بسم الله الرحمن الرحيم جامعة ام درمان الأسلامية كلية الطب والعلوم الصحية OBESTRICTIC PROBLEM Patch16-Group4 ezpaseva
AMENORRHEA <ul><li>DEFINTION   Absence of menstruation </li></ul><ul><li>Types   </li></ul><ul><li>There are 3types  1-  1...
oligomenorrhea <ul><li>DEFINTION </li></ul><ul><li>Is infrequent or light menstruation </li></ul><ul><li>Menstrual duratio...
<ul><li>CAUSES </li></ul><ul><li>1. emotional or physiological   stress </li></ul><ul><li>2. chronic illness </li></ul><ul...
DYSMENORRHEA <ul><li>DEFINTION </li></ul><ul><li>Painful menstruation </li></ul><ul><li>PREVALENCE </li></ul><ul><li>45%-9...
<ul><li>AETIOLOGY </li></ul><ul><li>(1) PRIMARY </li></ul><ul><li>Duration of menstrual flow of>5days </li></ul><ul><li>Yo...
<ul><li>C/F:   crampy supra pubic pain </li></ul><ul><li>INVESTIGATION:   history </li></ul><ul><li>Endocervical swab </li...
MENORRHAGIA <ul><li>DEFINTION </li></ul><ul><li>Blood loss of greater than 80ml/period </li></ul><ul><li>PREVALENCE </li><...
<ul><li>AETIOLOGY </li></ul><ul><li>1. DUB;   unclear but disordered   endometrial prostaglandin production has been impli...
<ul><li>OTHER PHYSIOLOGY  VonWillebrand’s disease </li></ul><ul><li>Fibroid uterus </li></ul><ul><li>Endometrial polyp </l...
<ul><li>C/F:  HISTORY </li></ul><ul><li>C/examenation </li></ul><ul><li>~ physical examenation </li></ul><ul><li>~ cervica...
<ul><li>TREATMENT </li></ul><ul><li>MEDICAL  treatment </li></ul><ul><li>Mephanamic acid </li></ul><ul><li>DANAZOL </li></...
ABNORMAL PUBERTY Puberty and pubertal changes may occur earlies than normal menstruation + secondary sexual characters bec...
1. Idiopathic 2. Intracranial lesion 3. Adrenal gland ,ovarian and Thyroid problem 4. Drugs Either   constitutional or pat...
The Idiopathic   treated by:- 1- proestrogens 2- Danazol 3- Cyproteroneac- etate 4- LHRHanalogues ----- TREATMENT PRE pube...
Sex Hormones & Function <ul><li>GnRH. </li></ul><ul><li>FSH&LH. </li></ul><ul><li>Progesterone & Estrogen . </li></ul>
GnRH
FSH & LH
Progesterone & Estrogen <ul><li>Estrogens:   3types estradiol (it is the main estrogen produced by the ovary) ,estriol and...
<ul><li>Cholesterol  androgens  </li></ul><ul><li>2- FSH (high level) stimulate granulosa cells  androgens  estrogens </li...
Progesterone & Estrogen <ul><li>Estrogens:   3types estradiol (it is the main estrogen produced by the ovary) ,estriol and...
<ul><li>2-deciduatization of endometrium in the late luteal  phase.  </li></ul><ul><li>3-devlopment of breast alveoli. </l...
Menstrual cycle  <ul><li>-Menstruation: means a periodic discharge of sanguineous fluid and a sloughing of uterine lining....
<ul><li>-Endocrine control  of MC. </li></ul><ul><li>-component of MC. </li></ul><ul><li>-Role of prostaglandin. </li></ul...
Androgen Excess  <ul><li>-Sources of androgen: 1-endocrine gland. </li></ul><ul><li>2- peripheral tissue.  </li></ul><ul><...
<ul><li>-Symptom:1- general appearance :obesity; muscular male body.  </li></ul><ul><li>2-miscllenous change. </li></ul><u...
2-Anti androgen.   3-corticosteroids.   4-promocriptin.   5-Insulin sensitive drugs.   6-surigcal .   7-diet. Treatment: 1...
Pre menstrual Syndromes PMS or PMTS <ul><li>Definition. </li></ul><ul><li>Prevalence. </li></ul><ul><li>Etiology: hormonal...
Delay or absent Puberty  <ul><li>When the menarche has failed to occur at age of 17years old. </li></ul><ul><li>Failure of...
Precocious & Delayed puberty  <ul><li>It is early but normal pattern of puberty due to an early of gonadotrpin secretion f...
<ul><li>Cerebral e.g.: disorder involve posterior hypothalamus  </li></ul><ul><li>tumors . </li></ul><ul><li>Infection. </...
Hyper prolactinemia  <ul><li>-prolactin contain 199 a.a secreted by endometrium and placenta. </li></ul><ul><li>Action:  <...
<ul><li>Hyper prolactinemia: in up to 70% of patient   with chromophobe adenomas of anterior pituitary   have elevated   p...
-  Hypogondism produce by prolactinomas  is associated  with  osteoporosis due to estrogen deficiency. Treatment : Bromocr...
<ul><li>CAST </li></ul><ul><li>Aml Alnor </li></ul><ul><li>Razan M Jafer </li></ul><ul><li>Ejlal Abd Mohamed </li></ul><ul...
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  1. 1. بسم الله الرحمن الرحيم جامعة ام درمان الأسلامية كلية الطب والعلوم الصحية OBESTRICTIC PROBLEM Patch16-Group4 ezpaseva
  2. 2. AMENORRHEA <ul><li>DEFINTION Absence of menstruation </li></ul><ul><li>Types </li></ul><ul><li>There are 3types 1- 1ry and 2ry </li></ul><ul><li>2- true and false </li></ul><ul><li>3- physiology and pathology </li></ul><ul><li>DIAGNOSIS </li></ul><ul><li>History </li></ul><ul><li>Examination </li></ul><ul><li>Investigation </li></ul><ul><li>TREATMENT </li></ul>
  3. 3. oligomenorrhea <ul><li>DEFINTION </li></ul><ul><li>Is infrequent or light menstruation </li></ul><ul><li>Menstrual duration : greater than 35day </li></ul><ul><li>Mean: 4-9 period/day </li></ul><ul><li>Common at extremes age of reproductive life (ovulation often does not occur) </li></ul>oligomenorrhea
  4. 4. <ul><li>CAUSES </li></ul><ul><li>1. emotional or physiological stress </li></ul><ul><li>2. chronic illness </li></ul><ul><li>3. increase level oestrogen </li></ul><ul><li>4. eating disorder </li></ul><ul><li>DIAGNOSIS </li></ul><ul><li>TREATMENT </li></ul>
  5. 5. DYSMENORRHEA <ul><li>DEFINTION </li></ul><ul><li>Painful menstruation </li></ul><ul><li>PREVALENCE </li></ul><ul><li>45%-95% of women in reproductive age </li></ul><ul><li>CLASSIFICATION </li></ul><ul><li>1-primary </li></ul><ul><li>2-secondary </li></ul>
  6. 6. <ul><li>AETIOLOGY </li></ul><ul><li>(1) PRIMARY </li></ul><ul><li>Duration of menstrual flow of>5days </li></ul><ul><li>Younger than normal age of menarche </li></ul><ul><li>Cigarette smoking </li></ul><ul><li>(2) SECONDARY </li></ul><ul><li>endometriosis </li></ul><ul><li>Pelvic inflammatory disease </li></ul><ul><li>Adenomyosis </li></ul><ul><li>( rarely ) cervical stenosis </li></ul>
  7. 7. <ul><li>C/F: crampy supra pubic pain </li></ul><ul><li>INVESTIGATION: history </li></ul><ul><li>Endocervical swab </li></ul><ul><li>Pelvic ultrasound </li></ul><ul><li>Laparoscopy </li></ul><ul><li>TREATMENT: Medical treatment NSAIDs </li></ul><ul><li>Oral contraceptive </li></ul><ul><li>Nifedipine </li></ul><ul><li>Surgical treatment </li></ul>
  8. 8. MENORRHAGIA <ul><li>DEFINTION </li></ul><ul><li>Blood loss of greater than 80ml/period </li></ul><ul><li>PREVALENCE </li></ul><ul><li>Extremely common </li></ul><ul><li>CLASSIFICATION </li></ul><ul><li>1-idiopathic: No organic pathology ( DUB ) </li></ul><ul><li>2-secondary: fibroid . </li></ul>
  9. 9. <ul><li>AETIOLOGY </li></ul><ul><li>1. DUB; unclear but disordered endometrial prostaglandin production has been implicated in the aetiology </li></ul>2 . secondary;fibroid
  10. 10. <ul><li>OTHER PHYSIOLOGY VonWillebrand’s disease </li></ul><ul><li>Fibroid uterus </li></ul><ul><li>Endometrial polyp </li></ul><ul><li>Thyroid disease </li></ul><ul><li>Drug therapy </li></ul><ul><li>Bleeding in pregnancy </li></ul>
  11. 11. <ul><li>C/F: HISTORY </li></ul><ul><li>C/examenation </li></ul><ul><li>~ physical examenation </li></ul><ul><li>~ cervical smear </li></ul><ul><li>~ suggest an organic cause </li></ul><ul><li>~ Initial investigation {full blood count} </li></ul>
  12. 12. <ul><li>TREATMENT </li></ul><ul><li>MEDICAL treatment </li></ul><ul><li>Mephanamic acid </li></ul><ul><li>DANAZOL </li></ul><ul><li>GESTRINONE </li></ul><ul><li>GnRHanalogues </li></ul><ul><li>SURGICAL treatment </li></ul><ul><li>Endometrial ablation </li></ul><ul><li>Hysterectomy </li></ul>
  13. 13. ABNORMAL PUBERTY Puberty and pubertal changes may occur earlies than normal menstruation + secondary sexual characters become early in life 8-9 years or even 3-4 years of age Puberty and pubertal changes has not developed on 16-17 years old DEFINITION Precocious puberty Delayed puberty Subjective
  14. 14. 1. Idiopathic 2. Intracranial lesion 3. Adrenal gland ,ovarian and Thyroid problem 4. Drugs Either constitutional or pathological The pathological causes: 1- chromosomal abnormalities 2- Hypothalamic ,pitutary, Thyroid,Adrenal gland, Ovarian and Uterine causes CAUSES PRE puberty D puberty Subjectives
  15. 15. The Idiopathic treated by:- 1- proestrogens 2- Danazol 3- Cyproteroneac- etate 4- LHRHanalogues ----- TREATMENT PRE puberty D puberty Subjectives
  16. 16. Sex Hormones & Function <ul><li>GnRH. </li></ul><ul><li>FSH&LH. </li></ul><ul><li>Progesterone & Estrogen . </li></ul>
  17. 17. GnRH
  18. 18. FSH & LH
  19. 19. Progesterone & Estrogen <ul><li>Estrogens: 3types estradiol (it is the main estrogen produced by the ovary) ,estriol and esterone. </li></ul><ul><li>It is a dominant hormone at follicular phase of menstrual cycle. </li></ul><ul><li>Two cell Theory for estradiol production: </li></ul><ul><li>-1 LH (low level) stimulate Theca cells </li></ul>
  20. 20. <ul><li>Cholesterol androgens </li></ul><ul><li>2- FSH (high level) stimulate granulosa cells androgens estrogens </li></ul><ul><li>Action: 1-secondary sex characteristics of female. </li></ul><ul><li>2-proliferation of endometrim during proliferative phase. </li></ul><ul><li>3-increase uterine blood flow . </li></ul><ul><li>4-development of breast duct. </li></ul><ul><li>Progesterone: mainly synthesized in the corpus lutum and so it is the dominant hormone in the luteal phase of menstrual cycle. </li></ul><ul><li>Action : 1-resposible for glandular secretory activity during secretory phase. . </li></ul>
  21. 21. Progesterone & Estrogen <ul><li>Estrogens: 3types estradiol (it is the main estrogen produced by the ovary) ,estriol and esterone. </li></ul><ul><li>It is a dominant hormone at follicular phase of menstrual cycle. </li></ul><ul><li>Two cell Theory for estradiol production: </li></ul><ul><li>-1 LH (low level) stimulate Theca cells </li></ul>
  22. 22. <ul><li>2-deciduatization of endometrium in the late luteal phase. </li></ul><ul><li>3-devlopment of breast alveoli. </li></ul>
  23. 23. Menstrual cycle <ul><li>-Menstruation: means a periodic discharge of sanguineous fluid and a sloughing of uterine lining. </li></ul><ul><li>-Parameters: frequency - length and amount of the menstrual flow. </li></ul><ul><li>A- average of menstrual cycle is frequently quoted to be 28 + 2days. </li></ul><ul><li>B- average of menstrual 5days. </li></ul><ul><li>C- average of frequency of blood flow is 60 ml. </li></ul>
  24. 24. <ul><li>-Endocrine control of MC. </li></ul><ul><li>-component of MC. </li></ul><ul><li>-Role of prostaglandin. </li></ul><ul><li>-Mechanism of uterine bleeding. </li></ul><ul><li>-Homeostasis in menstrual endometrium. </li></ul>
  25. 25. Androgen Excess <ul><li>-Sources of androgen: 1-endocrine gland. </li></ul><ul><li>2- peripheral tissue. </li></ul><ul><li>3-liver and gut. </li></ul><ul><li>-androgen excess mains: Abnormal secretion of adrenal and ovarian androgen. </li></ul><ul><li>-causes: 1-ovarian tumor. </li></ul><ul><li>2 -adrenal tumor. </li></ul><ul><li>3 -CAH. </li></ul><ul><li>4-decreas SHBG. </li></ul><ul><li>5-Pcos. </li></ul><ul><li>6-cushing syndrome. </li></ul><ul><li>7-pregnacy. </li></ul><ul><li>8-idiopathaic. </li></ul>
  26. 26. <ul><li>-Symptom:1- general appearance :obesity; muscular male body. </li></ul><ul><li>2-miscllenous change. </li></ul><ul><li>3- menstrual irregulatory. </li></ul><ul><li>4- endocrine change. </li></ul><ul><li>5- skin changes. </li></ul><ul><li>6- acanthosis Nigricans. </li></ul><ul><li>-Diagnosis: </li></ul><ul><li>-History. </li></ul><ul><li>-Lab finding: testosterone ,17hydroxy progesterone, DHEA, dexamethazone, LH,FSH, lipid. </li></ul>
  27. 27. 2-Anti androgen. 3-corticosteroids. 4-promocriptin. 5-Insulin sensitive drugs. 6-surigcal . 7-diet. Treatment: 1- oral contraceptive.
  28. 28. Pre menstrual Syndromes PMS or PMTS <ul><li>Definition. </li></ul><ul><li>Prevalence. </li></ul><ul><li>Etiology: hormonal, social, genetic, vitamin deficiency, others. </li></ul><ul><li>C/f :nervous,GIT,mastalgia,Fluid retention. </li></ul><ul><li>D/D . </li></ul><ul><li>Treatment. </li></ul>
  29. 29. Delay or absent Puberty <ul><li>When the menarche has failed to occur at age of 17years old. </li></ul><ul><li>Failure of menstruation due to pan hypopitutrism is associated with dwarf +endocrine abnormality patient with XO chromosomal pattern and gonadal dysgensis =dwarf. </li></ul><ul><li>In some patient puberty delayed even the gonads are present +other endocrine function are normal =primary amenorrhea. </li></ul>
  30. 30. Precocious & Delayed puberty <ul><li>It is early but normal pattern of puberty due to an early of gonadotrpin secretion form pituitary it is most frequent endocrine symptom of hypothalmic disease. </li></ul><ul><li>Abnormal exposure to estrogen lead early development of secondary sexual characteristics without gametogensis . </li></ul><ul><li>Classification of causes precocious puberty: </li></ul><ul><li>A- true precocious puberty: </li></ul>
  31. 31. <ul><li>Cerebral e.g.: disorder involve posterior hypothalamus </li></ul><ul><li>tumors . </li></ul><ul><li>Infection. </li></ul><ul><li>developmental abnormalities. </li></ul><ul><li>B- precocious pseudo puberty: </li></ul><ul><li>-no ovarian development. </li></ul><ul><li>-Adernal:1- congenital virilizing adrenal hyperplasia . </li></ul><ul><li>2- esterogen secreting tuomers. </li></ul><ul><li>-gonadal: granulosa cell tumors of the ovary. </li></ul><ul><li>pineal tumor may associated with precocious puberty but </li></ul><ul><li>associated when there is secondary damage to </li></ul><ul><li>hypothalamus . </li></ul>
  32. 32. Hyper prolactinemia <ul><li>-prolactin contain 199 a.a secreted by endometrium and placenta. </li></ul><ul><li>Action: </li></ul><ul><li>1 causes milk secretion from the breast after estrogen and progesterone priming. </li></ul><ul><li>Has role in preventing ovulation in lactating mother. </li></ul><ul><li>3 Inhibit the effect gonadotropins by an action at level of ovary. </li></ul><ul><li>-normal plasma prolactin conc is approximately 5ng/ml in men and 8ng/ml in women. </li></ul>
  33. 33. <ul><li>Hyper prolactinemia: in up to 70% of patient with chromophobe adenomas of anterior pituitary have elevated plasma prolactin levels, in some . instances, the elevation may be due to damage of pituitary stalk but in some cases the tumor cells are actually secreting the hormone . </li></ul><ul><li>Hyper prolactinemia may cause glactorrhea, conversely most women with glactorrhea have normal prolactin levels. </li></ul><ul><li>Observation that 15-20% of women with secondary amenorrhea have elevated prolactin (by blocking action of gonadotropins in ovaries) when the level decrease the normal menstrual cycle and fertility return. </li></ul><ul><li>- surgical. </li></ul><ul><li>- Radio therapy. </li></ul>
  34. 34. - Hypogondism produce by prolactinomas is associated with osteoporosis due to estrogen deficiency. Treatment : Bromocriptine or other dopamine agonist - surgical. -Radio therapy.
  35. 35. <ul><li>CAST </li></ul><ul><li>Aml Alnor </li></ul><ul><li>Razan M Jafer </li></ul><ul><li>Ejlal Abd Mohamed </li></ul><ul><li>Marwa Mohamed </li></ul><ul><li>Eman Abd elrahman </li></ul><ul><li>Arig Sorage </li></ul><ul><li>Hana Abdelhafeez </li></ul><ul><li>Nahlaa Marqani </li></ul><ul><li>Roqia Solima </li></ul><ul><li>Wedad A Ahmed </li></ul><ul><li>Shaza Abdelmonem </li></ul><ul><li>Rehab Alser </li></ul><ul><li>Fatma Aalim </li></ul><ul><li>Alaa Abdella </li></ul><ul><li>Nada </li></ul><ul><li>Reem </li></ul><ul><li>Taqwa Bashir </li></ul><ul><li>AND </li></ul><ul><li>Shadin Awad Ahmed </li></ul><ul><li>EZPASEVA 2008 </li></ul>
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