Menstruation

“ Absence of Menstruation—Amenorrhea.—The absence of menstruation after it has been established, does not, as a rule, indicate any disease of the womb or female sexual organs. It is to be regarded merely as a symptom and can be, as previously stated, safely ignored if the general health is good. If the general condition is poor, and the quantity and quality of the blood deficient, it is a provision of nature to suppress menstruation in the interest of the general health. ”

“ MENSTRUATION. In healthy women at the period of puberty, a certain amount of sanguineous fluid is secreted by the lining membrane of the uterus, and is excreted through the vagina every month; this is termed the catamenia, or menses, and the function itself menstruation. A female in whom the discharge recurs at the usual periods, in the usual quantity, and of the usual quality, is said to be regular, 71The occurrence of menstruation defines the period of puberty at which a girl becomes a woman capable of conception, and its cessation terminates the prolific period of female life. ”

“ Were there no other condition to bring about the cessation of menstruation, the diagnosis of pregnancy would be greatly simplified. But any one can appreciate the fact that diseases of the womb may interfere with the menstrual process. Menstruation is influenced, also, by the ovaries. As a result of age, for example, the ovaries undergo changes which invariably bring about the permanent cessation of menstruation, called the menopause. ”

“ The age at which menstruation begins is also affected by the conditions of life and the social circumstances. In the higher circles of society, in the upper, well-to-do classes, menstruation appears earlier than among women of the laboring classes, who are compelled to strive for their daily bread. Amongst upper-class girls the menarche occurs at the age of 14 in one-fourth of their number, whereas among lower-class girls barely one-sixth begin to menstruate at the age of 14. ”

“ The serious difficulties of menstruation are due to definite pathological conditions such as displacements of the uterus, affections of the uterine mucosa and of the ovaries. There are, however, many cases where the trouble is merely functional, dependent on conditions that can be easily corrected without serious surgical or even lengthy medical treatment, and where the patient's attitude of mind towards the trouble is the most important factor in the medical aspect of the case. ”

“ Cessation of Menstruation.—The non-appearance of the catamenia, though a most valuable sign, is by no means a conclusive one, as menstruation may be arrested by diseases of various kinds; while, on the other hand, there are many well-recorded cases of women who have menstruated regularly during the whole period of their pregnancy. There have been also cases in which the menses only occurred during pregnancy; and in a few still more curious cases, women who have never menstruated have been known to have borne several children. ”

“ There are two instances of delayed menstruation quoted: the first, a woman of thirty, well formed, healthy, of good social position, and with all the signs of puberty except menstruation, which had never appeared; the second, a married woman of forty-two, who throughout a healthy connubial life had never menstruated. An instance is known to the authors of a woman of forty who has never menstruated, though she is of exceptional vigor and development. She has been married many years without pregnancy.
The medical literature relative to precocious impregnation is full of marvelous instances. ”

“ Knowing as we do that generally speaking an intimate connexion subsists between menstruation and ovulation, we are indeed able to assert that regular menstruation and fertility in women run a parallel course, and further, that the greater the irregularity of the menstrual function, the greater the tendency to sterility. ”

“ It is rarely, that no pain at all is experienced; there are some women, however, who affirm that in their case menstruation begins quite unexpectedly, and without the slightest warning; but it does not follow that contractions of the uterus do not occur in these women also during menstruation. * * * The local disturbances which occur as an accompaniment even of physiological menstruation are, a sensation of fulness and weight in the pelvis, and pains in the lower part of the back, and these probably all result from the uterine contractions. ”

“ Women in our mid-European climates, in whom puberty appears at an early age, the first menstruation occurring between the ages of thirteen and sixteen, exhibit a more prolonged duration of the sexual life, of menstrual functional activity, than women in whom menstruation begins late, between the ages of seventeen and twenty. ”

“ In general it may be said that in persons of strong constitution, the type of menstruation is much more regular, than in persons of a weakly, delicate constitution; that in vivacious, ardent natures the menses more readily anticipate the expected period of their return, whereas in those of a flaccid, lymphatic temperament a retardation is more likely to occur; and that amongst women of the upper classes of society the type of menstruation is far more frequently irregular than amongst women of the working classes and amongst countrywomen. ”

“ No young girl should feel alarmed if, owing to the negligence of her parents or guardians to prepare her, she is surprised by this first flow from the genital organs. Puberty is the proper time for the appearance of menstruation. This is the periodical development and discharge of an ovule (one or more) by the female, accompanied by the discharge of a fluid, known as menses or catamenia. Menstruation, in general good health, should occur about every twenty-eight days, or once in four weeks. ”

“ When we call to mind also the close sympathy between the uterine organs and every other part of the system, it shows us how important a proper menstruation is to the general health, because without it those organs must be diseased, and consequently every other part of the system liable to suffer with them. ”

“ We have only to consider, whether there does not frequently, during pregnancy, take place a discharge, so closely resembling menstruation in its periods, quantity, duration, and appearance, that neither the female herself nor her medical adviser shall be able to detect any difference between them ”

“ Neglect during menstruation, especially in the young girl, is a frequent cause of subsequent suffering. The effect of menstruation upon the whole system is remarkable. The nervous, vascular, and digestive systems all share in the menstrual function. The usual work of the girl at school or other employment should be altered to suit the altered conditions of her body at the menstrual period. Long school hours and close mental application or active exercise are too often continued at this time. ”

“ During nearly one week out of every four there occurs the characteristic phenomenon of menstruation, which in itself has some temporary impoverishing effect, though, in health, nature speedily provides the means of recuperation. Along with this we have a marked disturbance in the circulation of the pelvis, leading to alterations in the weight, conformation, and position of the uterus. ”

“ Seldom if ever does it happen that menstruation suddenly ceases without any notable constitutional disturbance, so that in a moment, as it were, the menopause is effected, without any period of transition. Rarely, even, do we meet with cases in which the peculiar manifestations foreshadowing or accompanying the cessation of menstruation last for no more than a few weeks. ”

“ But even the gradual cessation of menstruation causes notable disturbance of the woman’s mental and physical equilibrium, if the irregularities in the menstrual process are very great and spread over a very long period—more especially when the loss of blood is extensive. ”

“ It may also press the reproductive organs out of place, and so cause much pain and suffering at menstruation.
“I am of the opinion that women were not intended to be invalids in any degree because of their womanhood; and very likely there would be much less flow at menstrual periods if women and girls lived in accordance with Nature’s laws.” ”

“ More particularly, those women who hitherto during menstruation, and for some days before and after the flow, have been the prey of numerous nervous symptoms and troubles, rejoice, after the menopause, at their new-won freedom from these pains and disquiets, at their delivery from the excitements of the reproductive system, at their now uninterrupted state of well-being. ”

“ Occurring from nine years to the ordinary time of puberty, many cases are recorded.
Instances of protracted menstruation are, as a rule, reliable, the individuals themselves being cognizant of the nature of true menstruation, and themselves furnishing the requisite information as to the nature and periodicity of the discharge in question. Such cases range even past the century-mark. Many elaborate statistics on this subject have been gathered by men of ability. ”

“ I shall, however, take this opportunity of stating that, as careful investigations have shown, the periodic processes in question are not limited to the uterus and the ovaries, but affect also the external genital organs, which become congested simultaneously with menstruation; and further that the entire feminine organism is affected by an undulatory rhythm of nutrition, the rise and fall of which correspond to menstruation and to the intermenstrual interval, respectively. ”

“ A further important consideration is the time at which the menarche occurs, and whether on the one hand it is at or near the average age, or whether on the other, as precocious menstruation, it is unusually early, anticipating the general bodily development, or again as retarded menstruation it is unduly delayed. ”

“ The time of the beginning of the menstrual period varies according to climate, race, condition of health, and temperament. In the tropical countries, menstruation begins from the tenth to the fourteenth year; in temperate countries, from the thirteenth to the sixteenth; in cold countries, from the fifteenth to the twentieth year. The Italian, Hebrew, Spanish, or French girl is apt to menstruate {55}earlier than the English, German, or Swedish girl. The Negro girl menstruates early, as a rule. The full-blooded girl usually menstruates earlier than the anemic one. ”

“ Lives have been lost by thus suppressing the monthly flux. Mothers should instruct their daughters when the menses are apt to begin, and what their function is. During menstruation great care must be taken in using water internally. A chill is sufficient to arrest the flow. If menstruation does not establish itself in a healthy or normal manner at the proper time, consult a physician in order to remove this abnormal condition. ”

“ Thus the object of secluding women at menstruation is to neutralise the dangerous influences which are supposed to emanate from them at such times. That the danger is believed to be especially great at the first menstruation appears from the unusual precautions taken to isolate girls at this crisis. Two of these precautions have been illustrated above, namely, the rules that the girls may not touch the ground nor see the sun. ”

“ In the case of women, another factor may have played a rôle, viz., the fact that menstruation is considered an illness, as may be seen in the widespread custom of treating girls medically during menstruation. ”

“ This menstrual rise in blood-pressure is accompanied by a rise in temperature and an increase in metabolic activity. The influence of menstruation on the heart is most powerfully displayed in cases in which for some reason a disturbance occurs of the normal appearance or normal course of menstruation. ”

“ And as there are thirteen lunar months a year, a woman menstruates not twelve but thirteen times a year.
Where does the menstrual blood come from? The menstrual blood comes from the inside of the womb. Every month, for a few days prior to menstruation, the inside lining of the womb (what we call the mucous membrane or endometrium) becomes congested and its bloodvessels become distended with blood. ”

“ When on careful examination no abnormality can be discovered in the reproductive organs, when the bleeding in question recurs at the intervals and in association with the general symptoms to which the woman thus affected has been accustomed during her previous menstruations, and when the amount of blood discharged is not abnormal, it is permissible to conclude that we have to do with a persistence of true menstruation, even though the woman has some time since completed the fifth decennium of her life. ”

“ ITS IMPORTANCE.—Menstruation plays a momentous part in the female economy; indeed, unless it be in every way properly and duly performed, it is neither possible that a lady can be well, nor is it at all probable that she will conceive. The large number of barren, of delicate, and of hysterical women there are in America arises mainly from menstruation not being duly and properly performed. ”

“ This primitive theory of the origin of menstruation probably brings before us in its earliest shape the special and intimate bond which has ever been held to connect women, by virtue of the menstrual process, with the natural or supernatural powers of the world. Everywhere menstruating women are supposed to be possessed by spirits and charged with mysterious forces. ”