This document provides information about disorders of the menstrual cycle. It discusses amenorrhea, which is the absence of menstrual periods, and outlines its various causes including natural states, contraceptive use, medications, lifestyle factors, and hormonal or structural issues. Signs and symptoms of amenorrhea are described. The diagnostic process and treatment options for restoring normal menstruation are also outlined. The document then discusses premenstrual syndrome, including common symptoms, potential causes, and treatment approaches like antidepressants, NSAIDs, diuretics, and lifestyle modifications.

1. Program: B.Sc Nursing, 3rd Year
BNSG-501 MSN
Unit No.4.
Topic- Disorders of Menstrual Cycle
Lecture No. 8
Dr. Sudharani B Banappagoudar
Professor, SONS/OBG
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BNSG 501

2. Outline
 Introduction
 Learning outcomes
 Exercise
 References
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BNSG 501

3. TOPIC-REPRODUCTIVE TRACT ANAMOLIES
INTRODUCTION
FEMALE REPRODUCTIVE SYSTEM
INDIFFERENT EMBRYO
DEVELOPMENT OF GENITAL DUCTS
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BNSG 501

4. Objectives
• The student will be able to Explain
• Introduction
 Female reproductive system
 Indifferent embryo
 Development of genital ducts
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BNSG 501

6. • AMENORRHOEA

7. • Amenorrhoea is the absence of a
menstrual period in a woman of
reproductive age.

8. • Physiological states of amenorrhoea
are seen, most commonly, during
pregnancy and lactation
(breastfeeding), the latter also
contraception known as
forming the basis of a form of
the
lactational amenorrhoea method.
• Outside of the reproductive years
there is absence of menses during
childhood and after menopause.

9. • Primary amenorrhoea (menstrual cycles
never starting) may be caused by
developmental problems such as,
• the congenital absence of the uterus,
• failure of the ovary to receive or maintain
egg cells.

10. • It is defined as an absence of
secondary sexual characteristics by
age 14 with no menarche or normal
secondary sexual characteristics but
no menarche by 16 years of age.

11. • Secondary amenorrhoea (menstrual
cycles ceasing) is often caused by
hormonal disturbances from the
hypothalamus and the pituitary gland,
from premature menopause or
intrauterine scar formation.
• It is defined as the absence of
menses for three months in a woman
with previously normal menstruation or
nine months for women with a history
of oligomenorrhoea.

12. 1. Natural amenorrhea
• During the normal course of life,
women may experience amenorrhea
for natural reasons, such as:
• Pregnancy
• Breast-feeding
• Menopause

13. 2. Contraceptives
• Some women who take birth control
pills may not have periods. Even after
stopping oral contraceptives, it may
take some time before regular
ovulation and menstruation return.
Contraceptives that are injected or
implanted also may cause
amenorrhea, as can some types of
intrauterine devices.

14. 3. Medications
• Certain medications can cause
menstrual periods to stop, including
some types of:
• Antipsychotics
• Cancer chemotherapy
• Antidepressants
• Blood pressure drugs
• Allergy medications

15. 4. Lifestyle factors
• Sometimes lifestyle factors contribute to
amenorrhea, for instance:
• Low body weight. Excessively low body
weight — about 10 percent under normal
weight — interrupts many hormonal
functions in your body, potentially halting
ovulation. Women who have an eating
disorder, such as anorexia or bulimia,
often stop having periods because of
these abnormal hormonal changes.

16. • Excessive exercise. Women who
participate in activities that require rigorous
training, such as ballet, may find their
menstrual cycles interrupted. Several
factors combine to contribute to the loss of
periods in athletes, including low body fat,
stress and high energy expenditure.

17. • Stress. Mental stress can temporarily
alter the functioning of your
hypothalamus — an area of your
brain that controls the hormones that
regulate your menstrual cycle.
Ovulation and menstruation may stop
as a result. Regular menstrual
after your
periods usually resume
stress decreases.

18. 5. Hormonal imbalance
• Many types of medical problems can
cause hormonal imbalance, including:
• Polycystic ovary syndrome (PCOS).
PCOS causes relatively high and
sustained levels of hormones, rather
than the fluctuating levels seen in the
normal menstrual cycle.

19. • Thyroid malfunction. An overactive
thyroid gland (hyperthyroidism) or
underactive thyroid gland
(hypothyroidism) can cause
menstrual irregularities, including
amenorrhea.

20. • Pituitary tumor. A noncancerous
(benign) tumor in your pituitary gland
can interfere with the hormonal
regulation of menstruation.

21. • Premature menopause. Menopause
usually begins around age 50. But,
for some women, the ovarian supply
of eggs diminishes before age 40,
and menstruation stops.

22. 6. Structural problems
• Problems with the sexual
themselves also can
organs
cause
amenorrhea. Examples include:
• Uterine scarring. Asherman's
syndrome, a condition in which scar
tissue builds up in the lining of the
uterus, can sometimes occur after a
dilation and curettage (D&C), cesarean
section or treatment for uterine fibroids.
Uterine scarring prevents the normal
buildup and shedding of the uterine
lining.

23. • Lack of reproductive organs.
Sometimes problems arise during
fetal development that lead to a girl
being born without some major part of
her reproductive system, such as her
uterus, cervix or vagina. Because her
reproductive system didn't develop
normally, she can't have menstrual
cycles.

24. • Structural abnormality of the
vagina. An obstruction of the vagina
may prevent visible menstrual
bleeding. A membrane or wall may be
present in the vagina that blocks the
outflow of blood from the uterus and
cervix.

25. • 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

26. • Headache
• Vision changes
• Excess facial hair
• Pelvic pain
• Acne
• Vaginal dryness
• Night sweats

27. • History collection
• Physical examination
• Blood tests may be performed to
determine the levels of hormones
secreted by the pituitary gland (FSH,
LH, TSH, and prolactin) and the
ovaries (estrogen).

28. • Ultrasonography of the pelvis may be
performed to assess the abnormalities
of the genital tract or to look for
polycystic ovaries.
• CT scan or MRI of the head may be
performed to exclude pituitary and
hypothalamic causes of amenorrhea.

29. • If the above tests are inconclusive,
additional tests may be performed
including:
• Thyroid function tests
• Determination of prolactin levels
• Hysterosalpingogram (X-ray test)
which examine the uterus
• Hysteroscopy

30. • Dopamine agonists such as bromocriptine
(Parlodel) or pergolide (Permax), are
effective in treating hyperprolactinemia. In
most women, treatment with dopamine
agonists medications restores normal
ovarian endocrine function and ovulation.
• Hormone replacement therapy consisting
of an estrogen and a progestin can be used
for women in whom estrogen deficiency
remains because ovarian function cannot be
restored.

31. • Metformin (Glucophage) is a drug
that has been successfully used in
women with polycystic ovary
syndrome to induce ovulation.

32. • In some cases, oral contraceptives may
be prescribed to restore the menstrual
cycle and to provide estrogen
replacement to women with amenorrhea
who do not wish to become pregnant.
• Before administering oral contraceptives,
withdrawal bleeding is induced with an
administration of 5-10 mg
injection of progesterone or oral
of
10
medroxyprogesterone (Provera) for
days.

33. • Some pituitary and hypothalamic
tumors may require surgery and, in
some cases, radiation therapy.
• Women with intrauterine adhesions
require dissolution of the scar tissue.

34. •PREMENSTRUAL
SYNDROME
(PMS)

35. • Premenstrual syndrome (PMS) refers
to physical and emotional symptoms
that occur in the one to two weeks
before a woman's period. Symptoms
often vary between women and
resolve around the start of bleeding.

36. • Common symptoms include acne,
tender breasts, bloating, feeling tired,
irritability, and mood changes. Often
symptoms are present for around six
days.
• Premenstrual dysphoric disorder
(PMDD) is a more severe form of PMS
that has greater psychological
symptoms.

37. • Exactly what causes premenstrual
syndrome is unknown, but several
factors may contribute to the
condition:
• Cyclic changes in hormones. Signs
and symptoms of premenstrual
syndrome change with hormonal
fluctuations and disappear with
pregnancy and menopause.

38. • Chemical changes in the brain.
Fluctuations of serotonin, a brain
chemical (neurotransmitter) that is
thought to play a crucial role in mood
states, could trigger PMS symptoms.
Insufficient amounts of serotonin may
contribute to premenstrual
depression, as well as to fatigue, food
cravings and sleep problems.

39.  Emotional and behavioral symptoms
• Tension or anxiety
• Depressed mood
• Crying spells
• Mood swings and irritability or anger

40. • Appetite changes and food cravings
• Trouble falling asleep (insomnia)
• Social withdrawal
• Poor concentration

41. Physical signs and symptoms
• Joint or muscle pain
• Headache
• Fatigue
• Weight gain related to fluid retention
• Abdominal bloating
• Breast tenderness
• Acne
• Constipation or diarrhea

42. are no unique physical
or laboratory tests to
diagnose premenstrual
• There
findings
positively
syndrome.

43. • Antidepressants. Selective serotonin
reuptake inhibitors (SSRIs) — which
include fluoxetine (Prozac, Sarafem),
paroxetine (Paxil, Pexeva), sertraline
(Zoloft) and others — have been
successful in reducing mood symptoms.
SSRIs are the first line treatment for
severe PMS or PMDD. These drugs are
generally taken daily. But for some
women with PMS, use of
antidepressants may be limited to the
two weeks before menstruation
begins.

44. • Nonsteroidal anti-inflammatory
drugs (NSAIDs). Taken before or at
the onset of your period, NSAIDs
such as ibuprofen (Advil, Motrin IB,
others) or naproxen (Aleve,
Naprosyn, others) can ease cramping
and breast discomfort.

45. • Diuretics. When exercise and limiting
salt intake aren't enough to reduce
the weight gain, swelling and bloating
of PMS, taking water pills (diuretics)
can help your body shed excess fluid
through your kidneys.
Spironolactone (Aldactone) is a
diuretic that can help ease some of
the symptoms of PMS.

46. • Hormonal contraceptives. These
prescription medications stop
ovulation, which may bring relief from
PMS symptoms.

47. • Eat smaller, more-frequent meals to reduce
bloating and the sensation of fullness.
• Limit salt and salty foods to reduce bloating
and fluid retention.
• Choose foods high in complex carbohydrates,
such as fruits, vegetables and whole grains.
• Choose foods rich in calcium. If you can't
tolerate dairy products or aren't getting
adequate calcium in your diet, a daily calcium
supplement may help.
• Avoid caffeine and alcohol.

48. • Engage in at least 30 minutes of brisk
walking, cycling, swimming or other
aerobic activity most days of the
week. Regular daily exercise can help
improve your overall health and
alleviate certain symptoms, such as
fatigue and a depressed mood.

49. • Get plenty of sleep.
• Practice progressive muscle
relaxation or deep-breathing
exercises to help reduce headaches,
anxiety or trouble sleeping
(insomnia).
• Try yoga or massage to relax and
relieve stress.

50. • Keep a record to identify the triggers
and timing of your symptoms. This
will allow you to intervene with
strategies that may help to lessen
them.