neuroses. 



220 THE SEX-COMPLEX 



Menstrual There is little doubt that apparently normal menstrua- 



tion may give rise to neuroses ; but, as a rule, it is some dis- 

 order of menstruation, especially dysmenorrhcea, which 

 causes what are known as ' functional ' disturbances. 



When normal menstruation causes a neurosis, it is 

 my experience that the neuropathic condition is cyclical 

 and only exists in relation to menstruation, and that 

 it is usually most acute just before and for the first two 

 days of the flow. 



The disturbances most commonly seen are neuralgias 

 in the face and limbs, headaches, giddiness and muscular 

 weakness. Generally, there is some slight psychopathic 

 condition associated with these symptoms. 



With dysmenorrhcea the general pains and muscular 

 weakness may be very great. Menorrhagia may give 

 rise to headaches and occasionally to neuralgias ; fre- 

 quently, however, especially when the patient rests 

 during the period, there may be none of these symptoms, 

 but only great lassitude. This often leads to invalidism, 

 especially in young girls who are petted and spoilt when 

 suffering with menorrhagia at puberty. 



Amenorrhcea itself probably does not give rise to 

 neuroses, although the condition causing the amenorrhcea 

 may do so. 



The etiology of these functional lesions appears to 

 be twofold. Those which occur during apparently 

 normal menstruation, or are associated with dys- 

 menorrhcea, are probably metabolic or < toxic ' in origin, 

 while those which are produced by menorrhagia are due 

 to the effect on the system of the excessive losses of 

 blood. 



The treatment of cases associated with dysmenorrhcea 

 and menorrhagia consists of the cure of the menstrual 

 disorder. When the neurosis accompanies normal 

 menstruation the management of it is more difficult. A 

 careful examination of each case should be carried 

 out — not infrequently the metabolism of calcium and 

 nitrogen is found to be deranged — and the treatment 

 based on scientific grounds. 



