The document discusses various topics related to female reproductive health including: 1. It defines amenorrhea as the absence of menstruation and describes its different types and causes. Diagnosis involves taking a history, doing an examination, and running investigations. 2. Oligomenorrhea is defined as infrequent or light menstruation. It has various causes including stress, chronic illness, and eating disorders. 3. Dysmenorrhea is defined as painful menstruation. It can be primary or secondary and has various causes and treatments. 4. Menorrhagia is defined as blood loss greater than 80ml per period. It has various causes like fibroids and treatments including

1. بسم الله الرحمن الرحيم جامعة ام درمان الأسلامية كلية الطب والعلوم الصحية OBESTRICTIC PROBLEM Patch16-Group4 ezpaseva

2. AMENORRHEA DEFINTION Absence of menstruation Types There are 3types 1- 1ry and 2ry 2- true and false 3- physiology and pathology DIAGNOSIS History Examination Investigation TREATMENT

3. oligomenorrhea DEFINTION Is infrequent or light menstruation Menstrual duration : greater than 35day Mean: 4-9 period/day Common at extremes age of reproductive life (ovulation often does not occur) oligomenorrhea

4. CAUSES 1. emotional or physiological stress 2. chronic illness 3. increase level oestrogen 4. eating disorder DIAGNOSIS TREATMENT

5. DYSMENORRHEA DEFINTION Painful menstruation PREVALENCE 45%-95% of women in reproductive age CLASSIFICATION 1-primary 2-secondary

6. AETIOLOGY (1) PRIMARY Duration of menstrual flow of>5days Younger than normal age of menarche Cigarette smoking (2) SECONDARY endometriosis Pelvic inflammatory disease Adenomyosis ( rarely ) cervical stenosis

7. C/F: crampy supra pubic pain INVESTIGATION: history Endocervical swab Pelvic ultrasound Laparoscopy TREATMENT: Medical treatment NSAIDs Oral contraceptive Nifedipine Surgical treatment

8. MENORRHAGIA DEFINTION Blood loss of greater than 80ml/period PREVALENCE Extremely common CLASSIFICATION 1-idiopathic: No organic pathology ( DUB ) 2-secondary: fibroid .

9. AETIOLOGY 1. DUB; unclear but disordered endometrial prostaglandin production has been implicated in the aetiology 2 . secondary;fibroid

10. OTHER PHYSIOLOGY VonWillebrand’s disease Fibroid uterus Endometrial polyp Thyroid disease Drug therapy Bleeding in pregnancy

11. C/F: HISTORY C/examenation ~ physical examenation ~ cervical smear ~ suggest an organic cause ~ Initial investigation {full blood count}

12. TREATMENT MEDICAL treatment Mephanamic acid DANAZOL GESTRINONE GnRHanalogues SURGICAL treatment Endometrial ablation Hysterectomy

13. ABNORMAL PUBERTY Puberty and pubertal changes may occur earlies than normal menstruation + secondary sexual characters become early in life 8-9 years or even 3-4 years of age Puberty and pubertal changes has not developed on 16-17 years old DEFINITION Precocious puberty Delayed puberty Subjective

14. 1. Idiopathic 2. Intracranial lesion 3. Adrenal gland ,ovarian and Thyroid problem 4. Drugs Either constitutional or pathological The pathological causes: 1- chromosomal abnormalities 2- Hypothalamic ,pitutary, Thyroid,Adrenal gland, Ovarian and Uterine causes CAUSES PRE puberty D puberty Subjectives

15. The Idiopathic treated by:- 1- proestrogens 2- Danazol 3- Cyproteroneac- etate 4- LHRHanalogues ----- TREATMENT PRE puberty D puberty Subjectives

16. Sex Hormones & Function GnRH. FSH&LH. Progesterone & Estrogen .

17. GnRH

18. FSH & LH

19. Progesterone & Estrogen Estrogens: 3types estradiol (it is the main estrogen produced by the ovary) ,estriol and esterone. It is a dominant hormone at follicular phase of menstrual cycle. Two cell Theory for estradiol production: -1 LH (low level) stimulate Theca cells

20. Cholesterol androgens 2- FSH (high level) stimulate granulosa cells androgens estrogens Action: 1-secondary sex characteristics of female. 2-proliferation of endometrim during proliferative phase. 3-increase uterine blood flow . 4-development of breast duct. Progesterone: mainly synthesized in the corpus lutum and so it is the dominant hormone in the luteal phase of menstrual cycle. Action : 1-resposible for glandular secretory activity during secretory phase. .

21. Progesterone & Estrogen Estrogens: 3types estradiol (it is the main estrogen produced by the ovary) ,estriol and esterone. It is a dominant hormone at follicular phase of menstrual cycle. Two cell Theory for estradiol production: -1 LH (low level) stimulate Theca cells

22. 2-deciduatization of endometrium in the late luteal phase. 3-devlopment of breast alveoli.

23. Menstrual cycle -Menstruation: means a periodic discharge of sanguineous fluid and a sloughing of uterine lining. -Parameters: frequency - length and amount of the menstrual flow. A- average of menstrual cycle is frequently quoted to be 28 + 2days. B- average of menstrual 5days. C- average of frequency of blood flow is 60 ml.

24. -Endocrine control of MC. -component of MC. -Role of prostaglandin. -Mechanism of uterine bleeding. -Homeostasis in menstrual endometrium.

25. Androgen Excess -Sources of androgen: 1-endocrine gland. 2- peripheral tissue. 3-liver and gut. -androgen excess mains: Abnormal secretion of adrenal and ovarian androgen. -causes: 1-ovarian tumor. 2 -adrenal tumor. 3 -CAH. 4-decreas SHBG. 5-Pcos. 6-cushing syndrome. 7-pregnacy. 8-idiopathaic.

26. -Symptom:1- general appearance :obesity; muscular male body. 2-miscllenous change. 3- menstrual irregulatory. 4- endocrine change. 5- skin changes. 6- acanthosis Nigricans. -Diagnosis: -History. -Lab finding: testosterone ,17hydroxy progesterone, DHEA, dexamethazone, LH,FSH, lipid.

27. 2-Anti androgen. 3-corticosteroids. 4-promocriptin. 5-Insulin sensitive drugs. 6-surigcal . 7-diet. Treatment: 1- oral contraceptive.

28. Pre menstrual Syndromes PMS or PMTS Definition. Prevalence. Etiology: hormonal, social, genetic, vitamin deficiency, others. C/f :nervous,GIT,mastalgia,Fluid retention. D/D . Treatment.

29. Delay or absent Puberty When the menarche has failed to occur at age of 17years old. Failure of menstruation due to pan hypopitutrism is associated with dwarf +endocrine abnormality patient with XO chromosomal pattern and gonadal dysgensis =dwarf. In some patient puberty delayed even the gonads are present +other endocrine function are normal =primary amenorrhea.

30. Precocious & Delayed puberty It is early but normal pattern of puberty due to an early of gonadotrpin secretion form pituitary it is most frequent endocrine symptom of hypothalmic disease. Abnormal exposure to estrogen lead early development of secondary sexual characteristics without gametogensis . Classification of causes precocious puberty: A- true precocious puberty:

31. Cerebral e.g.: disorder involve posterior hypothalamus tumors . Infection. developmental abnormalities. B- precocious pseudo puberty: -no ovarian development. -Adernal:1- congenital virilizing adrenal hyperplasia . 2- esterogen secreting tuomers. -gonadal: granulosa cell tumors of the ovary. pineal tumor may associated with precocious puberty but associated when there is secondary damage to hypothalamus .

32. Hyper prolactinemia -prolactin contain 199 a.a secreted by endometrium and placenta. Action: 1\ causes milk secretion from the breast after estrogen and progesterone priming. Has role in preventing ovulation in lactating mother. 3\ Inhibit the effect gonadotropins by an action at level of ovary. -normal plasma prolactin conc is approximately 5ng/ml in men and 8ng/ml in women.

33. Hyper prolactinemia: in up to 70% of patient with chromophobe adenomas of anterior pituitary have elevated plasma prolactin levels, in some . instances, the elevation may be due to damage of pituitary stalk but in some cases the tumor cells are actually secreting the hormone . Hyper prolactinemia may cause glactorrhea, conversely most women with glactorrhea have normal prolactin levels. Observation that 15-20% of women with secondary amenorrhea have elevated prolactin (by blocking action of gonadotropins in ovaries) when the level decrease the normal menstrual cycle and fertility return. - surgical. - Radio therapy.

34. - Hypogondism produce by prolactinomas is associated with osteoporosis due to estrogen deficiency. Treatment : Bromocriptine or other dopamine agonist - surgical. -Radio therapy.

35. CAST Aml Alnor Razan M Jafer Ejlal Abd Mohamed Marwa Mohamed Eman Abd elrahman Arig Sorage Hana Abdelhafeez Nahlaa Marqani Roqia Solima Wedad A Ahmed Shaza Abdelmonem Rehab Alser Fatma Aalim Alaa Abdella Nada Reem Taqwa Bashir AND Shadin Awad Ahmed EZPASEVA 2008

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