This document discusses various types of menstrual abnormalities including primary and secondary amenorrhea, dysmenorrhea, and other abnormalities of menstruation. Primary amenorrhea is defined as the absence of menses by age 14 without secondary sexual development or by age 16 with development. Causes include hypothalamic-pituitary issues, ovarian problems, or anatomical abnormalities. Secondary amenorrhea is defined as cessation of menstruation for 3 months or more and can be caused by pregnancy, menopause, diseases, drugs, or genetic disorders. Dysmenorrhea refers to painful periods and can be primary, caused by prostaglandins, or secondary, due to pelvic lesions. Investigations and management are

1. MENSTRUAL
ABNORMALITIES
PREPARED BY:
Mrs. VRUTI PATEL,
LECTURER,
SNC.

2. Most women suffer some form of menstrual
disturbances in their lifetime.
AMMENHOREA
• There are two types:
PRIMARY SECONDARY

3. PRIMARY AMENORRHOEA
Definition:
Absence of menses at 14 years of age
without secondary sexual development or
age 16 with secondary sexual development.

4. Causes /Risk Factors
• --Hypothalamic –pituitary insuficience
• --Ovarian causes
• --Out flow tract/Anatomical (e.g.vaginal
agenesis/septum, imperforated hymen or
Mulleriam ageneis)
• --Chromosomal (e.g. complete endrogene
insensitivity, gonadal dysgenesis”Turner
syndrome”)

5. Signs And Symptoms
• --Absence of menses at age 14 without
secondary sexual development
• --Presence of secondary sexual character
development and absence of menses at
age 16
• --Absence or presence of pelvic pain

6. Investigations
• --Progesterone challenge test
• --Hormonal profile (Serum FSH)
• --Pregnancy test
• Ultrasound
• --Thyroid test
• --Karyotyping
• --X ray of the skull (Sella Turcica: Pituitary)
Pituitary tumor or necrosis
• --CT scan

7. Management
• Etiologic treatment
• Hormonal treatment (Oral Contraceptive
Pills)
• Surgical treatment
• ȘȘHymenotomy if imperforate
hymen
• ȘȘResection of vaginal septum
• ȘȘTumor resection

8. Recommendations
• --Any patient with primary amenorrhea and
high levels of serum FSH should have
karyotyping
• --In cases of androgen insenstivity
syndrome (XYfemale), we should remove
the testes cause of the risk of malignancy

9. SECONDARY AMENORRHOEA
Definition: Cessation or stopping of
menstruation for a period equivalent to a
length of 3 consecutive cycles or 6 months.

10. Causes
• --Pregnancy and lactation
• --Menopause
• --Hyopthalamo-putuitary (Inflamamtory, neoplastic,
Traumatic)
• --Stress
• --Anxiety
• --Excessive loss of weight
• --Drugs (danazol, LHRH analogue like decapeptyl)
• --Contraceptives
• --Chronic diseases
• --Multiple genetic disorders
• --Premature ovarian failure (POF)
• --Polycystic ovarian syndrome (PCOS)
• --Traumatic curettage, Post partum infection
(Asherman syndrome)

11. Signs and symptoms
• --At least 3 consecutive cycles of absence
of menses
• --History of curretage, post partum
infection
• --Galactorrhea
• --Premature monapause
• --Obesity
• --Headache
• --Visual defects
• --Polyuria, Polydipsia

12. Investigations
• --Hormonal profile
• --Pregnancy test
• --Ultrasound
• --Thyroid test
• --X ray of the skull (turcique selle:
Pituitary) Pituitary tumor or necrosis
• --CT scan

13. Management
• --Etiologic treatment
• • Hormonal treatment
• --Surgical treatment
• • Tumor resection
• • Lysis of intrauterine synechiae
• --Weight loss
• --Normalize the Body Mass Index (BMI)

14. Recommendations
• --Patients with premature ovarian failure
should receive hormal replacement
therapy
• --Patients with premature ovarian failure
should receive contraception if they are
not desiring pregnancy
• --IVF and assisted reproduction is an
option if the patient is desiring pregnancy

15. Dysmenorrhea
Definition: Dysmenorrhea is characterized
by: Pain occurring during menstruation.
Types :
PRIMARY SECONDARY

16. Primary dysmenorrhea
• In adolscence with absence of pelvic lesions
after 6 months of menarche
• --6 months after menarche with the onset of
ovular cycles.
• --It is suprapubic, tends to be worst on the
first day of menstruation, and improves
thereafter.
• --Associated with increased frequency and
amplitude of myometrial contractions
mediated by prostaglandins
• --Associated with GIT symptoms like vomiting
and diarrhea

17. Causes
• --Excess secretion of prostaglandins
• --Immaturity of the Hypothalmo- Pituitary -
ovarian axis leading to anovulatory cycle
• --Outflow tract obstruction
Investigations
• --Ultrasound to exclude pelvic lesions
• --Hormonal profile

18. Management
First choice :
• • 80% respond to therapy with
• • NSAIDs started 24-48 hours before the onset
of pain.
• Aspirine 300-600mgPO TDS start 1or 2 days
before the menstruation
• Mefenamic acid PO 500 mg TDS or Ibuprofen
PO 400 mg TDS / day for 3 days.
Alternative
• • Combined oral estrogen-progestogen
contraceptive continued 9-12 months leading to
anovulatory cycles if symptoms improve
• • Surgical treatment: Interruption of pelvic

19. Secondary dysmenorrhea
• Later in reproductive life
• --Presence of pelvic lesion, such as
uterine fibroids or endometrial polyps
• --Pelvic lesions
• --Dyspareunia (pain with intercourse)
• --Pelvic/lower abdominal pain occurring
before, during, after menstruation
• --Pelvic/lower abdominal pain occurring on
days 1 and 2 of the menstrual cycle.
• --An endometrial polyp or submucous
fibroids usually occurring at the beginning
of menstruation cause Pelvic/ lower

20. Investigations
• --FBC ESR or C-reactive protein
• --Vaginal swab,
• --Urinalysis
• --Ultrasound
• --Laparoscopy
• --Hysteroscopy.
Management
• --The underlying condition (surgery,
endometriosis IUD)
• --NSAIDs: Aspirine 300-600mg PO TDS start
1or 2 days before the menstruation
Recommendations
• --Health care providers should explain the
physiologic of dysmennorrhea
• --Regular exercise

21. 1. Menorrhagia : excessively prolonged
menses.
2. Polymenorrohea : occurance of mc
greater than usual frequency.
3. Metrorrhagia : irregular acyclic bleeding
4. Oligomenorrohea : minimal quntity blood
loss
5. Hypomenorrohea : scanty menstruation
that last for less than 2 days.