An Investigation Into the Causes of Delayed Menstruation and Its Treatment in the Women's Auxiliary Air Force

1. A modification of a present classification of amenorrhoea is suggested - on a clinico-pathological basis, rather than on the time of onset of amenorrhoea. 2. A short historical review of delayed menstruation, or, Kriegsamenorrhoe, as it was then called by the German workers, is then given. The general consensus of opinion in German medical circles up to about 1928 was that the causes of Kriegsamenorrhoe in the order of their importance are: (1) Protein deficiency in the diet. (2) Increased work. (3) Psychical and emotional stress. 3. The incidence of delayed menstruation, on entry to service, in 2,312 airwomen between 1939 and 1943 is tabulated. 4. The relationship between delayed menstruation and occupation was investigated, and it was found that the greatest number of cases occurred in those with a sedentary occupation. 5. The diets of a number of stations with cases of delayed menstruation were examined and no protein deficiency was found. 6. 150 normal girls were weighed, and over 90% had put on weight since entry to service, but airwomen with amenorrhoea put on more weight than would be expected in the average normal girl. 7. Four cases of delayed menstruation were treated with carbaminocholine chloride and two of the cases menstruated in 17 and 96 hours, one menstruated in 35 days, and one menstruated with a placebo. No definite conclusions can be drawn, owing to the small number of cases treated, but it appears that carbaminocholine is a useful form of therapy and is worthy of further clinical trial. 8. Two normal controls were unaffected by treatment with carbaminocholine chloride. 9. Three cases of pregnancy were treated with carbaminocholine chloride, a total of 9 to 12 tablets (0.018 -0.024 gm. active drug) in each case was administered. No disturbance of pregnancy occurred. As a test for pregnancy, however, carbaminocholine cannot be regarded as efficient as the Zondek-Aschheim test owing to the number of cases of delayed menstruation in whom precipitation of the period does not occur in spite of treatment. 10. The control of the menstrual cycle and the probable mechanism of production of delay is discussed. It Is suggested that rhythmic impulses, either neural or neuro-humoral, from the hypothalamus stimulate the anterior pituitary gland to produce its gonadotropic hormones rhythmically, thus effecting a definite rhythm in the menstrual cycle. Disturbance of the rhythm or delay in onset of the bleeding phase can be caused by a change of environment, which affects hypothalamus and disturbs the balance of adrenalin to acetyl choline in the circulation. This brings about a relative deficiency of acetyl choline. Re-establishment of the menstrual cycle can occur by replacing the acetyl choline content of the body