THE most important disorders of menstruation are termed : (1) Amenorrhoea, (2) Menorrhagia, (3) Dysmenorrhoea. Before discussing these disorders I am going to touch on the questions of Premature and protracted menstruation.
As pointed out above, menstruation usually begins between the twelfth and fifteenth year, but there are cases, in which the flow sets in at a much earlier age. Campbell for instance (quoted from A System of Gynaecology, edited by Albutt, Playfair and Eden, London. Macmillian & Co. 1906) records a case in which a girl had menstruated regularly every three weeks since birth. Many other cases of menstruation during infancy or between the ages of seven and thirteen years have been published. In a number of cases this condition was due to a hereditary constitution, but the main factor in such cases might be immoral associations; neglected children coming in contact with vicious girls older than themselves, have their attention prematurely directed to the sexual organs. In other cases again the condition may be the result of over-excitability of the brain, or of irritation produced by worms in the rectum or by a caseous secretion about the clitoris or by a corrodent discharge from the vagina (vulvovaginitis).
Regarding protracted menstruation there are cases in which women after the change of life still have a regular or irregular menstrual flow till the sixty-fifth year of life. We find such cases especially amongst gouty women; but there can be no doubt, that in the majority of these cases the “menstrual” discharge is due to a local disease of the genital organs, especially due to tumours of the womb.
(1) AMENORRHOEA OR ABSENCE OF MENSTRUATION
We must differentiate between primary and secondary amenorrhoea, that means between cases, where a menstruation never took place at all and between cases, where, after menstruation had been starting for a certain period, the menstruation suddenly or gradually stops.
The primary amenorrhoea is permanent in all cases, where the ovaries or the womb or both are absent or remain in a rudimentary condition, whilst the external sexual organs are normally formed. The girl’s sexual development ceases and her characteristics tend to the masculine, or at least to a mixed type.
In another category of cases the internal sexual organs are normally developed, but no menstruation appears, a condition met with in chlorotic girls. Here the vascular system is at fault; not only are the walls of the blood vessels themselves imperfect, but the blood itself is of bad quality, containing fewer red blood cells than it normally should and there is a great deficiency in haemoglobin (the red matter in the blood cells). These patients are characterized by a marked tendency to plumpness from over development of fat and cellular tissue.
The right hygienic, dietetic and homoeopathic treatment is sufficient to cure at least a great number of these girls. A through medical examination is indispensable; each case has to be treated individually.
As a rule, all these patients are suffering from a lime deficiency, hence lime, that means Calcarea ought to be given; the best way to do it is the regular taking of the lime food can be combined with homoeopathic drugs like Iodine, Arsenicum, China, etc., according to the special symptoms of the patient.
Secondary Amenorrhoea :
These cases of amenorrhoea may be the result of the most various pathological conditions. I refer to constitutional diseases like anaemia, chlorosis, diabetes mellitus, Bright’s disease, malaria, tuberculosis or cancer. In another category of cases amenorrhoea may be due to acute feverish ailments, or to surgical affections, or it may be the result of syphilis. The influence of the nervous system is another decisive factor. Thus a sudden fright is often responsible for a temporary amenorrhoea. Mental depressions, met with amongst the insane or prisoners, very often result in amenorrhoea.
Furthermore I mention the cases of amenorrhoea in unmarried women, fearing that they may be pregnant, or the amenorrhoea of pseudo-pregnancy occurring in the newly married and in women leading irregular lives. Change of climate or diet, for instance a long sea voyage, is often responsible for such a nervous amenorrhoea.
Other cases of amenorrhoea, again, are due to local diseases of the sexual organ, especially tumours or chronic inflammation of the ovaries or womb.
In another cases, again, amenorrhoea is due to narrowing or even to a temporary obstruction of the cervix or vagina.
It goes without saying, that only a through examination by an experienced physician is yet to explain the whole situation and to give the clue to the right treatment, for the rational treatment depends upon the cause of the aliment. As a matter of course, if there is a marked narrowing or occlusion of the cervix, for instance, local treatment is indispensable. In all other cases (remembering that the simple causes are far more frequent than the serious) the indicated homoeopathic drug will be a great success. Referring to the attached Materia Medica I mention only Ferrum metallicum, Pulsatilla, Senecio aureus, Calcarea carbonica, China, Graphites.
(2) MENORRHAGIA (PROFUSE MENSTRUATION)
Menorrhagia is just the opposite to amenorrhoea. The term menorrhagia means excessive bleeding during the intervals between the periods. The blood is either fluid or coagulated and may differ greatly in colour and character. Such profuse haemorrhages are often met with amongst anaemic, asthenic under-developed girls during puberty as well as amongst strong, plethoric women, especially before the period of change of life. The condition is due either to a local disease of the womb or to a general constitutional disorder. Amongst the local diseases I mention polypi, fibromyomata of the womb, excessive thickness of the mucous membrane of the womb, especially following childbirth or miscarriage, inflammation of the Fallopian tubes or of the ovaries. Regarding the general constitutional disease I refer to ailments associated with plethora, such as chronic heart diseases, diseases of the blood vessels, Bright’s disease and exophthalmic goitre. In other cases, again, the disease is due to primary blood diseases, such as pernicious anaemia, leucaemia, haemophilia or purpura, both amenorrhoea and menorrhagia may be a symptom of endocrinous disorders, especially hypo- or hyperthyroidisms.
According to the great variety of causes and clinical symptoms the number of indicated drugs is immense, but considering sometimes very complicated clinical pictures and circumstances, even the most experienced physician might have great difficulty to find the indicated drug at once.
As a rule the following drugs should be considered : Calcarea carbonica, Belladonna, Hamamelis, Sabina, Ipecacuanha, China, Nitrum acidum and Secale.
(3) DYSMENORRHOEA (PAINFUL MENSTRUATION)
We speak of dysmenorrhoea or menstrual colic in cases where menstruation is characterized by serious pains without any morbid condition of the genital organs. Such cases are very common. Nearly 33 per cent. of all women do suffer from more or less painful menstruations. The pains usually radiate from the womb to the back and the lower part of the abdomen. As a rule the menstrual flow is scanty, but in some cases the quantity of the blood lost is very profuse.
We differentiate between spasmodic and congestive dysmenorrhoea.
The spasmodic dysmenorrhoea is characterized by painful contractions of the womb, the pains are always severe and cramp- like, being located in the back and the lower part of the abdomen, radiating to the legs. There is always indigestion, exhaustion and great nervous irritability. The pains usually start with the onset of the menstrual flow, lasting a few hours or days.
The congestive or inflammatory dysmenorrhoea is characterized by severe aching, beginning a week before menstruation starts and it is relieved by the flow. In nearly all these cases there is chronic inflammation of the womb or the Fallopian tubes or even tumours (polypi) of the womb, many of these cases follow an abortion.
Generally speaking these patients are neurotic. Psychical influences play a decisive part in the whole clinical picture. The hormonal balance in all these women is disturbed during the menstrual period, thus affecting the physiological action of the ovaries. The question, to what dysmenorrhoea is really due is not yet settled at all.
The homoeopathic treatment of dysmenorrhoea is very satisfactory; it has to be based on the totality of the symptoms. The most important drugs are : Gelsemium, Viburnum opulus, Magnesia phosphorica, Caulophyllum, Chamomilla and Xanthoxylum.
For special indications I refer to the attached Materia Medica.
In conclusion I add a few words about the so-called “Vicarious Menstruation”. That means a condition, where no menstruation starts; instead of the menstrual flow there is bleeding from the nose, the lips, the gums, pharynx, bowels, skin or nipples. In other patients there is bleeding from fistules, wounds or ulcers of the legs. Generally speaking these cases are rare; their cause is unknown.
Our most reliable drugs are Bryonia, Collinsonia, Hamamelis, Ferrum and Ustilago for which the homoeopath can find the indications.