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AMENORRHEA
By amenorrhoea is meant the absence or suppression of the menetrual function. Under certain phyeiological conditions temporary cessation of this Function is to be normally expected. This occurs during pregnaney, when menstruation is, as a rule, completely suppressed, the cessation occurring abruptly. Whilst the mother is suckling the infant, amenorrhoea is usually present, although not invariably. Absence of the periods is the normal condition before the onset of puberty. To the above conditions the name of physiological amenorrhoea has been applied. After the change of life the periods cease for good, owing to the shrinking of the ovaries and womb; this also is a normal condition and has besn called permanent physiological amenorrhoea.
Absence or cessation of the periods due to any other cause is abnormal and is termed pathological amenorrhoea. The process oF menstruation is initiated by a secretion elaborated by the ovary, the menstrual dis charge being derived from the lining membrane of the womb. Any condition tending to diminish the functional. activity of the ovary tends to cause cessation of the monthly period.
 
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Pathological amenorrhoea naturally falls into two classes. In the first class the age of puberty has been reached and passed but the periods have not appeared, though there is considerable variation in the age at which the periods first appear, depending on climate, race and other natural factors. To this class is given the name primary pathological amenorrhoea. The commonost causes of this variety are: (1) Chlorosis, a type of anaemia found in girls and young women; in this condition the number of blood corpuscles is reduced to a certain extent, but there is a great reduction in the colouring matter of the blood; (2) pulmonary tuberculosis; (3) minor degrees of imperfect activity of the ovaries. Causes of this want of naturai activity are unsuitable environment, lack of fresh air, deficient exercise, and unsuitable food. Speaking generally, the above causes are mostly removable, so that this type of amenorrhoea can be cured..
In cases of infantilism and cretinism, amenorrhoea is always present and is usually permanent. If the womb or ovaries, or both, havo been completely destroyed or removed, a permanent incurable amenorrhoea will ensue.
A less common cause of primary amenorrhoea is an obstruction to the flow of the menatrual fluid due to an imperforate hymen. In such a case the fluid collects and forms a swelling in the vagina.
In contradiatinetion to the primary variety there is a secondary pathological amenorrhoea. In this type menstruation has occurred for a varying period of time, but has now ceased entirely. The cessation may be gradual in onset, the loss at each aucceeding period being less than in the preceding one, until finally complete cessation occurs.
An abrupt cessation of menstruation in one previously quite regular is in virtually all cases due to conception.
The causes of secondary amenorrhoea are numerous, and often difficult of detection, several being present at one Co. and the same time. Amongst the more common may be mentioned:
(1) Any condition producing marked ill-health, such as severe anaemias, kidney disease, diabetes, eevere nervous diseases. Certain drug habits, such as chronic morphiniaxn, chronic alooholism, or chronic lead poisoning, will act in a aimilar way.
(2) Climatic causes. It is not at all uncommon for a sudden change from a very hot t,o a very cold climate to cause a temporary cessation of the menstrual periods.
(3) Certain varieties of heart disease.
(4) Nervous causes: post-nuptial, sudden shock, severe chill; these can only cause the ceasation of one or two periods at the most.
(5) Excessive shrinkage of the womb following childbirth, although not at all common, may cause permanent cesaation of the periods.
(6) Tumours of the ovaries, which destroy ovarian tissue, or removal of the ovaries or womb will cause a permanent ceasation.
Variations in the Natural Course
Lastly, the change of life may sometimes come on prematurely, when, of course, the menstrual function will cease; this is particularly likely to take place in obese, sterile women in whom menstruation started later in life than is usually the case.
The menstrual function usually starts about the age of fourteen years, but there are many variations of this within the normal. It is important to remember this, because many mothers become alarmed and think there must be something wrong if the periods do not appear at this age. It is quite common, even in healthy girls, for the onset of menstruation to be delayed until the middle of the fifteenth or beginning of the sixteenth year. The regular monthly recurrence is often not eatablished for some time following the initial menatrual period, the process occurring once and then often not appearing again for several months. This condition of affairs may be quite normal at the onset of menstrual life.
The only rational treatment of pathological amenorrhoea consists in ascertaining and removing the cause or combination of causes. In cases of primary pathological amenorrhoea, where the menstrual function has never been establiahed, it is important that advice should be sought early, because it has been found that treatment in these cases must be started early. In the cases of secondary amenorrhoea the same principle holds good, namely, careful inquiry into the cause and its removal. Abundance of fresh air, nutritious dietary and careful regulation of the bowels are of the utmost importance. In certain selected cases a course of treatment at a spa, such as Plombieres, may be of use.
There are certain drugs which have the undeserved reputation of hoing able to cause the onset or return of the periods and hence are called emmenagogues. Of these potassium permanganate and apiol, the essential extract of parsley, are probably the best known. Extracts of the ovaries of animals are often given, with the idea of making up for the deficiency of ovarian activity in the individual suffering from amenorrhoea. Speaking generally, the most useful drugs are iron and arsenic tonics; these may have to be taken over a long period of time, and act by improving the blood condition.
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