5. Signs And Symptoms
• --Absence of menses at age 14 without
secondary sexual development
• --Presence of secondary sexual character
development and absence of menses at
age 16
• --Absence or presence of pelvic pain
6. Investigations
• --Progesterone challenge test
• --Hormonal profile (Serum FSH)
• --Pregnancy test
• Ultrasound
• --Thyroid test
• --Karyotyping
• --X ray of the skull (Sella Turcica: Pituitary)
Pituitary tumor or necrosis
• --CT scan
8. Recommendations
• --Any patient with primary amenorrhea and
high levels of serum FSH should have
karyotyping
• --In cases of androgen insenstivity
syndrome (XYfemale), we should remove
the testes cause of the risk of malignancy
11. Signs and symptoms
• --At least 3 consecutive cycles of absence
of menses
• --History of curretage, post partum
infection
• --Galactorrhea
• --Premature monapause
• --Obesity
• --Headache
• --Visual defects
• --Polyuria, Polydipsia
12. Investigations
• --Hormonal profile
• --Pregnancy test
• --Ultrasound
• --Thyroid test
• --X ray of the skull (turcique selle:
Pituitary) Pituitary tumor or necrosis
• --CT scan
13. Management
• --Etiologic treatment
• • Hormonal treatment
• --Surgical treatment
• • Tumor resection
• • Lysis of intrauterine synechiae
• --Weight loss
• --Normalize the Body Mass Index (BMI)
14. Recommendations
• --Patients with premature ovarian failure
should receive hormal replacement
therapy
• --Patients with premature ovarian failure
should receive contraception if they are
not desiring pregnancy
• --IVF and assisted reproduction is an
option if the patient is desiring pregnancy
16. Primary dysmenorrhea
• In adolscence with absence of pelvic lesions
after 6 months of menarche
• --6 months after menarche with the onset of
ovular cycles.
• --It is suprapubic, tends to be worst on the
first day of menstruation, and improves
thereafter.
• --Associated with increased frequency and
amplitude of myometrial contractions
mediated by prostaglandins
• --Associated with GIT symptoms like vomiting
and diarrhea
17. Causes
• --Excess secretion of prostaglandins
• --Immaturity of the Hypothalmo- Pituitary -
ovarian axis leading to anovulatory cycle
• --Outflow tract obstruction
Investigations
• --Ultrasound to exclude pelvic lesions
• --Hormonal profile
18. Management
First choice :
• • 80% respond to therapy with
• • NSAIDs started 24-48 hours before the onset
of pain.
• Aspirine 300-600mgPO TDS start 1or 2 days
before the menstruation
• Mefenamic acid PO 500 mg TDS or Ibuprofen
PO 400 mg TDS / day for 3 days.
Alternative
• • Combined oral estrogen-progestogen
contraceptive continued 9-12 months leading to
anovulatory cycles if symptoms improve
• • Surgical treatment: Interruption of pelvic
19. Secondary dysmenorrhea
• Later in reproductive life
• --Presence of pelvic lesion, such as
uterine fibroids or endometrial polyps
• --Pelvic lesions
• --Dyspareunia (pain with intercourse)
• --Pelvic/lower abdominal pain occurring
before, during, after menstruation
• --Pelvic/lower abdominal pain occurring on
days 1 and 2 of the menstrual cycle.
• --An endometrial polyp or submucous
fibroids usually occurring at the beginning
of menstruation cause Pelvic/ lower
20. Investigations
• --FBC ESR or C-reactive protein
• --Vaginal swab,
• --Urinalysis
• --Ultrasound
• --Laparoscopy
• --Hysteroscopy.
Management
• --The underlying condition (surgery,
endometriosis IUD)
• --NSAIDs: Aspirine 300-600mg PO TDS start
1or 2 days before the menstruation
Recommendations
• --Health care providers should explain the
physiologic of dysmennorrhea
• --Regular exercise
21. 1. Menorrhagia : excessively prolonged
menses.
2. Polymenorrohea : occurance of mc
greater than usual frequency.
3. Metrorrhagia : irregular acyclic bleeding
4. Oligomenorrohea : minimal quntity blood
loss
5. Hypomenorrohea : scanty menstruation
that last for less than 2 days.