amenorrhea is a condition when female do not have regular mensural cycles by puberty or due to any causes this ppt can help the patient and nurses to gain knowledge about this disease process and apply their knowledge into their clinical practices

1. Amenorrhea
DEPARTMENT
OF
MEDICAL SURGICAL NURSING

2. Learning objectives
At the end of the class the students will be able
to
• define amenorrhea.
• enlist the types of amenorrhea.
• enumerate etiology of amenorrhea .
• describe the management of amenorrhea.

3. Amenorrhea
Definition : amenorrhea means the absence of
menses.
• Amenorrhea Is the absence or abnormal
cessation of the menses. It can be Physiologial
Amenorrhea Pathologial Amenorrhea

4. Types
• Primary Amenorrhea : age 16 years
• Secondary Amenorrhea : 6 months or 12
months in a women with a history of irregular
bleeding.

5. Etiology and risk factors
• Primary amenorrhea
Hypothalamus : anorexia nervosa
strenuous exercise
GnRH deficiency
congenital defects
tumor

6. • Pituitary : Prolactinoma
Hyperprolactinemia
Hypopituitarism
• Thyroid : Hypothyroidism
• Adrenal : Congenital Adrenal hyperplasia
Adenomas/Carcinoma

7. • Ovarian : Ovarian Failure
Polycystic Ovary Disease
• Vaginal : Vaginal Agenesis
Transverse Vaginal Septum
Imperforated hymen

8. Secondary amenorrhea
• Hypothalamus : Anorexia nervosa
Weight loss
Strenuous exercise
Systemic disease
Tumor

9. • Pituitary : Prolactinoma
Hyperprolactinemia
• Thyroid : Hypothyroidism
Hyperthyroidism
• Adrenal : Congenital adrenal hyperplasia
Adenomas/carcinoma
Cushing’s disease

10. • Ovarian : Ovarian failure
Tumors
• Extra uterine : Ectopic pregnancy
• Uterine : Intrauterine pregnancy.
Trophoblastic disease.

11. Clinical feature
• The main sign of amenorrhea is the absence
of menstrual periods. Depending on the cause
of amenorrhea, you might experience other
signs or symptoms along with the absence of
periods, such as:
• Milky nipple discharge
• Hair loss

12. • Headache
• Vision changes
• Excess facial hair
• Pelvic pain
• Acne

13. Diagnosis evaluation
Certain type of primary amenorrhea are of
heredofamilial in nature.
history collection
Physical examination

14. • CBC
• X-ray chest
• Biopsy
• USG
• UPT
• FSH
• T3T4TSH

15. Investigations secondary
• CT Scan
• MRI
• Prolactin test
• Serum testosterone
• Laparoscopy (hysteroscopy)

16. Management
Primary amenorrhea
Medical management
Treatment depends on the women's needs and
the cause of the amenorrhea.

17. Management
I. No Abnormality Detected
• The patient is anxious for amenorrhea but
not for fertility.
• The patient is anxious for fertility

18. • II. Cases with detectable cause.
(i) Anxiety and stress-
(ii) Systemic illness and malnutrition
(iii) Exercise induced amenorrhea is cured with
limitation of activity and appropriate diet.
• III. PCOS – management of PCOS
• Tumor :Appropriate surgery is done.

19. Developmental anomalies
• Complete agenesis of vagina:
Vaginal reconstruction is the accepted form of
treatment.

20. Hypothalamo-pituitary ovarian axis
defect
• Hypothalamic-pituitary tumors may need surgical
excision or radiotherapy.
• Thyroid and adrenal dysfunction:

21. Metabolic and nutritional
• Diabetes and tuberculosis are to be treated
by antidiabetic and antitubercular drug
respectively.
• Correction of anemia
• Correction of malabsorption,.

22. Nursing management
• Rule out pregnancy –
• Ask about the presence of manifestations of
pregnancy.
• Provide teaching : teaching opportunities are
an important part of nursing care.

23. Summary
• So far we have discussed about Definition,
types, etiology, clinical manifestation,
diagnostic evaluation and management of
Amenorrhea.

24. Bibliography
• Lewis et al, Medical Surgical Nursing, Mosby
Elsevier,7th edition.
• Joyce.M.Black et al, Medical Surgical Nursing,
Saunders publication.
• Brunner and Siddhartha, Medical Surgical
Nursing, Lippincott Williams and Wilkins.

25. Thank You