The Treatment of Benign Uterine Hemorrhage By Irradiation

Abstract

IT is not my intention to advance any new theories as to cause or methods of treatment but to review facts which are already well known. It has been stated by Anspach in the first edition of his work that, “almost every form of benign uterine hemorrhage is favorably influenced by radium treatment.” So far as my own personal experience is concerned, I have found the use of external irradiation by means of the roentgen ray extremely satisfactory and I now rarely use radium, thereby avoiding the surgical procedure necessary for its intra-uterine application. The causes of benign uterine hemorrhage may be classified as follows: 1. Myopathic uterine changes; 2. Glandular hyperplasia of the endometrium; 3. Functional disturbances of the ovary or ductless glands; 4. General diseases of the heart, kidney, liver, circulatory organs, etc. The hemorrhages may threaten life by producing anemia or they may be merely a constant source of annoyance. Irradiation is undoubtedly the treatment of choice in cases of menorrhagia of the menopause associated with fibromyoma. It yields extremely satisfactory results in cases in which the fibromyoma does not exceed in size a four-months pregnancy and in cases of a fibrous uterus in which the possibility of malignancy has been eliminated by the history or by a curettage (1). In cases of hemorrhage at or near the menopause it is considered proper by many radiotherapists to irradiate as for malignancy. Every attempt should be made, however, to eliminate malignancy by a bimanual and visual examination of the cervix, as advocated by Dr. J. Mason Hundley, of Baltimore, making use of Schiller's iodine test and by making a microscopic examination of the scrapings obtained by a careful curettage. I am more and more impressed with the necessity of this procedure. By observing these rules in all cases, disappointment to the patient and embarrassment to the therapist can be avoided. In treating uterine fibromyoma it is immaterial as to whether the tumor is submucous, interstitial, or subserous (2). A pedunculated fibromyoma is not considered suitable for treatment. A degenerating or strangulated fibromyoma should be removed by surgical procedure unless there are very definite contraindications to an operative procedure. Fibromyomas of such dimensions that they extend above the umbilicus, or those causing pressure effects should also be removed surgically. Pelvic infections are a definite contraindication to the use of radium but this statement does not so strictly apply to the use of the roentgen ray. Neill, of Baltimore, is responsible for the statement that 75 per cent of all uterine fibroids are amenable to irradiation therapy, probably meaning radium. This number is increased when the roentgen ray is the therapeutic agent used.