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  Gynecology - Part I - Menstrual Disorders

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By: Christoph Zerm, M.D.
Menstrual Disorders - Part I*

* The first of three parts from a lecture given at the yearly meeting of the Anthroposophical Association, U.K., 1992

I thought that we would come nearer to the menstrual cycle if we would go to the very beginning of the development of rhythms in humanity. I found some remarks of Steiner about the earlier forms of existence of the earth. Already in ancient times, on Old Sun, there was something like a rhythmic expulsion. This was a rhythmic expulsion of beings that were the remains of old Saturn; that means the transformation of these beings - that is, warmth. Now from our point of view one could say that the beginnings of changing of temperature originated in this rhythm of Old Sun, which was like a spiritual menstruation. One could also think of the thermogenicity of progesterone related to the temperature of the body.

In the time of the Old Moon, the World was entirely based on life. The world was vivid with colors, and everything was alive and nothing dead. The center was comparable to the uterus. One felt surrounded by this vivid world, and all that grew was based on the liquid sphere inside. With this imagination of Old Moon, we can better understand that there was no necessity of something like a "delivery" because that would mean an exit from that situation. All forms of life went on within the surroundings. Rudolf Steiner described this as a sort of reproduction, and that at time, “fertilizing rain” came which created in certain ways the Moon-like rhythm.

At this time the human being was both male and female. There was no separation yet into male and female. As you know, at the beginning of the earth’s evolution there was still no separation of the sexes. Only when the end of Paradise came, then we had the separation of the sexes.

I would like to look for just a little moment at the things which went on at that moment. You know, in the legend of the Fall, you hear that God took from Adam a rib. This is an imagination of the middle part, the rhythmic part of the human being, which at that time included both male and female parts.

It can serve as a picture that the whole man is divided into upper, middle and lower parts. The male human being remained with the upper and the lower parts as polarities and with this the tension of these polarities; and the female human being was centered in the middle part. One can see it also if one looks, for instance, to the phenomena of the physical, etheric, astral and spiritual levels, because it is quite clear that there is a stress on the physical constitution in the man, much more than in the woman. In comparison, on the etheric level, the forces of life are much more at the center in the female part of humanity. You can see this, for instance, with the possibility to produce new life and also the possibility to have long life, which is much more centered in the female than in the male. So in many aspects, man, masculine man, is not as strong at the level of life as woman. On the astral level, you will also have this, where there is much more constitutional possibility on the emotional level on the part of women than men. And now comes the difficult part! If we speak about the spiritual level, there can be opposition to the idea that it is more emphasized in man than in woman, but the original tendency of man's activity is to have ideas, to think things through, to have conceptions before activity. These things of abstract consideration are a typically masculine way of handling things, whereas the woman has much more direct relation to the things which are going on, and in this sense, one could say that on the "spiritual" level there is more emphasis on the part of the man than on the part of the woman.

So once again we can see that between the physical and the spiritual there is a polarity in the masculine, and in the female there is an emphasis on the middle part and on the etheric and astral levels.

This could seem a little bit theoretical, but one could give more examples of it. I have to be quite short, so I won't go more profoundly into this. One could also look at the special situation of the sexual organs, which are in the lower metabolic part of the human being. Here we have the great emphasis in the central organ, the uterus, and there is also something like a negative form, the vagina, and also the very small organs, the ovaries. Obviously it is this uterus which is really emphasized by nature, and still more emphasized at the height of its function, when there is a pregnancy.

If you look at the equivalent organs in the male body, and think of the central organ, the uterus, we really have nothing, only a bone, the symphysis pubis. With the organs which correspond to the ovaries and to the vagina, which lead to the outer world, in the male these parts are externalized. There is on the one hand the penis, and on the other hand the testes, that are pushed out. They are brought more into the area of consciousness than the female organs are, which are in the sleeping part of the organism, in the metabolic system. In man, both polarities are pushed out, and there is no organ corresponding to the central organ of the genital system. One could consider the prostate as something comparable, but it is not alike really.

So one can see that the middle part is taken out and is emphasized in the female, and in the male only the polarity is left. The imagination of the taking out of the rib is a reality if one looks with a little bit of understanding at the phenomena that we have before us.

So looking at the anatomy of the human organism, we can have an idea that the female organization of the human being is emphasized in the middle part. The middle part is the rhythmic system, which means that the female specialization of man has much more to do with rhythmic phenomena than the masculine. It is really one special condition of this specialization.

This has been related to aspects in space. Now we can look also at aspects in time. When we consider the time of life when rhythmic phenomena are emphasized in the woman is the part in the middle of life, not at the beginning and not at the end. We have a little time in the beginning when no specialized rhythmic phenomena are seen. Then there comes something like a preparation phase - then begins the time of rhythmic phenomena, the time of fully developed rhythmic phenomena. Then there is the little phase of transition and then the time when this emphasis on rhythmic proceedings is no more. It has retired. In the following part of life, both male and female have the possibility to look more to the general meaning of being human rather than on the specialization of being man or woman. Physiology already offers this possibility to be more entirely human than to be "specialized." The continuation of, let us say, the attraction between the sexes may not stop, but there is the possibility to develop this more fully.

So we can see that the rhythmic phenomena within the life of a woman are seen in the middle of life, and the rhythmic processes take place, first of all in the center of the genital organs. This central organ is the promoter of these rhythmic phenomena and is the part of the whole human organism which has most to do with the proceedings of life, maintaining life with in the metabolic system. The latter is also, as we know, the sleeping part in a certain sense, and these organs are also within this sleeping part; not outside the human body but inside, and they are protected and surrounded by many sheaths.

On the other hand, we have the fact that some places in the human organism have a double aspect - one aspect more central, more internal, and another part which leads to the outer world. That is the fact in the uterus. You can also see it in the lung and the respiratory passages. Here there is one part which is more inside and another part which leads outside. In the uterus you have something very similar. You have the corpus, which is that part of the uterus directed to the inner world, but there is also the possibility in the uterus of opening to the outside in the cervical part; and it is interesting that they have different tasks in the physiological processes.

The endometrium of the uterus has in its activity the possibility to open itself to cosmic influences, to external influences. It has, let us say, the possibility of lunar perception, of moonlight perception. In considering the lunar (= perceptive) parts of the body, we have another such lunar part in the brain, but on a different level. One can imagine two aspects - of the moonlight and of the sunlight perception. When one imagines night and moonlight, then one can perceive all things around but "diffused"; you don't have a very centered perception, but you live with your perception more diffused, more totally in the moment where you are, whereas when there is sun you have the possibility to have your consciousness concentrated in one point. You have the rays of the sun; you have the possibility of focusing with the sun; and that really means also a particular point of view. This is a ray-like quality. With the moon, you have the quality of "environmental' receiving, the moonlike perception.

In following the menstrual cycle, you also have phases of being more moon-like. With ovulation, you have something that comes like a ray and changes the whole way of development at that precise moment. There is a sun-like quality to it.

Now the female is a special aspect of life, but we can have another aspect, from a different point of view, when we look at general phenomena of life. We have that part of which you will all remember, in what Bernard Lievegoed has worked out about incarnation and excarnation. You have this flowering development of the physical condition in the first part of life and then the decay of the physical condition. In the beginning of life, there is the summit of physical possibilities and yet, at the same time, there is the descent from the spiritual world of the human being, entering more and more into the physical condition. Afterwards, in the second part of life, there is the preparing, more or less visibly, of excarnation. Once more there is a separation from the physical condition. Obviously this first part of life is the time when we inspire. Then we take up all the experiences, all the impressions that the world can give us, and we are forming ourselves by these experiences. Simultaneously, we are entering more and more into our bodily instrument to have the possibility to work on the physical plane. The comes another, the second part of life, where this physical condition is more concentrated and becomes closed - not so broad - and the loss of physical possibilities is felt by many people as a loss. They retire into themselves. By natural and by physical laws, the incarnating human being comes like this into the developing human organism, entering more and more into the physical plane. But from the middle of the life, there is the possibility to have another development, which comes more and more to a spiritual transformation of the physical condition. There is also the possibility to become more and more independent of the decaying organism, and to develop spiritual qualities; to grow in this sense more and more and to have this direction to development.

We know also from biographical studies that there is a crucial point in life, around the years 31, 32, 33, which we also know from the life of Jesus Christ. Nearly everybody goes through this crucial point of being very close to the phenomena of death and resurrection. One can say that in the first half of life we are accompanied by the forces which are given us to enter the world, but, when we come to the thirties and the time about this age, when most people feel that their forces are vanishing and that now there is something like a vacuum. Many people experience fear when they feel it - that moment when a person realizes that all the future development of themselves, of their life, depends on their own activity, or they will go down. We can say that there has to come a new impulse or there is no way out of is physical decay.

I will leave this picture like this. One could of course amplify it and work on it for weeks, but now I want to go on to another level which is like a picture of these phenomena - the female cycle. We also have the phenomena It in the first half of the cycle, most women feel the possibility of opening themselves to the world; to open themselves on the one hand but also to take world inside, to have a very good intercourse with the world. This is comparable with the inspiration of the surrounding world. The woman is open to the world and takes it in to herself. From a qualitative aspect, this is situation that arises in the first part of the cycle.

Then comes another impulse that is not a continuation of the development of the first part, and that is ovulation. This is completely different from the development of the first fourteen days. Simultaneously, it offers the possibility that not only a different impulse within the physiology of the human organism can arise, but also a completely different impulse from outside is possible - this is conception. This is on a physical level, but it is also the only moment where the spiritual world can unify the will of another human being with the physical condition. From this aspect, Rudolf Steiner poses the question - that we have to think about whether it is really the attraction between two persons which leads to conception, or - is it the will of the third person which brings the two people together?

In the second part of the cycle, we can realize that many women feel the concentration of their possibilities in some way, of their positive possibilities. But they can also retire into themselves, maybe showing a condition that is very close to pathological phenomena. In this situation the woman is no longer able to have normal relationships with her surroundings, and she retires into herself in such a way that she would lock herself into her room and send out the stings, both against outside and also in some situations inside, against herself. In this she is like a hedgehog which rolls up into a ball, completely closed within herself. So there can be this exaggeration of opening to the world and withdrawal from the world, but if the woman is perceptive enough for a new impulse to continue with those forces which lead upwards, then there is not necessarily this closing off, but there is the possibility to be and to remain more open.

The second part of the cycle has much to do with the enigma of the second half of life in total, of the possibilities and dangers which lie in it.

Now I will leave it like this and look at another aspect of the processes which we can see during the cycle - in respect of the different members of the human being. I don't think I need to explain in detail the human being with his threefoldness and the four members, but to look at the special relationship of these members in the functioning of the menstrual cycle.

In the beginning of the menstrual cycle, we have the phenomenon that the ovary is mainly an organ which deals with the etheric body. Because of the fluid processes, the intimate activity of life processes and especially if we look at the follicular development, we have mainly the filling more and more, of liquid within the follicle. The follicle grows and in the uterus that layer which has to do with the cosmic perception is also growing. Nothing else is growing, so we say that it is the physical body and the etheric body which are' working together in this part of the cycle, with some influence of the organ-building forces of the ego-organization relative to the ripening of the ovum within the follicle, which can be regarded as a little organ itself.

Then there comes an impulse of movement, which means not only that the follicle opens and the ovum goes out, but also the tube and the ovary are moving together, so that the outgoing ovum can enter into the tube. All phenomena of movement are signs of astral activity. So at this moment there comes a sudden impulse of astral activity within the organ. We can also receive it in another phenomenon; with this impulse there is the sudden change from more or less neutral plant-like growth, to the impulse of color in the organism. There comes a yellow in this part of the development, in the corpus luteum. Also then the mucosa within the uterus becomes mature to receive the fertilized ovum and there are two changes here. Firstly, the mere growth of glands stops and is changed to their becoming spiral, and then physiologically, there is a change to a secretory activity. Secretory activity means once more that activity of the astral body, because the astral is responsible for all types of secretion and of movement. At the time of ovulation there can be seen, at the mouth of the cervix, a great quantity of mucus, which also means an impulse of secretion. So the astral body at this moment is entering more visibly into the development and also the further development which may take place.

You can also observe an elevation of the temperature; there comes an impulse of warmth. This means that the ego organization has also entered into this development and goes on giving structure to the development. If there is no new impulse, i.e., in the form of conception, then the ego organization after some time retires, and the temperature goes down again. The ego organization in this part of the body withdraws also a little bit from the blood circulation so that a small part of the blood falls out of the sphere of life, and menstruation occurs.

The ego organization is also no longer giving structure to the astral body. In some cases the astral body exaggerates its activity in this part, and there comes an overactive impulse in the uterus then the woman feels the pain of dysmenorrhea. There is another phenomenon, in that the etheric body withdraws itself a little, and you can see that the liquid sphere is no more structured. Close to the time of menstruation, the activity of the ovary is less than before, as there is a slight withdrawal by the etheric body. If that is exaggerated, you can see that the astral body acts directly on the physical body without the mediation of the etheric body. There arises a consciousness in the pelvic area which is not normal, and that is to be felt as pain.

So we have with this description more or less the activities of the different members in the course of the menstrual cycle. The gesture of the second half culminates with the ego withdrawing. The etheric body can be overpowered and then the astral works directly onto the physical, creating the breakdown.

I often compare this with the observation in nature of the development of the apple. It is quite a good imagination. When the fruit of the apple grow in the first part of its growth it is green and sour. It only grows and it doesn’t do anything else. Then comes the moment in the summer when it no longer grows but starts to become mature. It changes also from green to colored; it turns red or yellow, and green would be for the plant something like "neutral." When color comes then there is a real impulse of color. The growth more or less stops, and the inner quality of sourness changes to sweet, and with it comes color. Some time is needed until it is really mature, and when it does reach maturity, one has to pick it. If not, then it either remains on the tree or it falls down, but in both these instances it rots. The meaning of its development is to reach the status of matureness, of maturity, and afterwards there is only decay - on the tree, or it falls and it becomes once more earth. All the processes of the physiology can be seen in this imagination - the phenomena of growth and then the stopping of growth and the starting of another quality.

Generally there is a change in the biochemistry. Otto Wolff has described in several examples a change towards a ring structure in the molecule where the astral forces are working. In the human being, for instance, there can be a change to molecular structures forming rings. I am quite sure you can find in the second half of the cycle ring structures where there were not ring structures before. So even from the point of view of biochemistry, one could see this change of quality, and of course in the menstrual cycle there are the estrogens which have to do with growth and then the progesterones which stop growth and are to do with the maturation of tissues.

In considering the disturbances of the menstrual cycle, we should consider the seven year periods. In the first seven year period, the ego is working within the physical body, elaborating or introducing the etheric body on the level of the physical. Here we have also a preparation phase of the labor with the astral body. With the third seven year period, there is the birth of astral and the taking possession of the physical by the astral and ego.

We have then the long period of 3 x 7, which is under the influence and help of the sun forces. Then, from 42 to 49, we have once more the word with the astral body, its possible spiritual transformation towards the achievement of spirit self. From 21 to 42, the ego is working at the soul level and successively developing the three types of soul. This is the very time of the complete manifestation of femaleness, in a certain sense, because of the rhythmic processes. These are not active much before or afterwards but just in this time when the ego works at the level of the soul. This is another sign that in the female the emphasis is at the level of the soul. The impressive manifestation of being a woman is in this time where the ego works on the level of the soul.

Before and afterwards, there is the work with the astral body, first when the astral body takes possession of the physical body and afterwards, there is the spiritualization of the astral body. These times of astral activity form a frame around the time of the greatest manifestation of femaleness.

The male human being does not emphasize so much this pattern. What he does, he does by will and by his own activity and he is not so much obliged by his organism to emphasize this rhythmic pattern on the sexual level. Woman are obliged by their organism to undergo rhythmic processes and eventually pregnancy. Men are not so obliged but there is the possibility by their will to share in it. It is up to each man whether he does so or does not. The middle years of the female have emphasized the difference between male and the female.

One very important thing that has to be said is that hypomenorrhea does not exist. This is not an illness; too weak menstruation does not exist, only too strong a menstruation. Two days’ loss a month is all right and it not the same as oligomenorrhea. Rhythm is of greater importance than the amount of blood loss or the length of the period. You may have to explain to the patient that it is all right. When it is the other way, when the intervals are too long, this is another thing.

If the menstrual loss is such that there are clots, this is a sign of something pathological. If someone very slowly becomes anemic and you measure the iron concentration, you will see that it is very low while the hemoglobin is still in the middle range. The presence of clots is a very reliable sign that the menstruation is too heavy. Do you know why it is like this? The menstrual secretion is composed of three ingredients - blood, mucus and the cellular components of the mucosa, of the endometrium. If there is a normal relation between these three components, then there will not be clots. If the blood proportion is too great, which means that she is actually losing too much blood, then there will be clots. In this situation the normal relationship between the three ingredients is disturbed. When too much blood is lost, the blood shows its normal behavior, which is to clot.

With an irregularity of rhythm, one should see if there are physical reasons for the menstruation not being in order. Maybe there are ovarian cysts or a tumor of the ovary or fibroid uteri. Then it is important not to start to treat the irregularity but to treat the underlying cause. If there is no physical cause, then it is a functional problem, and this functional problem is the real mirror of what I have explained - the possibility to perceive what is going on on the emotional level.

When there is oligomenorrhea or amenorrhea, for instance caused by anorexia, then I will not try to produce a cycle until the anorexia is treated. It is really senseless to have treated a symptom of another illness, whereas the symptom will go away when the main illness is overcome.

Sometimes you have cases of women who are in a special situation in their lives and there is no menstruation. This special situation can indicate various things, and then I usually ask them: "Do you suffer in not having menstruation, besides your main problem?" In many cases, I would say actually in the majority of cases, they don't suffer. They even say sometime; that it is quite nice not to have periods. Then I say: "Treat your problems and you will see that when you have reached a better level of internal equilibrium, your menstruation will return." That is what happens in many cases. In these cases I don't see it as necessary to treat as long as the woman can see it like that.

There is the question of periods not being regular before the age of 21. I have found it very important to make a common consciousness between the patient and doctor about this situation - If the woman is really alarmed about this phenomenon or if she can stand it, and because she is involved with other problems, it doesn't matter if it comes or doesn't come; she may even be relieved not to have menstruation. But if she is really alarmed and not content, then one should start treatment. What we have found works very well is the Weleda compositum - Melissa Phosphorus comp. It contains, beside Melissa D3 and Phosphorus D6, also Agnus castus D3, Pulsatilla D6, Marjorana D3, Mucilago Levistici D3 and Corpus Luteum D4. I give it twice a week or three times a week for the first four weeks as injections. This is for amenorrhea, both primary and secondary. Argenturn unguentum would also be a help and could be used as a compress to the lower abdomen during the night.

Oligomenorrhea you can also treat with the Wala preparation Argentum D6/Ovaria D6 globules, and with Menodoron. The latter should be stopped during the menstrual period as it can intensify the bleeding. Argentum compresses on the lower abdomen at night are also good. It is not quite clear in most of these cases whether the ovary is really not good or whether there are other influences which inhibit the normal function of the basically normal ovary.

With dysmenorrhea you can use Melissa Cupro culta and in some cases also Belladonna D6; both treat the pain also during the second part of the cycle. With the pain, Chamomilla Radix D4 and P:Pulsatilla can also have a good effect. One can imagine that Pulsatilla is a plant which has much to with the watery element, but at the same time it also shows a certain affinity to the air. When you compare, for instance, cacti or succulent plants, they are closed to the air and keep the liquid within themselves. Pulsatilla is open also to the air influence and that is what we need in this case - the astral sphere can really enter the etheric and vice versa, that the etheric body can act normally, can be strengthened, so that the astral body can collaborate.

Regarding the four members in dysmenorrhea, you can see that firstly the ego organization withdraws too much. Then the etheric body does not work in an efficient way so that the astral body is in too intensive contact with the physical body, simultaneously lacking the forming influence of the ego Therefore one has to look for a remedy which helps the etheric body to enter again, but in connection with the astral body, so that the astral body will have once more a connection with the etheric. Pulsatilla will help in this case.

Christoph Zerm, M.D.
Gemeinnuetziges Gemeinschaftskrankenhaus Herdecke
D-W-5804 Herdecke

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