A Text-book of Diseases of Women

by Charles B. Penrose

The length of time during which it is advisable to keep the woman in bed depends upon the extent and nature of the disease for which the curetting has been done. As a general rule, the longer the stay in bed the better it is for the woman. If the uterus is much enlarged or if subinvolution is present, the patient should stay in bed for two weeks. Such rest in the recumbent position diminishes the congestion of the pelvic organs and is of great aid in restoring the parts to a normal condition. Careful attention should be paid to the regularity of the bowels. Mild purgation with saline purgatives should be continued during the convalescence. Daily massage, started two or three days after the operation, will facilitate the cure.

All the endometritial structures are never completely removed by the curette. The distal ends of the utricular glands, which penetrate the muscular coat of the uterus (see [Fig. 123]), remain after thorough and vigorous curetting.

After removing the endometrium with the curette the cavity of the uterus does not become lined with a cicatricial membrane, but a new endometrium is produced. It is probable that the new membrane is developed from the remains of the utricular glands. The new endometrium grows in a very short time. In some cases it has been sufficiently well formed to permit pregnancy five weeks after curetting.

The first menstrual period, and sometimes the second and third, after the operation of curetting may be missed. As a general rule, the menstrual bleeding is much less profuse than before the operation.

The therapeutic object of curetting for endometritis is to replace the diseased endometrium by a new membrane which has grown under conditions of rest and asepsis.

EXFOLIATIVE ENDOMETRITIS, OR MEMBRANOUS DYSMENORRHEA.

There is a disease which has been called membranous dysmenorrhea or exfoliative endometritis, in which large membranous pieces of the endometrium or a cast of the whole structure is thrown off at the menstrual period (see [Fig. 124]). The condition is most often found in virgins or sterile women. The membrane may be thrown off at every menstrual period, or at periods separated by intervals of various length.

Fig. 124.—Membrane discharged in membranous dysmenorrhea.

The menstrual period is usually accompanied by intense uterine pain, which may resemble labor-pain, and which persists until the separation of the endometrium. In some cases of this disease menstruation is very irregular.