CHAPTER SEVEN ABNORMALITIES OF MENSTRUATION Disorders of Menstruation--Menorrhagia--Metrorrhagia--Amenorrhea-- Vicarious Menstruation--Dysmenorrhea of Organic and of Nervous Origin. In many girls and women menstruation is a perfectly normal, physiological process. They suffer no discomfort whatever from it. They suffer no pains, no headache, no irritability, they have no admonition of its onset, until they feel the blood oozing or trickling out. But, unfortunately, this is true only of a small percentage. The majority of women have some unpleasant symptoms. Some have a headache for a day or two, some complain of a dragging down sensation, some are irritable, feel depressed or quarrelsome; some have no appetite, no ambition, no desire for work or company, while some girls have such severe pains and cramps that they are obliged to go to bed for a day or two and call in medical aid. When the menstruation is very profuse, resembling more a hemorrhage than normal menstruation, it is called _menorrhagia_; if the hemorrhage from the uterus occurs out of the regular menstrual periods, it is called _metrorrhagia_. When the menses are skipped, or when they are so scanty that you can hardly notice any blood, we use the term _amenorrhea_. In a few rare cases the menstruation instead of coming normally from the uterus, comes from some other part of the body, for instance, the nose. Some women have a hemorrhage from the nose every month. In some a bloody discharge may come from the breasts. To such a substitute menstruation we apply the term _vicarious menstruation_. Such cases, however, are rare, and are mere curiosities. =Dysmenorrhea.= I mentioned before that in some girls and women the menses are accompanied by pains and cramps. This affliction, which is the lot of millions of women, and from which men are entirely free, is called _dysmenorrhea_. Dysmenorrhea means painful and difficult menstruation. A slight pain or at least a feeling of discomfort is present in most cases of menstruation. But in many cases the pain is so severe, so _excruciating_, that the sufferer, girl or woman, is incapacitated for any work, and must go to bed for a day or two. In some cases the pain is so severe as to necessitate the use of morphine, and as it is a very bad thing to have to give morphine every three or four weeks, every endeavor should be made to find out the cause of the trouble and to remove it. It is a mistake, however, to think that all or even most cases of dysmenorrhea are due to some local trouble, that is, to an inflammation of the ovaries, or a displacement of the womb. Many cases of dysmenorrhea are of _nervous_ origin; the cause resides in the central nervous system, and not in the genital organs themselves. It is, therefore, not advisable to undertake any local treatment, unless a competent physician has made a thorough examination and has decided that local treatment is advisable.