186 



THE SEX-COMPLEX 



Thyroid 

 insufficiency 

 and anieno- 

 rrhcea. 



Myxoedema 

 and meno- 

 rrbagia. 



Minor 

 degrees of 

 thyroid 

 insufficiency 



Mastidynia 

 with thyroid 

 insufficiency. 



to occur in the uteri of animals from which the thyroid 

 has been removed, but that the ovaries do not undergo 

 hypoplasia. 



Apparently in the human subject atrophy of the 

 uterus is never complete with pathological insufficiency 

 of the thyroid not even with myxcedema, for patients 

 who have suffered with this disease for some years have 

 been known not only to menstruate, but also to con- 

 ceive after treatment with thyroid extract. 



Paradoxically, as it appears, menorrhagia is stated by 

 certain writers (Allen Starr, 1 Ewald 2 , Hertoghe 3 and 

 others) to occur as the direct result of myxcedema, and 

 to be relieved by the administration of thyroid extract. 

 Of all the cases of thyroid insufficiency I have myself 

 seen, and the number is very large, I have never 

 encountered menorrhagia which could be attributed to 

 the thyroid lesion. I have, however, in such cases seen 

 menorrhagia which could be traced to other causes, such 

 as uterine polyps. 



It is, however, chiefly the disturbances arising from 

 minor degrees of thyroid insufficiency which come under 

 the notice of gynsecologists. Delayed puberty and 

 menstruation have already been discussed. Secondary 

 amenorrhcea and scanty menstruation, the latter also 

 associated with dysmenorrhcea, are very frequently 

 seen with thyroid insufficiency ; and the patients are 

 usually obese, lack energy, and have deficient sexuality. 

 As a rule, the administration of thyroid extract entirely 

 cures all these disabilities. 



There is another menstrual disturbance of interest in 

 this connexion namely, mastidynia, which sometimes 

 occurs regularly each month before the onset of menstrua- 

 tion. Usually the menstrual cycle is protracted beyond 

 30 days in these cases. If, however, a ' period ' occur 

 earlier than usual, the patient does not suffer with the 



1 Starr, Allen, Med. Record, 1893, voL xliii, p. 168. 



2 Kirk, R., Lancet, 1893, vol. ii, p. 743. 



3 Hertoghe, !&., Practitioner (Spec. Number on Internal Secretions), 

 1915, p. 26. 



