Menstrual desorder

1. TOPIC: MENSTRUATION DIS ORDERS
PREPARED BY;
IRADUKUNDA EMMANUEL
NIKUZE MARIE CHANTAL

2. MENSTRUATION DIS ORDER
1. Amenorrhea:
Absence of menstrual flow, is a clinical sign of a
variety of disorders.
absence of both menarche and secondary
sexual characteristics by age 14 years and 16
years, regardless of presence of normal
growth and development and to 6-month
absence of menses after a period of
menstruation.

3. Cont’t
• Although amenorrhea is not a disease, it is
often the sign of one. Still, most commonly
and most benignly, amenorrhea is a result of
pregnancy

4. Cont’t
• It also can result from anatomic abnormalities
such as outflow tract obstruction, anterior
pituitary disorders, other endocrine disorders
such as polycystic ovary syndrome,
hypothyroidism or hyperthyroidism, chronic
diseases such as type 1 diabetes.

5. Cont’t
• Hypogonadotropic amenorrhea reflects a
problem in the central hypothalamic-pituitary
axis. In rare instances a pituitary lesion or
genetic inability to produce FSH and LH is at
fault.

6. Management of amenorrhera
• Counseling and education are primary
interventions and appropriate nursing roles
• initial management involves addressing the
stressor. like reducing weight and other
stressors

7. 2.Dysmenorrhea,
• pain during or shortly before menstruation, is
one of the most common gynecologic
problems in women of all ages.
• Many adolescents have dysmenorrhea in the
first 3 years after menarche

8. Cont’t
• Menstrual problems,including dysmenorrhea,
are relatively more common in women who
smoke and are obese
• Pain is usually located in the suprapubic area
or lower abdomen.Women describe the pain
as sharp, cramping, or gripping or as a steady
dull ache.

9. CONT’T
• Primary dysmenorrhea is a condition
associated with ovulatory cycles.
• Primary dysmenorrhea usually appears 6 to 12
months after menarche when ovulation is
established

10. Management of primary
dysmenorrhea
• Massaging the lower back can reduce pain by relaxing
paravertebral muscles and increasing the pelvic blood
supply,
• Hatha yoga, acupuncture, and meditation are also used
to decrease menstrual discomfort like NSAID’s
• Exercise helps relieve menstrual discomfort through
increased vasodilation and subsequent decreased
ischemia
• maintaining good nutrition at all times, specific dietary
changes are helpful.

11. Secondary dysmenorrhea
• It is acquired menstrual pain that develops
later in life than primary dysmenorrhea,
typically after age 25 years.
This condition is associated with pelvic
pathology, such as adenomyosis,
endometriosis, pelvic inflammatory disease,
endometrial polyps

12. Cont’t
• In contrast to primary dysmenorrhea, the pain
of secondary dysmenorrheal is often
characterized by dull, lower abdominal aching
radiating to the back or thighs. Often women
experience feelings of bloating or pelvic
fullness.

13. Diagnosis
• physical examination with a careful pelvic
examination, diagnosis may be assisted by
ultrasound examination, dilation and
curettage, endometrial biopsy, or laparoscopy.

14. Management of secondary
dysmenorrhea
• Treatment is directed toward removing the
underlying pathology. Many of the measures
described for pain relief of primary
dysmenorrhea also are helpful for women
with secondary dysmenorrhea.

15. 3.Endometriosis
• Endometriosis is characterized by the presence
and growth of endometrial glands and stroma
outside of the uterus.
• The tissue may be implanted on the ovaries; the
anterior and posterior culde- sac; the broad,
uterosacral, and round ligaments; the uterine
tubes; the rectovaginal septum; the sigmoid
colon; the appendix; the pelvic peritoneum;

16. Symptoms of endometriosis
• The major symptoms of endometriosis are
pelvic pain, dysmenorrhea, dyspareunia
(painful intercourse), abnormal menstrual
bleeding, and infertility
• diarrhea,
• pain with defecation, and constipation

17. Management of endometriosis
• Treatment is based on the severity of
symptoms and the goals of the woman or
couple.
• Women without pain who do not want to
become pregnant need no treatment.
• In women with mild pain who may desire a
future pregnancy, treatment may be limited to
use of NSAIDs during menstruation

18. Management of endometriosis
• Primary symptoms can be treated by
postpone pregnancy by using oral
contraceptive pills or that have a low
estrogen-to-progestin ratio to shrink
endometrial tissue.

19. Management cont’t
• Continuous combined hormone therapy
(OCPs, estrogen/progestin patch,
estrogen/progestin vaginal ring) for menstrual
suppression and administration of NSAIDs is
the usual treatment for adolescents younger
than the age of 16 who have endometriosis.

20. 4. Oligomenorrhea/Hypomenorrhea
• The term oligomenorrhea often is used to
describe decreased menstruation, either in
amount, time, or both.
• Hypomenorrhea also may be caused by
structural abnormalitiesof the endometrium
or the uterus that result in partial
disintegration of the endometrium

21. Causes of oligomenorrhea
• The causes of oligomenorrhea are often
abnormalities of hypothalamic, pituitary, or
ovarian function. Oligomenorrhea also can be
physiologic, or part of a woman’s normal
pattern for the first few years after menarche
or for several years before menopause

22. Management
• . Hormonal therapy using progestins, with or
without estrogens, also may be used to
prevent complications of unopposed estrogen
production (endometrial hyperplasia or
carcinoma) or of absent estrogen (vaginal
dryness, hot flashes or flushes, or
osteoporosis).

23. 5. Metrorrhagia
• Metrorrhagia, or intermenstrual bleeding,
refers to any episode of bleeding, whether
spotting, menses, or hemorrhage, that occurs
at a time other than the normal menses

24. CONT’T
• Women taking OCPs may have midcycle
bleeding or spotting.Progestin-only
contraceptive methods (oral and injectable)
also may cause midcycle bleeding, especially
in the first several cycles
• Also women with an intrauterine device (IUD)
may have spotting between their periods and
possibly heavier menstrual flow.

25. Management of metrorragia
• Treatment of intermenstrual bleeding
depends on the cause and may include
reassurance and education concerning
observation of three menstrual cycles for
suspected functional ovarian cyst, adjustment
of an OCP, removal of foreign bodies, and
treatment for vaginal infections may aslo need
NSAID’s

26. 6. Menorrhagia
• Menorrhagia (hypermenorrhea) is defined as
excessive menstrual bleeding, in either
duration or amount. The causes of heavy
menstrual bleeding are many, including
hormonal disturbances, systemic disease,
benign and malignant neoplasms, infection,
and contraception (IUDs).

27. Cont’t
• Infectious and inflammatory processes such as
acute or chronic endometritis and salpingitis
may cause heavy menstrual bleeding.
• Medications also may cause abnormal
bleeding. Chemotherapy, anticoagulants,
neuroleptics, and steroid hormone therapy all
have been associated with excessive flow.

28. Treatment for menorrhagia
• Treatment for menorrhagia depends on the
cause of the bleeding. If the bleeding is
related to the contraceptive method, the
nurse provides factual information and
reassurance and discusses other contraceptive
options
• If it due to presence of fibroids,treatment
options include medical and surgical
management

29. 7.Dysfunctional Uterine Bleeding
• Abnormal uterine bleeding (AUB) is any form
of uterine bleeding that is irregular in amount,
duration, or timing and not related to regular
menstrual bleeding
• DUB is most frequently caused by anovulation.
When there is no surge of LH, or if insufficient
progesterone is produced by the corpus
luteum to support the endometrium, it will
begin to involute and shed

30. Management
• If the bleeding has not stopped in 12 to 24 hours,
dilation and curettage (D&C) may be done to
control severe bleeding and hemorrhage. An
endometrial biopsy may be collected at the same
time to evaluate endometrial tissue or rule out
endometrial cancer.
• If the recurrent, heavy bleeding is not controlled
by hormonal therapy or D&C, ablation of the
endometrium through laser treatment may be
performed.