There are two distinct classes of Amenorrhoea; one where the catamenia have never appeared, and the other where they have continued regular for some time, and then ceased.

In retention of the menses, where their appearance is delayed beyond the proper age, the countenance generally presents a sickly appearance; the appetite is variable, and there is often nausea, great debility and lassitude, and sensation of fatigue even after the slightest exertion. Palpitation of the heart, headache, consumption, derangement of the stomach, pains in the small of the back, head, limbs and side, and hysteric symptoms may also be present; haemorrhages may also take place in different organs. Not unfrequently the mind sympathises with the disturbance; the temper may be irritable, or there may be a sad, weeping, or desponding mood.

Suppression of the menses, may be of two kinds, acute and chronic. The acute form may arise from cold caught by wet feet dnring the time of menstruating; from a bodily or mental shock received, either just previous to or during the menstrual flow; from mental distress, or the depressing passions; from fever, or any serious disease setting in at that time.

In some cases no ill effects follow for some time this sudden suppression, but more generally a degree of fever arises, with headache, hot skin, quick pulse, thirst, nausea, etc.; or the patient may be attacked by local inflammations either of the brain, lungs, intestinal canal, or of the womb itself.

Chronic suppression may be the issue of an acute attack, or it may arise from the gradual supervention of delicate health from disease of the ovaries, uterus, or other parts. The time may become irregular, and the quantity gradually diminish until it ceases entirely. More frequently, however, the menses are gradually supplanted by a white discharge, until in time, the leucor-rhcea becomes permanently established.

Some of the prominent causes of amenorrhcea we have already enumerated. It may arise, however, from congenital deformity, but here the skill of the surgeon will be required.

Treatment

Pulsatilla is especially adapted to females of a mild and easy disposition, and particularly when it arises from taking cold, from violent passions and emotions, and in partial obstruction, accompanied with hysteric and dyspeptic symptoms. The prominent symptoms are languor; pain across the small of the back and in the lower part of the abdomen; palpitation of the heart, loss of appetite, nausea and vomiting; sensation of fullness in the head and eyes, and disposition to general coldness; alternate crying and laughter, or sadness and melancholy. The symptoms are generally worse in the afternoon, and may change from one place to another.

Dose

Dissolve two drops, or twelve globules in a glass half full of water and take a tablespoonful every six hours.

Cocculus

Great derangement of the nervous system, pinching and contracting pain in the lower part of the abdomen; also a scanty discharge of black blood, or when the patient is very weak, with agitation, sighing, groaning, etc.

Dose

Same as Pulsatilla.

Cuprum

A valuable remedy, in cases of spasms, with nausea and vomiting, or where cramps in the extremities are present.

Dose

Same as Pulsatilla.

Phosphorus

In persons of delicate constitutions and weak chest, and where, in place of menstruation, expectoration of blood occurs in small quantities, with hacking cough, and pain in the chest.

Dose

A powder, or six globules every second day.

Arsenicum

Great prostration; swelling of the feet, ankles or face, especially around the eyes, with paleness of the face.

Dose

A powder, or six globules, once in twelve or twenty-four hours.

Sulphur

After Pulsatilla, and also after other of the above remedies, when they seem indicated yet prove insufficient.

Dose

A powder, or six globules, every night

Bryonia will prove of benefit, where the suppression is attended with swimming or heaviness, or pressure in the head; pains in the chest, or in the small of the back, dry cough, bleeding at the nose, and constipation.

Dose

Two drops, or eight globules, in a tumbler of water, a tablespoonful once in six or twelve hours; or three globules on the tongue at the same intervals.

Sepia

Sallow complexion: nervous headache and debility; giddiness, toothache, melancholy and sadness; pain in the limbs, as if they were bruised; frequent colic and pain in the loins.

Dose

A powder, or six globules, once in six or twelve hours.

Ferrum and China are the prominent remedies where there is constitutional debility, seen in the sickly complexion, emaciation, pain in the chest, back, limbs, and loins, palpitation of the heart, debility, languor, derangement of digestion, and often leucorrhcea.

The remedy may be given every night or every other night.

Aconite may be alternated with Bryonia where there has been a sudden suppression of the menses, producing congestion to the head or chest, with throbbing and acute pains.

Dose

Two drops, or eight globules, may be mixed with a tumbler of water, and a tablespoonful given once in one or two hours.

Besides the above remedies, we may enumerate Belladonna, Veratrum, Calcarea, Graphitis Conium.

Diet And Regimen

Exercise in the open air is of importance. The diet should be simple yet nourishing. Warm foot-baths may be used, or a tepid sitz-bath. Great care should be taken to avoid the causes which might produce the disease.