Definition. Menorrhagia is a too profuse and too protracted menstruation an excessive discharge of blood occurring at the menstrual period; when not coincident in point of time with the menstrual period, it is known as metrorrhagia. The pathology and treatment are the same, so there need be no practical distinction between the two.
Pathology. It must be borne in mind that a flow of blood from the uterus is usually a physiological process, and also that the menstrual discharge is naturally more profuse in some than in others. Therefore the first point to decide is whether or not the discharge is excessive. This is sometimes difficult, as in practice we meet every form and degree of change from the normal individual type. In many cases the state of the general health informs us at once that the discharge is excessive, but this is not always the case. As menorrhagia is itself but a symptom of either functional or organic disease of the uterus, it follows that its pathology is that which characterizes the disease which produces it. However, it must be admitted that a violent menorrhagia may occur without any disease or pathological state being recognizable, the whole difficulty being simply a derangement of function.
Aetiology. The causes my be classified as constitutional and local.
Constitutional causes: Delicate constitution; diseases resulting from mal-nutrition, especially Bright’s disease; tuberculosis; anaemia; purpura; scorbutic conditions; haemorrhagic diathesis; excessive lactation; plethora; mental disturbances; cardiac, hepatic or other visceral disease.
Local causes. Endometritis; metritis; subinvolution; displacements; inversion; submucous and interstitial fibroids; polypi; fungus growths of the endometrium; carcinoma; sarcoma; retained products of conception; lacerated cervix; congestion occurring in ovaries, Fallopian tubes, or pelvic connective tissue or pelvic peritoneum.
We also should consider such predisposing influences as luxurious living; sedentary or unhealthy occupations; over work or over-study; inordinate sexual indulgence; malaria, climate, residents in tropical countries being especially liable.
Menorrhagia may also occur as a sequel to fevers and inflammations, especially exanthemata. Varieties: Menorrhagia may be either (1) functional, (2) sympathetic or (3) organic.
1. Functional. This variety is due solely to functional disturbances, there being simply an increase in the quantity of the discharge or the frequency of its occurrence, or both. It most often arises from plethora, but on the contrary is not infrequently the result of such causes as tend to produce debility and constitutional disease.
2. Sympathetic. By this term is understood those cases that occur in the course of severe forms of general disease, such as Bright ‘s disease, tuberculosis, cardiac or hepatic disease. In such cases menorrhagia is often a critical symptom, frequently serving to exhaust the feeble forces and hasten a fatal termination, on the same principle as a haemorrhages of the nose or bowels.
3. Organic. This terms “includes those cases that occur in connection with and are caused by organic disease of the uterus or its appendages, from simple congestion to fibroid and carcinomatous tumors.”
Symptoms. The subjective symptoms are dependent entirely upon the character of the local or constitutional disease that induces the haemorrhage. The discharge itself may vary considerably in different cases without regard to the primary disease. Sometimes, from month to month, it becomes gradually increased in quantity, until there is considerable haemorrhage at each nisus. Again, the profuse discharge may commence at once, and much blood b lost at each period, and be accompanied b severe pain and the discharge of clots This may be the case and the same time a copious haemorrhage occur during the inter-menstrual interval-metrorrhagia. Or, the discharge may at no time be very excessive, but it is continuous, sometimes alternating with leucorrhoea; this constitutes a variety of metrorrhagia. Or, the case may be one of pure metrorrhagia, the loss of blood occurring suddenly, and not at the menstrual period, and be accompanied by pains in the back, hypogastrium etc.
The character of the discharge also varies, as do the concomitant symptoms. Sometimes the latter become serious, arising from loss of blood, or because the discharge is only a manifestation of some grave disease; but such cases are too numerous to allow of any detailed description.
Diagnosis. It is easy enough to diagnosticate menorrhagia but it sometimes becomes extremely difficult to establish the nature of the disease which is causing it. In every case where the cause is not plainly evident the uterus should be carefully explored, and its appendages systematically examined, in order that any abnormal conditions of these parts may be brought to light.
Prognosis. In functional menorrhagia the prognosis is favourable. In the organic and sympathetic varieties it depends entirely upon our ability to discover and remove the cause.
Treatment. During an attack the patient should be kept at rest in a recumbent posture, the foot of the bed being elevated a few inches. None but cold acidulated drinks should be permitted, and cold applications, especially ice-bags, applied over the hypogastrium.
In all cases to menorrhagia, no matter how violent the haemorrhage may be, the homoeopathic physician will not forget that he has at his command remedies which, if indicated, will often control like magic the most desperate attack.
The remedies most often used during an attack are Ipecac, Belladonna, Aconite, Trillium, Erigeron, Sabina, Cinnamonum, Hamamelis, Ferrum, Sulphuric acid. Not less important are the means which must be adopted to accomplish a radical cure. These depend largely upon the cause, which it must be our endeavour to remove. Constitutional defects must be combated by the indicated remedy and such hygienic measures as the nature of the case suggests. If the blood be impoverished, attention must be paid to the patient’s habits of life. She should have nourishing food, plenty of fresh air and sunlight, and moderate exercise. A sea-voyage is often of great benefit, and frequently a change from a warm to a cold climate or from the lowlands to a mountainous region will in itself accomplish a cure. Especially in cases of malarial or tuberculosis origin is a change of climate desirable. Daily cold hip-baths are of great value, or a sponge bath, the skin being thoroughly rubbed with a crash towel. Rest in the recumbent posture should be secured for two or three days before the period, and sexual intercourse be prohibited during that time. The remedies, liable to be called for in constitutional conditions are too numerous to mention in detail. They are chiefly Arsenicum, Calcarea carb., Chininum, Chininum ars., Ferrum., Ferrum phos. Mercurius, Nitric acid, Nux vomica, Silicea, Sulphur Zincum met.
I will mention the chief indications for as few of the remedies most frequently used in menorrhagia.
Belladonna. Especially from plethora. Discharge profuse, bright red and feel hot to the parts;l flushed face, throbbing carotids; hard, full; and bounding pulse; blood sometimes dark red, decomposed and offensive; pressure, uneasiness and weight in uterine region, as if contents of abdomen would protrude through the vulva.
Calcarea Carb. Chronic cases arising from constitutional diseases, scrofula, tuberculosis, etc., especially in women of a leuco-phlegmatic temperament. Feet feel cold and damp; chilly and sensitive to slightest draught of air; also during lactation or at the menopause.
Caulophyllum. Passive haemorrhage from atony of the uterus; especially after abortion or confinement.
Chamomilla. Discharge of clotted blood, which is dark red or black and fetid, accompanied by severe labor-like pains; flow intermittent and irregular; sensitive, to pain; peevish and irritable; attacks of faintness.
Chininum. From atony of the uterus; ringing in ears, fainting, cold, loss of sight, blood dark and clotted; uterine spasms; twitches, jerks; wants to be fanned; especially in those who have lost much blood.
Cinnamonum. Very profuse flow of bright red blood. Dr. Winterburn says: It has always done well in my hands and has several times stopped severe haemorrhages after other apparently well-selected remedies had failed to make on impression.”
Crocus Sat. Menorrhagia of dark, stingy, tenacious blood, coming away in long black string; sensation of something alive in the abdomen. Dr. Winterburn says he has never been able to verify the last symptom, which is according to my own experience. He especially recommends Crocus in functional menorrhagia occurring in young unmarried women.
Cyclamen. Blood black and clotted; dizziness, stupefaction, and obscuration of vision, as if a fog were before the eyes.
Erigeron Can. Profuse and alarming haemorrhage of bright red blood; every movement of the patient increase the flow; pallor and weakness in consequence of the discharge; frequent and urgent desire to urinate and spasmodic pelvic pains.
Ferrum. Haemorrhage from the uterus, with labor-like pains in abdomen, and glowing heat in the face; blood light or lumpy, coagulates easily; flow generally delayed and frequently intermittent, comes hours, returns, again causes, but returns, and so on. Women who, though weak and nervous, have a very red face; in delicate chlorotic women.
Hamamelis: Active haemorrhage; blood bright red, or, passive flow of venous blood; no uterine pains. According to Winterburn this remedy is useful in those passive haemorrhages, without much pain, in patients who suffer from varicoses, and who belong to the class of easy bleeders.
Helonias. Atonic and passive menorrhagia; very profuse flow at every period, so that her strength is exhausted, and she suffers from debility; swallow and pale complexion, menorrhagia from ulcerated os or cervix, the blood being dark and bad smelling and continuing a long while; the flow is increased by the least exertion.
Ipecacuanha. Blood bright red, profuse clotted; nausea, breathing heavy, oppressed; stitches from navel to uterus. This remedy is more often used than any other in uterine haemorrhages, but is seldom useful unless there is constant nausea. Winterburn says: “If the haemorrhage is very severe, and it seems desirable to stop it at once. I give Ipecacuanha, unless some other remedy is characteristically indicated.”
Millefolium. Haemorrhage of bright red and fluid blood; uterine haemorrhages after great exertion; with congestive headache.
Nitric Acid. This remedy is not often used in menorrhagia, but Dr. Ludlum recommends it highly in cases of supervening abortion or during the menopause where there is a passive, irregular, flow, and other remedies have tailed. There is a loss of appetite, headache, malaise, and a series of symptoms that are chargeable to the continual drain upon her physical resources. She cannot sit upright or stand erect but the difficulty is increased.
Nux Vomica. Especially suitable to women of irascible temperament; fiery and easily excited, and to those who suffer from mental over-exertion, sedentary habits, excess of coffee- drinking or stimulants, or from too much rich food; flow dark, thick and coagulated; preceded by contractive uterine spasms.
Platinum. Flow dark and clotted, with much bearing down and drawing pains in abdomen; sensation as if she were growing large,r and feels that everything about her is small and inferior; hysteria; great sexual excitement, but shrinks from an embrace because the organs so painfully sensitive; organic menorrhagia, accompanying carcinoma, fibroids, etc.
Sabina. This is one of our most frequently used remedies in uterine haemorrhages; the flow occurs in paroxysms; worse from motion, blood dark and clotted, sometimes offensive. The chief characteristic is a drawing pain from the back through to the pain. I once cured the most desperate case of menorrhagia that ever came within my knowledge, of over twenty years’ standing, with this drug, my attention being called to it by the fact that the patient could not endure the sound of music. Dr. Winterburn says: “The pathological condition calling for Sabina is hyperaemia of the uterus; and the nearer this approaches the inflammatory stage, the more likely is this remedy to be of service.” This is true, yet, nevertheless, Sabina will often cure long standing cases resulting from atony, and, on the other hand, also menorrhagia from plethora. Lilienthal says “plethoric women with habitual menorrhagia.” In some respects the remedy is similar to Belladonna, but the symptoms will readily differentiate. Secale Cor. Discharge black, fluid and very fetid; worse from the slightest motion; strong, spasmodic, expulsive pains in the uterus; especially in feeble, cachectic, dyscratic women.
Trillium. Active or passive haemorrhage; gushing of bright red blood at least movement; later blood pale, from anaemia; sometimes blood dark, thick and clotted; pain in back and cold limbs; flow returns every two weeks; at menopause; after exhaustion from exercise.
Ustilago Maidis: From atony of the uterus; blood dark and clotted; aching distress in uterus; slow and persistent oozing of dark blood, with small black coagula; the finger upon being withdrawn from the vagina is covered with dark semifluid (but not watery) blood, as though partial disorganization had taken place; uterus enlarged, cervix tumefied, os dilated, swollen, and flabby; perfect inertia of the uterus (Lilienthal).
Zincum. Dr. Winterburn says of this remedy: “It has this singular characteristic, that although the flow is abnormal in frequency and quantity, she feels perfectly well as soon as it sets in and as long as it continues. Before menstruation she is in constant pain in the small of her back, especially about the last lumbar vertebra; worse when sitting, better when walking, and relieved by pressure. Her restlessness is peculiar. She cannot keep her feet still, and she suffers from a variety of hysteric complaints. These conditions all return after menstruation, and with them an irresistible sexual desire, caused by vulvar pruritus. Zincum vies with Hamamelis in the varicose diathesis, Varices on the genitals, legs and elsewhere are the source of the eroticism and of much of her pain; hence the relief from a free catamenial discharge. Zincum cures the varicosis and restores the functional operations of the womb to pristine rectitude”.