Menorrhagia

MENORRHAGIA (from Greek *men* month and *rhegnymi* I break), strong menstrual bleeding. Menorrhagia corresponds in time to menstruation but differs from normal menstruation either by excessive blood loss (hypermenorrhoea) or, besides large blood loss, by a significant prolongation of the duration of menstrual bleeding accompanied by a shortening of the intermenstrual intervals (polymenorrhoea). Menorrhagia can occur in various diseases of the female genital organs (fibroids, carcinoma, inflammatory changes of the tubes and ovaries, parametritis, perimetritis, polypoid growths of the endometrium, changes in the position of the uterus, etc.), as well as in diseases of other organs and of the whole organism in general. In menorrhagia, no definite anatomical changes are usually found either in the ovary or in the endometrium. The former teaching of Ruge and Gebhard, which explained menorrhagia by endometritis and in particular by its so-called glandular-hyperplastic form, has been refuted by the works of Hitschmann and Adler, who proved that all changes in the uterine mucosa in menorrhagia represent a part of a completely normal menstrual cycle (they belong to the premenstrual period). Menorrhagia is often caused by various functional disorders in the activity of the ovaries (most often improper maturation of egg cells—disorders of ovulation); as a result, frequent menstruations. Menorrhagia apparently also depends on muscular (anatomical or functional) insufficiency of the uterus and on underdevelopment of the whole organism (constitutional anomalies, general or sexual infantilism, asthenia); as a result, profuse menstruations. Schroder considers the immediate causes of menorrhagia to be atony of the uterine musculature, fluctuations in the blood filling of the pelvic organs, and disorders in the activity of the ovaries. Disturbance of the contractile capacity of the uterine musculature may depend on fibroids, improper positions and prolapse of the uterus, exhaustion of the uterine musculature as a result of frequent repeated childbirths, weakness of the uterine musculature in connection with inflammatory changes in it itself or in neighboring tissues; the latter leads, among other things, to immobilization of the uterus with a subsequent sharp lowering of the ability to contract. In addition, causes of menorrhagia are also considered to be disturbances in the blood filling of the pelvic organs: active hyperemia of ovarian origin, inflammatory hyperemia, hyperemia on the basis of excessive sexual excesses, coitus interruptus, masturbation; then passive hyperemia in the small pelvis of cardiac, pulmonary, renal origin; hypertension of the vessels; varicose dilatation of veins in the pelvic connective tissue; chronic stasis in the organs of the small pelvis; disturbance in the distribution of blood of psychogenic origin. Menorrhagia occurs in the so-called thrombopenic purpura, in chronic intoxications, and in disorders of the function of various endocrine glands that are in a correlational connection with the ovaries. Menorrhagia can also be observed in some chronic occupational diseases (e.g., lead, benzene). Usually menorrhagia is limited to known limits, i.e., the anemia that occurs is relatively easily and quickly corrected. Sometimes, however, menorrhagia takes on a protracted, very long, and completely atypical character (see Uterus, uterine hemorrhages). When approaching the study of menorrhagia, it is necessary in each individual case to establish the etiological factors as thoroughly as possible. Often it is sufficient already for preventive measures, i.e., the elimination of various harmful influences that can cause an intensification of menstruations, such as excessive or early physical labor, an inappropriate way of life during menstruations, prolonged constipation, etc. Treatment of menorrhagia is very difficult and prolonged. General strengthening treatment, good nutrition, care, sensible physical culture (with great caution), climate treatment are necessary; internally—iron preparations (see Amenorrhea). Where the cause of menorrhagia lies in one or another insufficiency of the endocrine glands, organ preparations are recommended: Pituglandol, Ovoglandol, Glanduitrin (no. 1 daily), thyroidin, etc., injections of adrenaline (0.0007 g every three days, about 6–10 times). For insufficiency of the uterine musculature—contractile agents: Secale, Secacornin, Ergotin, Ergotamin, Tenosin (all these agents can be applied per os and in the form of intramuscular injections), then Extr. Ilydrastis, Hydrastininum (0.01–0.02), Stypticin (3 times a day 0.05 in tablets). Opitz recommends, especially for prolonged use, a mixture of Secacornini 10.0, Stypticini 0.5, Natr. salicylici 2.0, Aquae dest. ad 25.0 three times a day 10–20 drops. The action of all these preparations is not prolonged. As thermal irritation, hot douches in 45–48° from 1–2 liters of water (in the intermenstrual period) are applied. However, they should not be widely recommended because of the danger of introducing infection. Surgical treatment of menorrhagia. Previously, scraping of the mucosa of the uterine cavity was widely practiced. After the works of Hitschmann and Adler, this method was abandoned. Schroder recommends abrasio in hypoplasia of the genital apparatus, considering that injury and the associated regenerative hyperemia stimulate the activity of the ovaries. In cases of menorrhagia with a sharp deterioration of the general condition, it is sometimes necessary to resort to high amputation of the uterus. In such cases, it is recommended for relatively young women to leave as much of the uterine mucosa as possible so that it can participate in the menstrual cycle. Treatment of menorrhagia with X-ray rays has received wide application in recent years. X-ray therapy is especially recommended in the pre- and climacteric age. Some recommend X-ray therapy for menorrhagia in patients younger than 40 years. In these cases, however, strict indications and the most careful conduct of treatment in terms of dosage are necessary. The dose used in menorrhagia for elderly women is the usual castrative dose (up to 35% HED for the most resistant ovary). In dosage, all individual peculiarities of the case must be taken into account (age, thickness of the abdominal wall, character of bleeding, degree of anemia, and some others). Stephan and Vogt proposed in menorrhagia the irradiation of the spleen with a small dose. The irritating action of X-ray rays on the spleen manifests itself in an increase in the functional activity of reticular cells, which in turn leads to an increase in the coagulability of the blood. Eufinger explains the effect obtained in this way by the hormonal connection between the spleen and the ovary. The dose usually applied to the skin in the area of the spleen corresponds to 4 HED. The effect is rapid but mostly of short duration. Lit.: Konstantinov V., On the question of essential thrombopenia as a source of uterine hemorrhages, J. Akut. i Zhensk. Bol., 1928, No. 5; Snezhirev V., Uterine hemorrhages, M., 1900; Neun, "Uber die Ursachen der zu starken u. zu haufigen Regelblutungen, Munch. med. Wochenschr., 1925, p. 186; Hotting R. u. Mikulicz-Radecki F., Milzbestrahlung als Therapie gynakologischer Blutungen, Zentralbl. f. Gynak., 1925, No. 9; Nurnberger L., Milzbestrahlungen bei gynakologischen Blutungen, ibid., 1923, No. 1; Rieck A., Zur Therapie ubermassig starker menstrueller Blutungen, Deutsche med. Wochenschr., 1913, p. 653 u. 878. See also the corresponding chapters of the main handbooks listed at the end of the article Gynecology.

A. Kantan.