The time of the beginning of the menstrual period varies according to climate, race, condition of health, and temperament. In the tropical countries, menstruation begins from the tenth to the fourteenth year; in temperate countries, from the thirteenth to the sixteenth; in cold countries, from the fifteenth to the twentieth year. The Italian, Hebrew, Spanish, or French girl is apt to menstruate earlier than the English, German, or Swedish girl. The Negro girl menstruates early, as a rule. The full-blooded girl usually menstruates earlier than the anemic one.
Normally, menstruation should proceed naturally and without pain or suffering. When pain or suffering is experienced in connection with menstruation, it is simply because of some lack of health in the general system; and when such general health is restored, the trouble ceases. Painful menstruation is called "dysmenorrhea," and arises from several causes, principal among which are the following: Errors in diet, errors in dress, undue exposure, constipation, lack of proper exercise, or to a contracted or congested condition of the Uterus or the Fallopian Tubes. The pain, however, cannot be considered as a feature of normal menstruation, for the latter is no more painful than a normal movement of the bowels—the painful condition results from abnormal conditions, the removal of these conditions resulting in the cure of the complaint.
Dysmenorrhea should be treated by the discarding of all unhygienic clothing, tight shoes, etc., and their replacement by rational clothing; the dietary should be carefully scanned, and improper articles replaced by nourishing elements of food—discard the pastries, pickles, confections, and stimulants, and substitute sensible articles of diet; if constipation is present, remove it by eating articles of food which promote free movements of the bowels, and drink more water each day; take a proper amount of exercise—housework is as good a form of exercise as any; many authorities advocate the free drinking of water prior to and during the menstrual period—some going so far as to say that where there is painful menstruation there is always a lack of a proper amount of water taken into the system. In some cases Dysmenorrhea is due to disorders of the general nervous system, and treatment therefore should be sought at the hands of a capable physician.
Amenorrhea, another disorder arising in connection with the menstrual process, consists of the retention or suppression of the menses, or of "scanty" menses, or occasional "skipping" of the periods. This condition is apt to be manifest in cases of extreme obesity or "fatness;" the nervous system being burdened with superfluous flesh, its menstrual rhythm is often affected. Suppression of the menses also sometimes results from exposure and disturbing mental emotions. The most approved treatment is that of remedying the abnormal general physical condition, proper diet, and the use of hot drinks, hot sitz baths, and hot enemas about the time of the beginning of the normal period.
Menorrhagia, another menstrual-period disorder, consists of very profuse flowing—it is, in fact, a mild form of hemorrhage. It usually arises from general debility, shocks, too violent exercise or labor, and also in many cases from undue and too frequent sexual intercourse. Sometimes the excessive flow occurs during the regular menstrual period, while in other cases it may manifest itself out of season—sometimes as often as two or three times a month. The duration of the normal period of menstrual flow, however, varies greatly among different women; the normal period may be said to last from two to six days, so what might be an excessive flow for one woman would be only normal for another—temperament plays a large part in determining the quantity of the menses.
Some of the accompanying symptoms of Menorrhagia, or profuse flow, are lassitude, shortness of breath, faintness, dizziness, headache, irritability and nervousness, and often also leucorrhea between periods. The general treatment consists in measures calculated to bring the general health of the woman back to the normal. The building up of the general system, by means of nourishing food, proper exercise, etc., will almost always result in curing this disorder.
A well-known authority has well said: "The hygiene of menstruation can be expressed in two words: Cleanliness and Rest."
So far as Rest is concerned, the woman need not be urged to take it at this period—that is, if she is able to do so. Care should be taken not to exercise unduly at this time, and under the head of exercise may be included dancing, horseback riding, and automobiling, as well as the more common forms of athletic work.
It would seem that common sense and the general desire for cleanliness and daintiness would cause all women to observe the plain hygienic laws of Cleanliness at the time of the menstrual period. And, indeed, it is probable that such would be the case were it not for the fact that some ancient superstitions still exert their power over the mind of many women, in regard to the use of water during the menstrual period. While it is true that cold baths, or cold-water bathing, are not advisable for the average woman during the menstrual period (although some especially robust women bathe and swim as usual during this period), this prohibition does not apply to the use of warm water during the period. Lukewarm baths are permissible at this time; and the woman should wash the external genital parts with warm water, with soap if desired, every morning and evening of the period. A vaginal douche of lukewarm water is an excellent adjunct to the bathing of the parts.
It is astonishing to meet with the superstitious prejudice existing in the minds of some women concerning the use of the vaginal douche; these good creatures seem to think that it is either unnatural and unhealthy, or else is something "not respectable," and fit only for the use of immoral women. These women should get in touch with modern hygienic methods, and learn to use the douche at least during their menstrual periods. At this time, if the plain rules of cleanliness are not observed, there often occurs a decomposition of the blood which has gathered in or about the genitals, and an offensive odor is manifested. Some women, while feeling distressed about this odor, are afraid to use lukewarm water in washing themselves, owing to some old unexplored superstition handed down from the great-grandmother's time.