CALCIUM IN THE TREATMENT OF DYSMENORRHEA

RUTH E. BOYNTON, M.D., ~VINNEAPOLIS

AKD
E. C. HARTLEY, M.D., ST. PAUL, NINN.

A GROUP of symptoms occurring in pregnant women has been de-

scribed1 and the explanation for their presence presented as
being apparently due to a deficiency in calcium. In a later paper
the relation of this group of symptoms with other factors, particularly
dysmenorrhea, was described. A definite correlation between the
symptoms and dysmenorrhea was found. It seemed likely that the
indirect relationship thus shown between dysmenorrhea and calcium
deficiency might be direct and definite.
A limited investigation of this possibility was therefore undertaken
at the Students Health Service of the University of Minnesota upon
a group of undergraduates, each of whom had menstrual cramps
severe enough to incapacit,ate her for one or more days each month.
All of the patients were unmarried women, the mean age of the group
being 20.3 years. Menstrual histories revealed no cases of menor-
rhagia, metrorrhagia, or oligomenorrhea.
Forty-nine cases of dysmenorrhea were treated. The therapy con-
sisted of calcium gluconate alone, calcium gluconate with viosterol,
alkaline mixture alone, or calcium gluconate and the alkaline mixture.
Pelvic examinations were made on about one-half of the patients.
Of the 49 patients treated, 33 had either complete relief from ab-
dominal pain, leg cramps, paresthesias, and nausea, or felt that they
were definitely benefited, while 16 had no improvement.
Table I shows the type of therapy used and the findings at the pelvic
examination in the two groups, those benefited by the therapy and t,hose
receiving no benefit.
The calcium was administered in the form of calcium gluconate by
mouth. Sixty grains of calcium gluconate were given daily for ten
to four&en days before the onset of the menstrual period and con-
tinued through the first two days of the period. When viosterol was
given with the calcium gluconate the dosage was thirty drops daily
during the same period.
The alkaline mixture, which was used alone in a few cases and
with calcium gluconate in other cases, consisted of equal parts of
magnesium carbonate and sodium bicarbonate. The dosage used was
*From the Students Health Service and the Departmmt of Obstetrics and Gyne-
cology. University cf Minnesota.
253
254 AMERJOAN JOURNAL OF OBSTETRICS AND GYNECOL0GT

sixty grains three times a clay for ten days befort& the onset, of the
menses. This alkaline rnisture was tried becaustk it had comet to 0111
attention that in one of I-hr leache~x (nlleges in this statr. the school
TAIll>E I
--- ____-.--~_-^
MEDICATICh SO. CASES PELVIC EXA3fINATION NO. CASES
_-_ -- --A-
Cases Bmrflted by Calcium Thernpy
Calcium Gluconate $1 Xegative .i
Calcium Gluconate and Viosterol lfi ! Retroversion 3
Alkaline Mixture R ! Anteflexion fi
Calcium Gluconate and Alkaline Mixture 3 / Cystic ovary 2
-. Not done 17
Total 33 1 -
Total 33
._-I__- ------
Cases Nob Benefited by Calciwtn Therapy
Calcium Gluconate 5 Retroversion .i
Calcium Gluconate and Viosterol !I Anteflexion 1
Alkaline Mixture 2 Not dorw 10
- 1
Total 16 I Total 16
_________ ____... . . -- .__._ _-~~~_._-.._ ..-.--- -.. -... .--- ----

nurse, who suffered from severe dysmenorrhea happened to take an

alkaline mixture, of similar composition, for a gastrointestinal upset
that coincided with her menstrual period. To her surprise, this men-
strual period was painless. The following period she repeated thP
medicat,ion and again was free from pain. She t.hen gave this alkaline
mixture to some of the students who had severe dysmenorrhea with
equally good results. What. the rflect. of magnesium carbonate in
preventing dysmenorrhea may be is unknown. Carswell and Winter
have shown that with adequate phosphorus intake, magnesium appears
to favor calcium storage instead of causing calcium loss.
There seems to be little therapeutic difference with variations of the
drugs. The alkaline mixt.ure was Itsed less frequently than thp Cal-
cium and viosterol, however.
In all of the cases reported, the drug was taken before two or more
menstrual periods.
Each case in this series is considered to be one of essential dysmenor-
rhea in the sense that in no inst.ance, so far as could be determined.
was it an aggravation during the menstrual congestion of the more or
less continued pain from various pelvic disorders, such as salpingitis,
pelvic inflammation, appendicitis. chocolate cysts, etc. Q
Since all cases were apparently alike in being of the essential type, some
factor in the symptoms was sought which might indicate a significant dif-
ference between those patients who were relieved by calcium and those
who were not. With one possible exception, none was found, so that the
distinction between the two groups remains largely a therapeutic one.
 TABLE II. PERCEP;TAGE OF CASES HAVIZVG CERTAIN SYMPTOMS
-L.
BACKACHE BRUISE EASILY LEO CRAMPS NAUSEA TENSE TYPE

NO. PER CENT NO. PER CENT NO. PER CENT NO. PER CENT NO. PER CENT

Cases Improved ---iiT 57.5 2 6.3 13 68.4 2 7.1 13 54.1 2 6.7 13 54.1 f 6.7 16 53.1 ? 6.1
Cases Not Improved 9 56 2 f. 6.3 2 18.1 k 7.8 0 64.2 2 8.6
Differences in Percentages 13 ? 8.85 50.3 2 10.55 5 38.4
15.7 f+ 11.3
9.1 9 ;::i : 1:::: / . 110.9 + 10.54
NOTE: In tabulxtiw the data, some of the items were wjectecl from corkAeration for varioo~ ~aaons. In each case perceotages were rle-
I~VHI for the number of items remaining under each group after elimination of rejected itenls.
 It is apparent, that the symptom of bruising easily is a signifiicant
one, SO much so that its mathemat-ical exposition was expected from
the regularity wit,h which it appeared clinically. Fifty per cent more
of the cases which wer(l bcnefitrtl by this therapy gave a history of
bruising easily than of thr cases receiving no benefit from calcium.
8ince this difference in percentage is five times the probable error of
the difference, it, is of tIefinite statistical significancrh.
The basis for this symptom perhaps lies in tho effect of calcium upon capillary
and vessel permeability. (antaron refers to this question in his work on calcium.
Loebc states that a certain concentration of calcium ions tends to make capillaries
impermeable and to constrict vessels, while potassium ions, if uot counteracted by
calcium, tend to have an opposite effect. SpieglerT has shown that while there is
hat little variation during the lncnstrual eyc+le of the blood calcium, there is quite
an appreciable variation in the potassium content of the blood, rising just before
menstruation, decreasing during the flow, and later regaining the normal level. It
has also been pointed outs that the serum calcium level in women having dysmenor
rhea shows no demonstrable diffsrcnce from that of women having no menstrual pain.
In a personal letter to out of us (lt. E. B.j Burnett has suggested that this dis-
turbed calcium-potassium ratio map be of importance in that it might explain certain
beneficial effects of calcium therapy, even though there existed no apparent diminu-
tion in calcium levels. Whether there is a connection between this factor of easy
bruising and the coagulability of blood is not known. Huntc,rlO states that there
is no evidence to indicate a calcium defect in hrmophilia.

The production of pain in the menstrual process appears to be due

to an increased irritability of the muscles and nerves involved, smooth
muscle and the autonomic nerves being affected equally with the other
parts of the nerve and muscle systems. The Ale of calcium here
is, as IIunt,er says? to maintain, alon,w with the other ions, a balanced
system determining the degree of irritability of muscle and nerve.
In this way calcium ions help to control the heartbeat, and con-
tractility of plain and stripecl muscle; and the transference of impulses
at the neuromuscular junctions and through synapses. In general, it
may be stated that calcium ions play an important part in lessening
the irritability of the tissues containing them.

SUMMARY

Of 49 cases of essential dysmenorrhea treated with calcium, or cal-

cium and viosterol, 33 or 67.3 per cent were greatly benefited; 16 or
32.7 per cent seemed to have no relief.
The symptom of bruising easily seemsto indicate, in eases of esaen-
tial dysmenorrhea, that a more favorable response to calcium therapy
may be expected than in caseswithout this symptom.

REFERENCES

(1) Hartley, E. C.: AX 5. 0115~. & GYNEC. 19:. 54, 1930. (2) Hartleg, E. C.:
AM. J. OBST. & GPNEC. 21: 725, 1931. (3) Carswall, 3. E., aad Wider, J. E.:
J. Biol. Chem. 93: 411, 1931. (4) Gra*e.~: Gynecology, ed. 4, Philadelphia and Lon-
 JACOBS : >IAI,IGNANT SEOLLASJIS OF OVAlIT Z:ji

don, IV. B. Saunders Co., p. 617. (5) Ccmtarow, A. : Wcium i\letabolism and Cal-
I*ium Therapy, Philadelphia, 1931, Lea 8: Febiger, p. 69. (6) Lo&, L.: Medicine 2:
171, 19% (7) Spiegler: Arch. fiir. GJtik. 134: 322, 1928; 143: 48, 1930. (8)
Hoynton, R&7& E., ad Greishcimrr, Esther: Proc. Sot. Esper. Riol. & Med. 28:
907, 1931; 29: 115, 1931. (9) Bu?~~t~ff, 75. El.: Mellon Institute of Tndustrial Rc,-
wawh. (10) IIZIHIPT, 11.: Quart. J. 1Z~d. 24: 393, 1931.

MALIGNANT NEOPLASM8 OF THE OVSRY

AN ANALYSIS OP ONE HUNDRED AND FIPTY CASES

A. W. JACOBS, X.D., NEW YORK, N. Y.

(Proal the lVew Pork City Camw Institute)

T HE usual results following surgery in the treatment of malignancy

of the ovary have not been very encouraging. Though occasion-
ally a patient so treated may live for a period of five or six years, in
most cases, the average duration is only two years.
In January, 1932, the author reported a case of malignant disease of
the ovaries with recurrence and metastases, treated by surgery and
radiation,l still under observation thirteen years after trea.tment, and
the patient is in apparent comfort, attending to her daily duties as sec-
retary. This cooperation between t.he surgeon and radiation therapist
ofters the best results obtainable in t.he care of these difficult cases.
During the period of eight years from 1924 to 1931, inclnsivc, 130
patients with malignant diseases of the ovaries were admitted to t,he
hospital and clinic division of the ?Cew York City Cancer Instit,nte.
The majority of these patients had already been treated elsewhere and
were in, more or less, hopeless condition; and in many. complete data
mere unobtainable regarding t.heir previous condition and treatment.
Such information on hand, however, has been used for the conclusiotts
herein expressed, regarcling the therapeutic measures best snitetl for
1his condition.
The youngest w-as eleven, the oldest was seventy-four. The three patients under
twveuty were eleven, sixteen, and seventeen gears of age, respectively. ,Most of the
p:\tients, or i8 per cent, xvei-e between the ages of thirty-one and sixty. AlJout 80

Acr: TWXLIENCE OF MBLIGNAXT DISEASE OF THE OVARY

-__~- ~-
AGE NUMBEROFCASES PERCENT
UmIer PO par.9 3 I>
01 to 30 .i i
31 to 40 37 0
41 to 50 57 36
51 to 60 33 0
61 to 70 16 10
71
~~~-to 80 ~___ 6 4
__._~~~.