Menses Absent/Suppressed

(October 2006)

Female aged 24 years presents with menses absent for 3 months, she is not on the pill and has been off it for some months as it bloated her, made her put on weight and feel generally unwell when she was on it. She has had pregnancy tests to ensure that she is not pregnant. She has been checked by a gynecologist and told that she may have endometriosis (early stages). Her family, on her father’s side have a history of endometriosis, in fact most of her female cousins have had hysterectomies by the age of 35 years and they also have had difficulty conceiving.

Her periods have always been difficult, irregular and painful. Her abdomen often is distended and bloated…, “it feels hard as a rock, then it feels like a knife is cutting through it”. She is also prone to being very emotional and reactive, especially around the time of ovulation and before her period is due. She is very sensitive to what people say and gets hurt very easily and can also be very jealous with boyfriends. She seems quite soft and yielding in her approach in the clinic.

She is in an unhappy relationship with a guy who was quite controlling. Her relationship with her mother is quite frayed as she is really controlling about her life, boyfriends and career. Her mother’s interference with her performing career makes her not want to try but she still wants her approval and feels very vulnerable around her as she makes her feel down and not good enough when they speak. She gets upset every time she calls her and feels quite depressed and a little sick.

She can only eat plain foods as anything too rich upsets her stomach. She often has wind and it can feel ‘stuck’. She feels worse after she eats if she takes a big meal. Her teeth break easily and one has never come through in the front, so she has had them filed to make them match.

She had her appendix removed at age 4. She has vivid dreams often about sex or they can be frightening and violent. She says that every boyfriend that she has ever had, although they have never been aggressive to her, they always get into fights when they go out. Her current boyfriend had had an incredibly violent upbringing. She says that although her mother is quite volatile and scary when angry there was not real violence in her childhood but she remembers being very afraid when she made her mad. She can not understand why she draws people like this to her because she is not like that.

I chose the following rubrics using Murphy:

• Female, Menses, suppressed (pg 673)
• Mind, mild, disposition (pg 1373)
• Mind, humiliation, ailments from (pg1345)
• Dreams, amorous, sexual dreams (pg 451)
• Abdomen, Cutting, pain (pg 12)
• Food, eating, after, agg (pg734)
• Food, fat, food, agg (pg 736)