In this presentation Amenorrhea ,menarche, dysmenorrhea and its management are discussed. I hope these slides help you in your studies.

1. MENARCHE,
AMENORRHEA, AND
DYSMENORRHEA

2. MENARCHE

3. 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.

4. 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.

6. 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.

7. 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)

9. 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.

10. PRIMARY AND
SECONDARY
AMENORRHEA

11. 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.

12. 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

13. 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

14. 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)

15. 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.

16. 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.

17. 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.

18. DYSMENORRHEA

19. 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.

20. 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.

21. 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.

22. 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