Profuse Menstruation. Menorrhagia.
MENSTRUATION May continue too long, or occur too often, or be too profuse while it lasts; or all these irregularities may be experienced by the same person. Any one of them will prove a serious irritation, and a drain upon the constitution ; the whole together, if not arrested, will undermine and destroy it.
The Cause of this, like the source of all other female diseases, is, in a great majority of cases, overlooked.
It is not to be attributed, as so many suppose, to a congested state of the womb; but is rather the result, in a great many instances, of the inflammatory or ulcerated condition of the uterine neck.
In still another large number of cases, it arises from a succession of ovarian abortions. When the blood has run low, and nutrition is defective, as in the consumptive habit, the ovarian vesicles fail to reach maturity. Like other products of the economy, they become blighted and abort. And as these blights occur often, nature is busy every two or three weeks casting them off. Hence, the menses appear often. They come and go without order, because they spring from a process which is a contraversion of nature's laws.
Profuse menstruation, like scanty menstruation, is a symptom of a variety of diseases. The quantity may be increased only on one or more days, or be so great as to cause death from hemorrhage. At all events, the amount of blood lost is often so great as to cause anemia and impaired health for a long time. This is, however, usually the result of continued free bleeding extending through a number of months.
The local causes of uterine hemorrhage are fibroid tumor of the womb; inflammation of the womb or metritis; inflammation of the lining membrane, or endometritis; uterine congestions from any source; cancer of the womb in its early stages; retroversion, or tipping over backward of the womb onto the rectum; polypus; enlargement of the womb following labor or abortion; the retention of placental tissue, etc., etc. These also are among the local causes of hemorrhage. But not infrequently the excess of flow is due to impaired general health. Wasting diseases like phthisis or consumption cause the blood to be so thin as to render it unable to form a clot, thus facilitating the easy or profuse hemorrhage often seen in young girls in the earlier stages of consumption; later, amenorrhea ensues from utter lack of blood. This flowing often attends acute fevers, purpura, Bright's disease, jaundice, heart disease and debility. This last cause is often seen in the case of young girls who have grown rapidly since puberty and pursued a vigorous course of study with little or no out door exercise. The strain on the nervous system in these girls is kept up constantly by sharp competition, and no heed is paid to nature's demand for rest and relaxation at the menstrual time. The claims of society on the young girl add no small share in the production of this evil.
Explanation. It is not easy to explain how inflammation and ulceration of the uterine neck should in one case produce suppression, and in another profuse menstruation. Yet it is a settled truth that such opposite results do come from one and the same apparent cause. Probably the explanation is to be found in the different degrees of inflammatory action, in the varieties of constitution, and in the variant degrees of tenacity with which the vessels hold the blood.
Bleeding from the female genital organs may be produced by a variety of causes which have nothing to do with menstruation. Such bleedings are properly uterine or vaginal hemorrhages, and not profuse menstruation. They are the result of inflammations, or tumors within the uterine neck (Fig. 140), or weakness. The womb may bleed for days, or even months, from pure debility.
Treatment. As profuse menstruation and uterine hemorrhage spring from a variety of causes, so the remedies are various. Here again we are confronted with the same absolute necessity to investigate accurately the true nature of the complaint before we venture a single prescription. All the cases present one general feature. There is too great a loss of blood; and the first thought is that astringent medicines are necessary to arrest it. But if the bleeding be occasioned by a polypus, or by inflammatory ulceration, astringents would not arrest it, and might do great mischief.
When the immoderate flowing is caused by a general breakdown of the nutritive powers, and by ovarian abortions, the great aim must be to rally the vital powers by iron, quinine, porter, wine, a generous diet, exercise on horseback and on foot, and warm and cold bathing. When produced by local diseases of the ovaries and neck of the womb, the treatment is to be local, such as has been described. If a polypus or other tumor be the cause, the remedy must be sought for under the appropriate head. If the womb has become relaxed, and bleeds from pure debility, as it may, something must be found, if possible, which will condense its substance, making it harder, smaller, and more solid. For this purpose, cold bathing, astringent injections into the front passage, and acid drinks are useful. But one of the best remedies is the wine of spurred rye (267). One teaspoonful should be taken three times a day. This article, by causing the womb to contract, solidifies and condenses it, thus arresting the blood which oozes from its relaxed tissues. Of course, the object of all treatment is twofold: the one to stop the hemorrhage for the time being, the other to remove the cause. The physician may have to be called, and resort had to tampons in the vagina; the uterus itself might have to be packed with gauze; hot douches of 115 to 120 F. will frequently quiet a stubborn hemorrhage, especially if rest in bed with the Mps elevated be strictly enjoined. The hot douche should be repeated every three hours. Besides the giving of ergot, hydrastis, hamamelis and atropia are also quite useful, as, for instance: Fluid extract ergot, fluid extract hydrastis, fluid extract hamamelis, of each twenty drops, in water every three hours, with the addition of 1/100 grain of atropia at the same time.
Sedatives, like the bromide of soda, in ten grain doses every hour or two, will be of service if the hemorrhage be caused by fright, grief, or injury. The treatment of the intervals must depend on the cause, but generally some systemic tonics like iron or quinine are of great service ; rest in bed is, par excellence, the treatment in most cases at some stage of the flowing, generally during the flow itself ; but rest from excitement and freedom from overwork are equally important when the hemorrhage is due to this cause. Out door exercise, fresh air and good food are none the less important for weary brains and tired nerves.
Hemorrhage between the periods, or menorrhagia. When hemorrhage from the womb occurs between the periods, it is called menorrhagia, and is more apt to occur in women past thirty years of age, or, at all events, in married women. It is of more significance usually than profuse menstruation, and almost always proceeds from the womb itself. This bleeding comes on often after the menopause, or 11 change of life." The causes are quite similar to those just considered, but local causes are oftener found. Some sloughing surface, as from cancer, fibroid, erosion of the lining membrane, exists in half the cases. Abortion, and the retention of small pieces of afterbirth, are frequent causes of this kind of flowing.
This trouble demands the immediate attention of the family physician or the specialist, who will examine the uterus and ascertain the cause; and, as not infrequently, the cause consists in something to be removed, a brief mention of the methods employed will not be out of Place.
The size, shape, position and firmness of the uterus and ovaries are made out by the examining fingers of the left hand being pressed into the abdominal walls above the bladder, while the fingers of the right hand, with the knees drawn well up, are introduced into the vagina and pressed against the neck of the womb. An endeavor is then made to bring the womb between the two sets of fingers, which maps out its locality, position, etc. The ovaries and ligaments are likewise located. Any erosion of the mouth of the womb, foreign growth there, malposition, excessive size, etc., can thus be readily detected. To explore the inside, one of the various specula before described are used, and the uterus dilated either with tents, so called, or more commonly with a steel dilator. If, then, there is found aught to be removed, a sharp, spoon like instrument, called a curette, is used to scrape away all diseased tissue or foreign growth, and the womb then washed out with some antiseptic solution. The womb is then often packed with gauze to still further disinfect its interior and afford a means of draining away all oozing blood or forming mucus.
This operation called curetting is now frequently done as a regular means of treatment to do away with the causes of hemorrhage and to restore the normal bulk and character of the womb, instead of resorting to the slow, tedious, and less successful methods of former times. It is, to be sure, a regular operation; but when done under so called aseptic methods, to be described later, is a perfectly safe and trustworthy treatment, far in advance of old fashioned methods, which seem less heroic.
It necessitates rest in bed, nursing, and the disadvantages of sickness; but on the other hand, it saves lives, stops disease, and renders useful what otherwise might become useless and dangerous to life and health.
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