Menarche refers to a girl's first menstrual period and marks the beginning of her fertility. Most girls experience menarche between ages 11-14. Hormonal changes trigger the development of the menstrual cycle. Amenorrhea is the absence of periods and can be primary if periods do not start by age 15, or secondary if a woman stops menstruating. Dysmenorrhea causes painful cramps during periods from prostaglandins released in the uterus. Treatment options depend on the underlying cause.

1. MENARCHE

2. INTRODUCTION
▪ Menarche is defined as the first menstruation, the first menstrual
cycle, or first menstrual bleeding, in female humans and signals the
start of the fertile age.
▪ From both social and medical perspectives, it is often considered the
central event of female puberty.
▪ Menarche is an important milestone that marks the beginning of your
fertility.
▪ Females can get their period as early as 9 or as late as 15.
▪ Most females get their periods between 11 and 14.

3. CAUSES
▪ Females get their first period when their body has matured enough to
support their menstrual cycle. Each month, ovaries produce an egg,
and the lining of uterus thickens. If the female have intercourse, the
egg can become fertilized. A fertilized egg travels to the uterus and
implants in the uterus lining, where it grows into a fetus. If the egg
doesn’t get fertilized, the egg and the uterus lining is shed through the
vagina. The material shed from the uterus each month is called period
blood or menstrual blood.

5. CONT....
Genetics and other factors play a role in triggering menarche:
▪ Heredity: The genes influence when the female get their first period.
Females commonly get their periods when their mother or birthing parent
did.
▪ Hormones: Hormones in the brain and the sex organs regulate the
menstrual cycle and play a role in menarche, too.
▪ Body composition: Height, weight, and fat distribution in the body
influence when the female get their first period.
▪ Health: Stress, poor nutrition and certain health conditions can lead to
later menarche and cause irregular periods.

6. SIGNS AND SYMPTOMS
These symptoms might be noticed by the females:
▪ Cramping (pain or achiness in your belly, back or legs)
▪ Bloating (your belly feels full or swollen)
▪ Tender or sore breasts (chest)
▪ Breakouts (acne/pimples flare-up)
▪ Mood swings
▪ Fatigue (tiredness)

8. MANAGEMENT OF SYMPTOMS
▪ Take a warm bath.
▪ Exercise and stretch.
▪ Place a heating pad or warm washcloth on your belly.
▪ Take medicines that contain ibuprofen or naproxen.

9. PRIMARY AND
SECONDARY
AMENORRHEA

10. INTRODUCTION
▪ Amenorrhea is the absence of menstrual periods. There are two types of
amenorrhea:
▪ Primary amenorrhea: This is when a girl does not get her first period by age
15.
▪ Secondary amenorrhea: This is when a woman who already menstruates does
not get her period for 3 months or more.
▪ About 1 in 4 women who are not pregnant, breastfeeding, or going through
menopause experience amenorrhea at some point in their lives.

11. SYMPTOMS
The main symptom is the lack of periods. Other symptoms depend on the cause.
The female may experience:
▪ Hot flashes
▪ Nipples leaking milk
▪ Vaginal dryness
▪ Headaches
▪ Vision changes
▪ Acne
▪ Excess hair growth on your face and body

12. CAUSES OF PRIMARY
AMENORRHEA
When periods do not start in girls, there may be medical reasons, including:
▪ Genetic conditions, such as Turner syndrome and androgen insensitivity
▪ Problems with the brain (with the hypothalamus or pituitary gland)
▪ Problems with development of the uterus, vagina, or hymen
▪ A delay in puberty

13. CAUSES OF SECONDARY
AMENORRHEA
When periods stop in women who were menstruating and who are not pregnant,
the reasons may include:
▪ Low body weight (about 10 percent under normal weight)
▪ Rapid weight loss
▪ Eating disorders (such as anorexia nervosa)
▪ Problems with the brain (with the hypothalamus or pituitary gland)
▪ Polycystic ovary syndrome (PCOS)

14. CONT....
▪ Problems with the thyroid gland
▪ Primary ovary insufficiency (also called premature ovarian failure)
▪ Stress
▪ Other chronic medical conditions, such as kidney failure
or inflammatory bowel disease (IBD)
Some medications, such as hormonal birth control, can stop periods
while you are taking them. And smoking can increase your risk of
amenorrhea.

15. TREATMENT of primary
amenorrhea
▪ If a teen is going through puberty normally, but a little later than usual, then
typically no treatment is needed. If there is another cause for the delay in
puberty, then the teen may need to see a specialist for treatment.
▪ If primary amenorrhea is caused by the ovaries not producing enough estrogen,
you can discuss using hormone therapy to start puberty and your
periods. Hormone therapy also can help prevent osteoporosis.
▪ Some girls are born with a physical difference that prevents them from having
vaginal bleeding, such as an imperforate hymen, vaginal septum, or uterine scar
tissue. Surgery may be needed in these cases.

16. TREATMENT of secondary
amenorrhea
Treatment for secondary amenorrhea depends on the cause:
▪ Primary ovarian insufficiency: Hormone therapy can replace estrogen
and progesterone, which the ovaries are not able to produce.
▪ PCOS: Treatment may involve weight loss and hormone therapy.
▪ Other causes: The ob-gyn may suggest the female to see an expert in treating
eating disorders, thyroid issues, or other medical problems.
Most females with amenorrhea benefit from a healthy diet and exercise. Reducing
stress also may help. And it is important to consume enough calcium and vitamin
D to help prevent osteoporosis.

17. DYSMENORRHEA

18. DEFINITION
▪ Dysmenorrhea, also known as period pain, painful
periods or menstrual cramps, is pain during menstruation.
▪ Its usual onset occurs around the time that menstruation begins.
▪ Symptoms typically last less than three days.
▪ The pain is usually in the pelvis or lower abdomen.
▪ There are two types of dysmenorrhea: primary and secondary.

19. PRIMARY DYSMENORRHEA
▪ Primary dysmenorrhea is the cramping pain that comes before or
during a period. This pain is caused by natural chemicals
called prostaglandins that are made in the lining of the uterus.
▪ Prostaglandins cause the muscles and blood vessels of the uterus to
contract.
▪ On the first day of a period, the level of prostaglandins is high. As
bleeding continues and the lining of the uterus is shed, the level goes
down.
▪ This is why pain tends to lessen after the first few days of a period.

20. SECONDARY DYSMENORRHEA
▪ Secondary dysmenorrhea is caused by a disorder in the reproductive
organs.
▪ The pain tends to get worse over time and it often lasts longer than
normal menstrual cramps.
▪ For example, the pain may begin a few days before a period starts. The
pain may get worse as the period continues and may not go away after
it ends.

21. SYMPTOMS OF
DYSMENNORRHEA
Symptoms of menstrual cramps include:
▪ Throbbing or cramping pain in your lower abdomen that can be intense
▪ Pain that starts 1 to 3 days before your period, peaks 24 hours after the onset of
your period and subsides in 2 to 3 days
▪ Dull, continuous ache
▪ Pain that radiates to your lower back and thighs