Definition. Dysmenorrhoea is a painful menstruation, the pain usually occurring just before or during the flow, but it may also be present after the flow has ceased.
Pathology. Dysmenorrhoea being but a symptom of various pathological states, it cannot be said to have any pathology which is distinctively its own. If all the organs of generation and their surrounding tissues are in perfect form and vigour, and sustain their normal relations to one another, and at the same time the blood and nervous systems are unimpaired, menstruation will take place without creating distinct pain, it being accompanied by only a sense of fullness and discomfort in the parts, and slight bearing-down sensations in the back and loins. As to its severity, dysmenorrhoea may vary in degree from this normal condition, to one in which the patient suffers for a few hours or for many days the most excruciating and agonizing pains, may induce other complications which together eventually destroy life. This condition may be brought about by any pathological state which causes a change in the shape or position of the uterus, congestion of the uterus, ovaries or surrounding cellular or serous tissues; or, a depreciated condition of the blood and nervous system creating a tendency to neuralgia, the uterine nerves, as a consequence, being in a state of hyperaesthesia. If neither of these conditions are present, dysmenorrhoea is not likely to occur, though our knowledge of pathology is not yet so perfect that we can say that such a thing would be impossible.
Varieties. For study and clinical convenience we may classify dysmenorrhoea as follows: (i) Congestive; (2) Neuralgic; (3) Membranous; (4) Obstructive. Some authors include also the spasmodic and ovarian varieties, but, as a rule, cases included in the former belong rather to the obstructive variety, while those dependent, supposedly at least, upon ovarian disturbance, may properly be classified as either congestive or neuralgic. It must be remembered, however, that any classification is more or less arbitrary, and cannot be rigidly followed. Nature does not always follow the lines thus established, to say nothing of those cases which present the characteristic of more than one variety, being dependent upon more than one pathological condition.
1. Congestive Dysmenorrhoea
At the menstrual period, as has already been noted, a certain amount of congestion is normal, which involves the mucous lining of the uterus and tubes, sometimes also including the ovaries, the cellular tissue and the peritoneum. Whenever from any cause this normal congestion increases beyond physiological limits, the condition is known as congestive dysmenorrhoea.
Aetiology. As may be readily inferred, but slight causes are sometimes necessary to induce an aggravation of the already existing normal congestion. These are most apt to operate in full-blooded, plethoric girls, who sometimes suffer more or less from this form of dysmenorrhoea through life, the least exciting cause serving to intensify their sufferings. Yet at the same time congestive dysmenorrhoea may occur in weak and anaemic girls who are subject to any of the following causes. General plethora; sedentary or luxurious mode of life; exposure to cold or wet; displacements; fibroid tumors; chronic metritis; endometritis; salpingitis; ovaritis; pelvic cellulitis; pelvic peritonitis.
Symptoms. The patient usually complains for a few days before the period of a feeling of fullness. Weight and heat in the back and pelvis, the flow being ushered in with more or less violent symptoms of a congestive or inflammatory nature, flushed face, hot skin and increased temperature. The pain varied in severity and character, but it is usually a steady, dull pelvic pain. The hypogastrium is usually more of less distended, hot and sensitive to the touch, the latter being often more noticeable over the left ovarian region. If the flow comes on freely the patient is ordinarily relieved, but this is not always the case, the suffering sometimes continuing to greater or lesser extent for several days.
Prognosis. As a rule the prognosis is favourable, though cases resulting from irremediable pathological states are sometimes found. There are cases, too, occurring usually in plethoric women, where more or less aggravation of the normal menstrual congestion seems to become a habit of the individual, and relief comes only with the menopause.
Treatment: Ordinary this from of dysmenorrhoea is amenable to the indicated remedy. The remedies most often required are, Aconite, Apis, Belladonna. Bryonia, Cimicifuga, Ferrum phos., Lachesis, Nux vomica, or Viburnum op.
2. Neuralgic Dysmenorrhoea
In this class there is usually no structural lesion or organic disorder, the dysmenorrhoea depending upon the presence of a neurotic constitution, the nervous system in general and the uterine nerves in particular, being in a state of morbid sensibility, so that the causes which might in others produce neuralgia of the head or stomach or other parts, here concentrate their force upon the uterine nerves, giving rise to hyperaesthesia, which, under the influence of the menstrual congestion, causes pain. As one author says, the nerves play a part corresponding to that of the vessels in the congestive form.”
Aetiology. The predisposing causes are in general the same as those which tend to produce neuralgia in other parts: The neuralgic diathesis, either hereditary or acquired; hysteria, which is rather a result of the nervous condition, than a cause; chlorosis; plethora; malaria; gouty or rheumatic diathesis; mental onanism; excessive sexual indulgence, or ungratified sexual desire; ovaralgia.
Symptoms. In this variety of dysmenorrhoea the patient seldom at any time experiences an entire freedom from suffering During the inter-menstrual period she may feel only a sensation of weakness, weariness and weight, but oftener she suffers more or less with headache, neuralgia and other nervous affections, including hysteria, which become more pronounced as she approaches the menstrual nisus. At this time also she may show aberrations of temper, irritability and a tendency to melancholy. In some cases there is no considerable inconvenience until the menstrual period arrives, which is usually quite regular. At this time, whether prodromata have been present or not, the patient experiences excruciating pain in the uterine region, back and loins, which usually moderates or entirely disappears when the flow is established, but in some cases continues with more or less severity during the whole period. The neuralgic nature of the pain is recognized not only by its character, but also by the fact that in some women it occurs at some distant part of the body, as the eye or face, instead of the uterine region, while in others it may alternate in its location, or involve different localities at the same time. The feet and hands are almost invariably cold. After the attack she is usually greatly exhausted for several days.
Diagnosis. The presence of the above described symptoms and the absence of anatomical changes, are usually sufficient to establish the diagnosis. The pains are not expulsive, the blood is not clotted, and physical examination reveals no obstruction. From the congestive form it is chiefly differentiated by the absence of congestive symptoms. It is also, when once established, more regular in its occurrence, regardless of exciting causes.
Prognosis. As in other neuralgias the prognosis depends largely upon our ability to discover and remove and cause. If the patient inherit a neuralgic diathesis, the prospects for a cure are very discouraging. Otherwise, if she will consent to the adoption of such hygienic measures as are required to restore the tone of the nervous system, the prognosis is quite favourable.
Treatment. The first duty of the physician is to prescribe, such hygienic measures as will have a tendency to restore the tone of the nervous system. The patient should, if possible, be relieved of all mental worry and excitement and not be exposed to the influences to cold or damp, though in pleasant weather an abundance of fresh air and sunlight are indispensable. Flannels of proper weight should be worn next the skin during all seasons. She should take regular and systematic exercise, though never carrying it to the point of fatigue. A plain, nourishing diet is essential, and all the habits of life, especially as to sleeping, eating and defecation, should be regular. Often a change of climate and scenery will afford much benefit.
In cases in which the suffering is extreme, the temptation to give an opiate is very great, but we should remember that such relief is only temporary often no more than can be had with the properly indicated homoeopathic remedy, that it is obtained at the expense of the patient’s general health, and, being oft repeated, is almost sure to lead her to acquire the morphine habit.
The remedies most often required are: Asclepias, Belladonna. Caulophyllum, Chamomilla, Cimicifuga, Gelsemium, Hyoscyamus, Ignatia, Phosphorus, Platinum, Pulsatilla, Viburnum, Xanthoxylum.
ALLEN CORSON COWPERTHWAITE was born at Cape May, New Jersey, May 3, 1848, son of Joseph C. and Deborah (Godfrey) Cowperthwaite. He attended medical lectures at the University of Iowa in 1867-1868, and was graduated from the Hahnemann Medical College of Philadelphia in 1869. He practiced his profession first in Illinois, and then in Nebraska. In 1877 he became Dean and Professor of Materia Medica in the recently organized Homeopathic Department of the State University of Iowa, holding the position till 1892. In 1884 he accepted the chair of Materia Medica, Pharmacology, and Clinical Medicine in the Homeopathic Medical College of the University of Michigan. He removed to Chicago in 1892, and became Professor of Materia Medica and Therapeutics in the Chicago Homeopathic Medical College. From 1901 he also served as president of that College. He is the author of various works, notably "Insanity in its Medico-Legal Relations" (1876), "A Textbook of Materia Medica and Therapeutics" (1880), of "Gynecology" (1888), and of "The Practice of Medicine " (1901).