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MENSTRUAL
ABNORMALITIES
PREPARED BY:
Mrs. VRUTI PATEL,
LECTURER,
SNC.
Most women suffer some form of menstrual
disturbances in their lifetime.
AMMENHOREA
• There are two types:
PRIMARY SECONDARY
PRIMARY AMENORRHOEA
Definition:
Absence of menses at 14 years of age
without secondary sexual development or
age 16 with secondary sexual development.
Causes /Risk Factors
• --Hypothalamic –pituitary insuficience
• --Ovarian causes
• --Out flow tract/Anatomical (e.g.vaginal
agenesis/septum, imperforated hymen or
Mulleriam ageneis)
• --Chromosomal (e.g. complete endrogene
insensitivity, gonadal dysgenesis”Turner
syndrome”)
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
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
Management
• Etiologic treatment
• Hormonal treatment (Oral Contraceptive
Pills)
• Surgical treatment
• ȘȘHymenotomy if imperforate
hymen
• ȘȘResection of vaginal septum
• ȘȘTumor resection
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
SECONDARY AMENORRHOEA
Definition: Cessation or stopping of
menstruation for a period equivalent to a
length of 3 consecutive cycles or 6 months.
Causes
• --Pregnancy and lactation
• --Menopause
• --Hyopthalamo-putuitary (Inflamamtory, neoplastic,
Traumatic)
• --Stress
• --Anxiety
• --Excessive loss of weight
• --Drugs (danazol, LHRH analogue like decapeptyl)
• --Contraceptives
• --Chronic diseases
• --Multiple genetic disorders
• --Premature ovarian failure (POF)
• --Polycystic ovarian syndrome (PCOS)
• --Traumatic curettage, Post partum infection
(Asherman syndrome)
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
Investigations
• --Hormonal profile
• --Pregnancy test
• --Ultrasound
• --Thyroid test
• --X ray of the skull (turcique selle:
Pituitary) Pituitary tumor or necrosis
• --CT scan
Management
• --Etiologic treatment
• • Hormonal treatment
• --Surgical treatment
• • Tumor resection
• • Lysis of intrauterine synechiae
• --Weight loss
• --Normalize the Body Mass Index (BMI)
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
Dysmenorrhea
Definition: Dysmenorrhea is characterized
by: Pain occurring during menstruation.
Types :
PRIMARY SECONDARY
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
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
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
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
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
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.

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Menstrual abnormalities

  • 2. Most women suffer some form of menstrual disturbances in their lifetime. AMMENHOREA • There are two types: PRIMARY SECONDARY
  • 3. PRIMARY AMENORRHOEA Definition: Absence of menses at 14 years of age without secondary sexual development or age 16 with secondary sexual development.
  • 4. Causes /Risk Factors • --Hypothalamic –pituitary insuficience • --Ovarian causes • --Out flow tract/Anatomical (e.g.vaginal agenesis/septum, imperforated hymen or Mulleriam ageneis) • --Chromosomal (e.g. complete endrogene insensitivity, gonadal dysgenesis”Turner syndrome”)
  • 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
  • 7. Management • Etiologic treatment • Hormonal treatment (Oral Contraceptive Pills) • Surgical treatment • ȘȘHymenotomy if imperforate hymen • ȘȘResection of vaginal septum • ȘȘTumor resection
  • 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
  • 9. SECONDARY AMENORRHOEA Definition: Cessation or stopping of menstruation for a period equivalent to a length of 3 consecutive cycles or 6 months.
  • 10. Causes • --Pregnancy and lactation • --Menopause • --Hyopthalamo-putuitary (Inflamamtory, neoplastic, Traumatic) • --Stress • --Anxiety • --Excessive loss of weight • --Drugs (danazol, LHRH analogue like decapeptyl) • --Contraceptives • --Chronic diseases • --Multiple genetic disorders • --Premature ovarian failure (POF) • --Polycystic ovarian syndrome (PCOS) • --Traumatic curettage, Post partum infection (Asherman syndrome)
  • 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
  • 15. Dysmenorrhea Definition: Dysmenorrhea is characterized by: Pain occurring during menstruation. Types : PRIMARY SECONDARY
  • 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.