic troubles, there may be present an alteration in the amount or frequency of micturition, such as is found in the conditions of anuria and polyuria.
(h) Menstruation becomes disturbed, and we may meet with conditions of dysmenorrhea, amenorrhea, menorrhagia, and other disturbances of the tubes, ovaries, and uterus. ”

“ If the absence of menstruation is dependent upon defective development of the sexual organs we cannot expect much from any treatment. The amenorrhea from exhaustive diseases will usually correct itself with, or soon after, the establishment of convalescence. In diseases which tend to death, as in consumption, heart disease, etc., the function is never reestablished. A very common habit of most people is to regard the absence of the monthly periods as the cause of their ill health. It is not, it is the result of the ill health. ”

“ Every physician knows that much less serious mental influences than a profound shock or fright may somewhat disturb menstruation and, in young women at least, this disturbance is nearly always in the direction of lessened flow and amenorrhea. Home-sickness, for instance, will often have this effect. Many of the foreign-born domestics who come to this country have serious disturbances of their menstrual flow, usually a diminution, during the first three or four months after they arrive in America. ”

“ If an attempt at menstruation is made, as shown by periodical local pain and general disturbance, and the uterus is found to be small 407 and sharply anteflexed, benefit may sometimes result from thorough dilatation of the cervix.
Most cases of amenorrhea demand general treatment. The mode of life should be regulated according to strict hygienic principles. Fresh air, sunshine, baths, and suitable exercise should be prescribed. Studious girls should be made to lead more active lives. A change of surroundings is beneficial. ”

“ Get rid of the bad health and the menses will take care of themselves. That form of amenorrhea which is the result of change of climate or surroundings will regulate itself as soon as the victim becomes acclimated or reconciled to the change, or returns home if the visit is of brief duration. ”

“ The diet may be improved by animal broths, roasted meats, fresh beef, mutton, chicken, or eggs, and the dress should be comfortable, warm, and permit freedom of motion. The patient should indulge in amusing exercises, walking, swinging, riding, games of croquet, traveling, singing, percussing the expanded chest, or engage in healthful calisthenic exercises. The hygienic treatment of this form of amenorrhea, then, consists in physical culture, regular bathing, and the regulation of the bowels, if constipated, as suggested in this volume under the head of constipation. ”

“ Prideaux cites a case at five, and Gaugirau Casals, a doctor of Agde, has seen a girl of six years who suffered abdominal colic, hemorrhage from the nose, migraine, and neuralgia, all periodically, which, with the association of pruritus of the genitals and engorged mammae, led him to suspect amenorrhea. He ordered baths, and shortly the menstruation appeared and became regular thereafter. Brierre de Boismont records cases of catamenia at five, seven, and eight years; and Skene mentions a girl who menstruated at ten years and five months. ”

“ The symptoms, continual thirst, dryness of the mouth, emaciation, in spite of an inordinate appetite, frequent and profuse urination, are correctly given, but no knowledge of the presence of sugar in the urine is indicated.
Dyampnes (involuntary micturition) claims a page or more of explanation and treatment, and its frequent occurrence in old men and children is noticed.
In the department of the diseases of women chapters are devoted [pg 38] to amenorrhea, menorrhagia, hysteria (suffocatio matricis) , prolapse, ulceration, abscess, cancer, dropsy and "ventosity" of the uterus (physometra) . ”

“ The Fallopian tubes, which penetrate and are attached to the peritoneal sack, together with the uterine broad ligaments, are designed to hold the womb in place, but if the womb and ovaries are crowded down into the pelvic cavity and the womb doubled upon itself, dysmenorrhea or painful menstruation, or amenorrhea, with convulsions, is the result. Perhaps there may even be a complete stoppage, so that Nature menstruates vicariously and casts it off through the lungs or bowels. ”

“ Chlorosis and other forms of amenorrhea are, beyond doubt, caused by these unnatural habits in which children are too often reared at the present day.
A sudden suppression of the menses is often caused by taking cold, as we say. A young woman is in the habit of being much confined within doors, and perhaps in poorly-ventilated and overheated rooms; she dresses too tightly, sleeps perhaps on a feather bed and feather pillow; 77she drinks freely of tea and coffee, as people generally do ”

“ Amenorrhoea may arise from physiological causes, such as pregnancy, lactation, the menopause; constitutional causes, such as phthisis, anaemia and chlorosis, febrile disorders, some chronic intoxications, such as morphinomania, and some forms of cerebral disease; local causes, which include malformations or absence of one or more of the genital parts, such as absence of ovaries, uterus or vagina, atresia of vagina, imperforate cervix, disease of the ovaries, or sometimes imperforate hymen. The treatment of amenorrhoea must be directed towards the cause. ”

“ In Women,, ulceration of the uterus, stricture of the cervix, congestion or other diseases of the ovaries, such as cysts, abscesses, etc., inflammation of the Fallopian tubes, characterized with more or less periodical discomfort and attacks of leucorrhea, or "whites," are common causes.
In all cases in which the nervous disease depends upon local causes, we find that the relief of the local source of irritation, which tends to reduce the general health and interfere with perfect nervous tone, is all that is necessary to give the invalid a perfect restoration to health, vigor and activity. ”

“ Menstruation may cease in consequence of intercurrent diseases or constitutional anomalies; amenorrhœa may occur during the convalescence from acute diseases, in obese women, in those suffering from tuberculosis, diabetes, alcoholism, or psychoses. On the other hand, severe menorrhagia or atypical metrorrhagia may occur, the bleeding either being due to diseases of the uterus, such as endometritis, retroflexion of the 220uterus, or uterine myomata, or resulting from infectious diseases, disease of the heart or kidney, or from general disturbance of the health by chill or over-exertion. ”

“ The first type is the common one. The spleen generally becomes enlarged; it is sometimes tender and painful, it may occupy over half of the abdominal cavity and varies in size after a hemorrhage, diarrhea or after a meal. There may be paleness of the face, etc., early and late nausea, vomiting, diarrhea, and dysentery are common, as is also ascites (dropsy in the abdomen) . The pulse is rapid, full and soft. Fever is usual. Hemorrhages occur in the skin, retina, pleura, peritoneum, etc. Headache, dizziness, short breathing, and fainting may occur from the anemia. The liver may be enlarged. ”

“ Sometimes amenorrhoea takes place. Sterility is usually present, and so almost always is nerve-exhaustion with all its emotional manifestations. Pressure over each ovarian region elicits pain and causes a contraction of the rectus muscle on the affected side. The finger per vaginam or per rectum will often discover behind the cervix uteri or to one side of it the very tender ovary, of the form and size of an almond. Pressure on it gives a sickening pain, very unnerving in its character. Reflex nervous symptoms are very common, especially those of hysteria. ”

“ The most important factor of all is, however, the contraction of venereal disease, especially of that form known as syphilis.
The termination of aneurism cases is usually by rupture with profuse hemorrhage. Death takes place in a moment or two. Aneurisms often cause intense pain, which is sometimes thought to be rheumatic in origin. If the aneurism, in its enlargement, meets with bony structure, it produces absorption of the bone by pressure upon it and so finds a way even through the bone to the overlying skin. ”

“ Symptoms of an overdose are rare; vomiting and diarrhea occur. Then the medicine must be discontinued for a few days.
SECONDARY ANEMIA. Causes.—Hemorrhage form (bleeding) . (a) Rapid bleeding from the rupture of an aneurism, from a blow, or eating into the blood vessels by an ulcer. (b) Slow bleeding as from nose-bleed, flow from the womb, piles or in "bleeders" people who bleed readily.
2. Inanition form.—Not nourished because of interference in taking food or assimilating food, from cancer of the gullet, or disease of the stomach. ”

“ I am of the opinion, that the menstrual fluid is capable, in some cases at least, of coagulating like common blood. For all practical purposes then, it will be sufficient to understand by the term menorrhagia, all immoderate menstruation that does not actually amount to a plain and palpable hemorrhage.
83Who are the persons that are most subject to menorrhagia? “Women who live indolently and indulge in stimulating articles; who use little or no exercise; who keep late hours; who dance inordinately; who are intemperate; who have borne many children; who have been subject to febrile affections ”

“ The symptoms of chronic inversion are hemorrhage, discharge, backache, bearing-down pains in the pelvis, vesical disturbance, very pronounced anemia, and general physical weakness. Menstruation is very much increased in amount, and intermenstrual bleeding may occur after standing or on any physical effort.
Inversion of the uterus very rarely exists without causing serious symptoms. The majority of unrelieved cases end fatally from anemia, septicemia, or peritonitis. ”

“ Exercise produces pain in the small of the back and the lower portion of the spine, and, owing to a relation of the vaginal walls, the womb falls far below its natural position, or turns in various directions, according to the manner in which the weight above rests upon it. Ulcers are apt to appear upon the mouth of the womb, the matter from which tinges the discharge and stains the linen. Hysteria is often an attendant of this disease.
Causes. The immediate cause of leucorrhea is either congestion, or inflammation of the mucous membrane of the vagina or womb, or both. ”

“ There can be no question that menorrhagia is frequently of malarial origin, and even when the patient does not present a cachectic appearance. The disease may be produced by hepatic and splenic derangement, by deteriorated sanguinification, or by depression of nervous force. Menorrhagia is not infrequently a result of Bright's disease; an examination of the urine would determine this point. That the opposite conditions of plethora and anæmia should both cause menorrhagia is not difficult of explanation; in the one there is excess of blood with increased vascular pressure ”

“ Menorrhagia sometimes leads to cardiac symptoms, owing to the severity of the anæmia which follows extensive and long-continued loss of blood; sometimes, however, the heart troubles associated with menorrhagia are reflex manifestations, dependent on the disease which has also caused the menorrhagia, endometritis, it may be, new growths, lukæmia, or scurvy. Sometimes here also we observe transient attacks of acute dilatation of the heart. ”