In any case the cure is always hastened by thorough curetting of the uterus. This operation should always be performed when the woman is etherized for the relief of any other condition, as a laceration of the cervix or of the perineum.
The cure of subinvolution depends a great deal upon the time that has elapsed from the inception of the condition to the institution of treatment. The secondary changes in the endometrium and body of the uterus resulting from chronic congestion and inflammation in time becomes so established that the disease will not yield to any treatment, even though the primary cause of the trouble may be cured.
In obstinate chronic cases of subinvolution of the uterus amputation of the cervix sometimes has a most marked effect, and this operation should always be resorted to whenever the disease has resisted the milder treatment already prescribed. Amputation of the cervix is sometimes followed by a transformation of all the tissues of the uterus similar to that occurring in normal involution after labor, and a striking diminution in the size of the uterine body takes place. The amputation of the cervix should always be accompanied by a thorough curetting. Sometimes the change in the body of the uterus is so marked after amputation of the cervix, or even after trachelorrhaphy, that a condition of superinvolution, or uterine atrophy, results.
SUPERINVOLUTION OF THE UTERUS.
Superinvolution of the uterus is a disease the reverse of subinvolution. In this condition the uterus, after childbirth or abortion, not only undergoes the normal involution, but continues to atrophy until the length of the uterine cavity may measure but one and a half inches. The atrophy involves the neck as well as the body of the organ, the Fallopian tubes, and sometimes the ovaries.
Superinvolution of the uterus is a rare condition. The cause is difficult to determine. It has been attributed to great loss of blood at confinement, to prolonged lactation, and to pelvic peritonitis occurring during the puerperium.
Amenorrhea is the most marked symptom of superinvolution. Nervous disturbances and hysterical symptoms may also be present.
The diagnosis is easily made from the history of the case and by means of bimanual examination and the use of the sound. Congenital malformation may be excluded from the fact that a pregnancy has occurred, and senile atrophy from a consideration of the age and history of the woman. The treatment should be directed to restoring and maintaining the general health of the woman.
Iron and the remedies useful in other forms of amenorrhea may be of advantage.