Symptoms of Menstruation.—After menstruation is established there should be no actual pain at each period. There are, however, certain undefined feelings,—premonitory symptoms,—which may be explained in the following terms:—A day or two before the date on which the menstruation is expected, the girl will appreciate that "her sickness" is coming. She will not, or should not, complain of pain, but will state that she has a bearing down feeling, is a little more nervous than usual, has no desire to go into company, and wants to be more or less her own entertainer. The "sick" period usually lasts four or five days. The second day is the most important.
Menstruation Should Not be Accompanied With Pain.—If any actual pain accompanies menstruation, either before or after it is established, the mother should at once take the daughter to the family physician. Menstruation is a natural, physiological act and should not be accompanied with actual distress or pain. It is astonishing how many mothers will allow their daughters to suffer needlessly, for months and years, because of the mistaken idea that "since the pain is there, it must be," or because she—the mother—suffered, so also must the daughter suffer. There is no more unfortunate mistake, and many a girl's health and happiness has been blasted because of this misbelief. The cause of the pain is, in a vast majority of the cases, a very simple one, and can be removed in a very brief time.
Should the menstrual period last too long, be too frequent, or be in any way not what it should be, consult your physician. If you are not sure of "what it should be," or if you have any doubt, ask your doctor. Don't let any false pride or feeling of modesty on your part, or on the part of your daughter, dictate your policy under such circumstances. Don't take the advice of your friends or neighbors in a matter so vital. It is too important, and they are not qualified to "guess" any more than you are. Don't, if you have any respect for yourself, or love for your child, begin dosing her with the advertised patent medicines and "Female Regulators" for which so much is claimed, and which seem to "just suit" your daughter's case at this particular time. Take her to the doctor, whose advice you value (or you should not have him as a family physician), who has no interest at stake except to help you and your child, and whose fee is no more than the price of one of these bottles of advertised poison. He is the only one qualified to speak with authority on such a momentous subject, and you will never spend a dollar to better advantage. Warn your daughter not to speak about "her sickness" to other girls.
Especial attention should be paid to cleanliness during this period. The mistaken idea that bathing of any kind at this time may have disastrous consequences is responsible for much of this neglect. If proper care is taken warm sponge baths, in a warm room, will not cause any trouble. Unpleasant odors can be avoided by sponging the parts with a warm solution, into which a mild antiseptic is put, upon changing the cloths.
Leucorrhea in Girls.—It has been stated above that a displaced womb may cause leucorrhea or a discharge. It must be remembered that leucorrhea, or "whites," may occur in girls as well as in married women. It can also result from catching cold during the menstrual period. Another mistaken idea is that girls should not take douches for fear of injuring the hymen. This is erroneous, and while they are entirely unnecessary in a vast majority of cases it is sometimes absolutely essential to douche in order to cure leucorrhea. When they are given, it is advisable to use the small nozzle that comes with every douche bag set.
Constipation and Displaced Wombs.—When the picture is fresh in the mind of the girl, of how the womb is held upright in her body, the mother should speak to her about the serious results that may occur from constipation. If the rectum is full of hardened feces the womb will be pushed out of place, and if under these circumstances straining is necessary to empty the bowel, and if this condition is habitual, constipation may be the actual cause of displacement of the womb.
Dress and Menstruation.—It is also an opportune time to demonstrate to what extent serious results may follow mistakes in dressing. The habit of permitting growing girls to constrict the waist, to bind and pull the abdomen by too tight garters, or too tight corset, is wrong, and no mother should permit it. In another part of the book, this matter is taken up more fully, but if it is explained to the girl while she is considering the subject of menstruation, she may more quickly and more fully appreciate its significance.
Absence of Menstruation—Amenorrhea.—The absence of menstruation after it has been established, does not, as a rule, indicate any disease of the womb or female sexual organs. It is to be regarded merely as a symptom and can be, as previously stated, safely ignored if the general health is good. If the general condition is poor, and the quantity and quality of the blood deficient, it is a provision of nature to suppress menstruation in the interest of the general health. For this reason it is safe to disregard the amenorrhea and build up the bodily strength. This explains why some girls pass the usual age of puberty and show no signs of menstruating. They are poorly developed sexually, through deficiency of blood. If, on the other hand, a girl should have all the symptoms of menstruation every month, but no flow, she should be examined by a physician to determine if there is any obstruction to the escape of blood. Total absence of any symptoms of menstruation extending into adult life, may indicate an absence of the sexual organs. During the first year after puberty it is quite natural for menstruation to be irregular; after the function is thoroughly established there are many causes that may be responsible for its temporary absence.
Causes of Amenorrhea.—Any condition or circumstance which reduces the general health or impoverishes the quality or quantity of the blood and weakens the nervous system, will result in a stoppage of the monthly periods. Among these are insufficient food and exercise, overwork, overstudy, exposure to cold, sitting on cold steps or gold ground, wearing damp clothes, bathing in cold water at the beginning of menstruation, powerful emotions, as great fright, anger, anxiety; acute diseases, such as typhoid fever, cholera, the infectious skin diseases; chronic diseases such as Bright's disease, heart disease, consumption; anemia and chlorosis are very common causes. Obesity or an overfat condition will cause an early suppression of the menses which may result in a fruitless marriage. Displacement of the womb and other local disorders frequently result in scanty or delayed menstruation. Anxiety lest pregnancy may occur in the newly married may cause a delay in the periods. A radical change of climate or sometimes a visit to the country, or changed circumstances may stop the flow for the time being.
Treatment.—The treatment of amenorrhea, or absence of menstruation, will depend on the underlying cause. A careful investigation should be made into the mode of life and the hygienic surroundings of the patient. Her general health and her mental condition should be inquired into. If the patient is not in good health, or is not obtaining exercise in the open air, or if she is a victim of mental worry or of domestic unhappiness, or if any sufficient cause exists for the amenorrhea it must be removed before any treatment may be expected to relieve the condition. If the patient is a married woman the possibility of pregnancy should always be borne in mind, and no radical treatment instituted until this has been excluded. If the absence of menstruation is dependent upon defective development of the sexual organs we cannot expect much from any treatment. The amenorrhea from exhaustive diseases will usually correct itself with, or soon after, the establishment of convalescence. In diseases which tend to death, as in consumption, heart disease, etc., the function is never reestablished. A very common habit of most people is to regard the absence of the monthly periods as the cause of their ill health. It is not, it is the result of the ill health. Get rid of the bad health and the menses will take care of themselves. That form of amenorrhea which is the result of change of climate or surroundings will regulate itself as soon as the victim becomes acclimated or reconciled to the change, or returns home if the visit is of brief duration.