Though the disease seems to be of a simple neuralgic character, it is supposed that there is a degree of inflammation of a peculiar kind in the mucous membrane where the plastic lymph is thrown off.
In regard to the duration of the period, the constitutional injury sustained, and as to the relief on the appearance of the menses, the cases vary.
A peculiar irritability of the uterus is a common cause of this form of the disease, but, like amenorrhœa, it may be caused by cold, mental emotion, or local injury from a fall.
In the treatment of this class of cases, to reduce the pain, opium, conium, hyoscyamus, etc., are given, often combined with camphor. (F. 161, 163, 166, 167.) These should be given in the form of an enema, or a suppository, if the stomach is irritable. (F. 160.) The hot hip bath should be employed, the patient remaining in it from thirty-five to forty minutes; an ounce of carbonate of soda may be added to the water. The good effects of the bath may be kept up by the use, immediately afterwards, of a pessary of oxide of zinc and belladonna. (F. 163.) It will be of benefit to take vaginal injections of tepid, or warm, or hot water on the approach of the menses, and the patient should use a pediluvium, or a hip bath, for two or three nights in succession antecedent to the show of the menses. During the interval every effort should be made to strengthen the patient, and to diminish the irritability. Injections of tepid or cold water may be taken daily; the diet should be nourishing, and plenty of exercise in the open air should be taken by the patient. Some preparation of iron should be given, and I have found F. 177 particularly useful.
Congestive dysmenorrhœa, sometimes described as inflammatory dysmenorrhœa, generally comes on at a later time of life than the neuralgic form. It occurs in females of a full habit and of a sanguine temperament; in the married as well as the unmarried, and those that have not borne children.
Restlessness and feverishness, rigors, flushing and headache generally precede the severer symptoms. The sufferings commence, or are generally aggravated four or five days before the period, and it may continue for a week or more. Both before and after the catamenia appear, there is great pain across the back, aching of the limbs, intolerance of light and sound, weariness, the face is flushed, the skin hot, the pulse full and bounding; when the flow gets abundant the pain is mitigated, though there are paroxysms of pain, as small clots and shreds of membrane are thrown off from the uterine cavity. Under the influence of inflammation, the epithelial coat of the uterine cavity and of the vagina is sometimes expelled. In the interim between the periods the cervix uteri is congested and tender, and pain will be excited by pressing the ovaries; usually there is a tenacious leucorrhœal discharge. Frequently the breasts swell and become tender as the period approaches.
In treating this form of dysmenorrhœa, opiates must be used, as in the former variety, to afford some alleviation. Give also saline purgatives, febrifuge medicines, such as aconite, veratrium, and gelsemium; also cooling drinks. During the interval the patient should live plainly, avoid stimulants, and take moderate outdoor exercise. The suppositories (F. 163) may be used steadily. If the disease be associated with a rheumatic diathesis, the appropriate remedy for that should be used. It is in such cases especially that chalybeate mineral water, warm sea water, baths, colchicum, iodide of potassium, with friction and electricity applied directly to the hypogastric region, succeed in restoring health. (F. 103, 165).
Mechanical dysmenorrhœa is that form in which there is some mechanical obstruction to the escape of the menstrual discharge. The causes of the obstruction are various. There may be either a stricture of the internal orifice of the uterus, or a narrowing of the whole canal of the cervix, or the external os uteri may be small and contracted, or some tumor may interfere with the patency of the cervical canal, and there may be retroflexion or antiflexion of the uterus.
In these cases there is more or less violent expulsive pain coming on in paroxysms, and there is usually a scanty flow. Often the discharge escapes in gushes, each gush being preceded by a bearing down effort, and accompanied by an expulsive pain. There are attacks of nausea, restlessness and retching, with flatulence; there is always severe headache and congestion, with tenderness of the ovaries; and if there is endometritis, there are some other inflammatory symptoms.
Modern gynecology has various remedies for this class of cases, of which it is not necessary to speak here.