Dysmenorrhea

“ PAINFUL MENSTRUATION—MENSTRUAL COLIC—DYSMENORRHEA.
Dysmenorrhea means a difficult monthly flow, and is always preceded by severe pains in the back and lower part of the abdomen. It is caused by taking cold during the period; fright, violent mental emotions, obstinate constipation, sedentary occupations, smallness of the mouth and neck of the womb. Females subject to this trouble are generally relieved by marriage. The symptoms are severe bearing-down pains in the region of the uterus, like labor pains ”

“ Dysmenorrhea, or painful menstruation, is of such frequent occurrence that it deserves especial attention. Most young ladies experience more or less suffering at this time. It may be only nervousness, wakeful nights, a slight headache, some pain in the back or pelvic regions, and a disposition to be alone; or the attacks may be severe, with pain in the back and pelvis, running down into the limbs; the surface and extremities cold, face pallid, with nausea, vomiting or fainting, and perhaps spasms. ”

“ Professor Goodell's reminder that women have many organs outside of their pelvis is important in dysmenorrhea. Almost any ailment that drains a woman's strength and brings a series of irritations to bear upon her nervous system will be reflected in her genito-urinary system and will cause discomfort during the menstrual period. ”

“ Effects of Pregnancy.—Pregnancy appears sometimes to break in upon the disease, and cure it; but it is far oftener true, that females who suffer from dysmenorrhea, are incapable of conceiving. Oftener, in this disease, there is a too scanty flow of the menstrual discharge. Sometimes, however, it commences with little or no discharge, but ends in a very copious gushing forth of the menses, which brings entire relief from the pain. ”

“ In the congestive variety of dysmenorrhea, the menstrual period may be ushered in without pain; after a few hours, the pulse becomes stronger and more rapid, the skin grows hot and dry, the menses stop, there is uneasiness, restlessness, and severe pelvic pains. Evidently, the mucous membranes of the Fallopian tubes and uterus have become congested, and the pain results from the arrest of the functional process, the exudation of blood.
The causes are plethora, exposure to cold, excitement of the emotions or passions, and a morbid condition of the blood. ”

“ The neuralgic variety of dysmenorrhea, sometimes called spasmodic or idiopathic, occurs when there is excessive sensibility of the ovaries and uterine nerves, which sympathetically respond, especially to cutaneous, biliary, and sexual irritation, and when ovarian or uterine irritation is communicated to distant nerve-centres. ”

“ The treatment, in all the preceding varieties of dysmenorrhea, should consist of measures to determine the circulation of the blood to the surface, and increase the perspiratory functions. Congestion and inflammation of the internal organs are generally induced by exposure to cold or from insufficient clothing. Sometimes they follow from neglect of the skin, which is not kept clean and its excretory function encouraged by warm clothing. ”

“ Anyone who has seen the difference between the reaction to menstrual moliminia when patients are in good condition and when they are otherwise run down will realize how much a matter of over-reaction to symptoms dysmenorrhea may be. Teachers who begin the school year, invigorated by their vacations, scarcely notice their periods, but at the end of the course, when run down by months of hard teaching work and especially by the confinement of the winter, they find the strain extremely hard to bear. ”

“ Menstruation is usually painful. At the menstrual period the backache, headache, ovarian pain, and vesical disturbance are increased. Dysmenorrhea due to obstruction is unusual in cases of retroflexion. Retroflexion usually occurs in parous women, in whom the cervical canal is large, and the flexion therefore does not cause sufficient obstruction to impede the escape of menstrual blood. All the symptoms arising from retroversion of the uterus are ameliorated by the recumbent posture. ”

“ I mentioned before that in some girls and women the menses are accompanied by pains and cramps. This affliction, which is the lot of millions of women, and from which men are entirely free, is called dysmenorrhea. Dysmenorrhea means painful and difficult menstruation. A slight pain or at least a feeling of discomfort is present in most cases of menstruation. ”

“ Normally, menstruation should proceed naturally and without pain or suffering. When pain or suffering is experienced in connection with menstruation, it is simply because of some lack of health in the general system; and when such general health is restored, the trouble ceases. Painful menstruation is called "dysmenorrhea," and arises from several causes, principal among which are the following: Errors in diet, errors in dress, undue exposure, constipation, lack of proper exercise, or to a contracted or congested condition of the Uterus or the Fallopian Tubes. ”

“ Local treatment or remedies will seldom be found necessary, if the whole system is kept in the best hygienic condition. A young woman had for nine years been a martyr to dysmenorrhea, spasms attending every period, often continuing for days. ”

“ Some are forced to do it, because, if they don't, their dysmenorrhea is worse and the amount of blood they lose is considerably increased. The same cannot be said of cleanliness. Due undoubtedly to the superstitious opinions about menstruation, which came over to us from the ages-of-long-ago, menstruation is still considered a noli-me-tangere, and women are afraid to bathe, to douche or even to wash during the periods. And if there is any period when a woman needs a douche it is during menstruation. Any leucorrhea that a woman may be suffering from becomes aggravated around the periods ”

“ 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. ”

“ Preventive treatment really begins very early. In the chapter on menstruation we referred to the importance of a young woman’s ascertaining the cause of painful menses, in the interest of good obstetrics, since inflammation of the uterine lining or a uterine misplacement might be responsible not only for the dysmenorrhea, but if neglected might, later, be factors in causing interrupted pregnancies. ”

“ Tardy and Suppressed Menstruation—Chlorosis—Sudden Check of the Menses. One of the most important of all subjects connected with the health of females, is that of disordered menstruation.
You will find, as you read medical works on Females, the word amenorrhœa, which signifies a partial or total obstruction of the menses in women, from other causes than pregnancy and old age. You will find, also, the words menorrhagia, signifying an immoderate flow of this discharge, and dysmenorrhea, meaning difficult or painful menstruation. ”

“ 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. ”

“ But in many cases the pain is so severe, so excruciating, that the sufferer, girl or woman, is incapacitated for any work, and must go to bed for a day or two. In some cases the pain is so severe as to necessitate the use of morphine, and as it is a very bad thing to have to give morphine every three or four weeks, [77] every endeavor should be made to find out the cause of the trouble and to remove it. It is a mistake, however, to think that all or even most cases of dysmenorrhea are due to some local trouble, that is, to an inflammation of the ovaries, or a displacement of the womb. ”

“ Is it any wonder they become sickly, become victims of hysteria and suffer from menstrual disorders? Dysmenorrhea must follow such carelessness, and the parents are to blame in many cases. Be careful of your children, especially girls at this age, care less for their intellectual growth, and pay more attention to their body development, even if it should happen to be at the expense of their intellectual development. A healthy body is better than all the knowledge that can be obtained, if it goes, as it too often does, with a body that is weak and sick. Outdoor life is necessary. ”

“ In general, gonorrhea is a less painful disease in woman, and this is a bad thing, because she thus neglects treatment and loses valuable time, permitting the disease to develop. Even when the urethra is affected in women, it does not give as severe symptoms as inflammation of the urethra in men. If the woman does have pains she often pays no attention to them, because woman is used to pains; as we have seen before, fifty per cent. of all women suffer more or less with dysmenorrhea. ”

“ 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. ”

“ In anaemia and phthisis menstruation often returns after improvement in the general condition, with good food and good sanitary conditions, an outdoor life and the administration of iron or other tonics. In local conditions of imperforate hymen, imperforate cervix or ovarian disease, surgical interference is necessary. Amenorrhoea is permanent when due to absence of the genital parts. The causes of dysmenorrhoea are classified as follows: (1) ovarian, due to disease of the ovaries or Fallopian tubes ”

“ Women who suffer from severe dysmenorrhœa, frequently become pregnant, though later, it may be, than women in whom menstruation is normal and painless. Dysmenorrhœa is not due solely to contraction of the cervical canal, but also to a variety of other pathological conditions. The anomalies of the genital organs which give rise to dysmenorrhœa do not, for the most part, offer any obstacle to conception; and, on the other hand, stenosis of the cervical canal may exist in women who are entirely free from dysmenorrhœa. ”

“ While menorrhagia is often attributed to colds or to getting the feet wet (and undoubtedly the disturbance of the circulation consequent upon wet feet is an active factor in the production of an increased menstrual flow) there is no doubt that in most cases there is some more distinctly local cause at work. Another important cause of profuse menstruation is the presence of a fibroid tumor or other neoplasm which brings an increased blood supply to the uterus and a consequent greater elimination at the menstrual epoch. ”

“ I now believe that the subjects of the kind of menstrual pain to which I am referring are naturally endowed with a very irritable nervous apparatus of the pelvic organs, and that there is a certain character at once of immaturity and excitability in their sexual organs, especially in the virgin condition. So far from these females being disposed to sterility, as is too often the case with those dysmenorrhœal subjects whose troubles depend upon occlusion, distortion, or narrowing of the outlets, they are often extremely apt to the generative function ”

“ It is always necessary in treating amenorrhœa to consider the cause of it, and we should know that it may come from torpitude of the secernent vessels of the uterus, produced by anxiety of mind, cold, or suddenly suppressed perspiration; falls, especially when accompanied with terror; or a general inertness and flaccidity of the system, and more particularly of the ovaries. (F. 172, 173) .
DYSMENORRHŒA. There are few women who pass through the whole period of sexual vigor without having more or less frequently to endure an attack of dysmenorrhœa. ”

“ Some of the accompanying symptoms of Menorrhagia, or profuse flow, are lassitude, shortness of breath, faintness, dizziness, headache, irritability and nervousness, and often also leucorrhea between periods. The general{57} treatment consists in measures calculated to bring the general health of the woman back to the normal. The building up of the general system, by means of nourishing food, proper exercise, etc., will almost always result in curing this disorder.
A well-known authority has well said: "The hygiene of menstruation can be expressed in two words: Cleanliness and Rest." ”

“ Amenorrhœa at the time of the menarche may depend on complete aplasia of the ovaries, associated with a rudimentary and imperfect development of the uterus. In such girls, the development of whose reproductive system is thus imperfect, the continually expected menstrual flow fails to appear, in spite of the fact that a recurrent menstrual discomfort, evoked by the congestion of the genital organs, recurs at intervals of four weeks; as, for instance, colicky pains in the abdomen, irritable, nervous states, and mental disturbances. ”