1. The document discusses physiology of menstruation and menstrual disorders. It provides definitions for various terms used to describe abnormal menstruation such as menorrhagia, metrorrhagia, and oligomenorrhea.
2. Heavy menstrual bleeding (HMB), also known as menorrhagia, can be caused by structural issues like fibroids, polyps or adenomyosis or non-structural issues like anovulation. Common symptoms of HMB include soaking pads frequently and having to change protection every hour.
3. Investigation of HMB involves full blood count, coagulation screening, ultrasound, and possibly endometrial biopsy. Treatment requires considering the patient's preferences, risks
Implantation of the blastocyst in the uterine lining leads to formation of the placenta and fetal membranes. The ovarian cycle results in follicular development and ovulation. The decidua forms from secretory endometrium under the influence of estrogen and progesterone. Implantation involves apposition, adhesion and invasion of the trophoblast into the decidua. The placenta develops from chorionic villi and undergoes remodeling of the maternal spiral arteries to establish maternal blood flow to the intervillous space. The fetal membranes, including the amnion and chorion, develop and enclose the developing embryo.
The document summarizes the physiology of the human menstrual cycle. It describes the hormonal interplay between the hypothalamus, pituitary gland, and ovaries that regulates the cycle. Key points include:
- The hypothalamus secretes GnRH in pulses, stimulating the pituitary to release FSH and LH. These regulate follicle development and ovulation.
- Estrogen levels rise in the follicular phase, triggering the LH surge and ovulation. After ovulation, the corpus luteum forms and secretes progesterone to prepare the uterus if implantation occurs.
- If implantation does not occur, progesterone levels drop and menstruation begins, restarting the cycle. A complex feedback system precisely regulates hormone production throughout
This document summarizes the female reproductive cycle. It describes the ovarian cycle and uterine cycle, which include hormonal changes and cyclical changes in the breasts and cervix. The reproductive cycle has four phases - menstrual, pre-ovulatory, ovulatory, and post-ovulatory. During the menstrual phase, the endometrium is shed. In the pre-ovulatory phase, a dominant follicle develops under rising estrogen levels. Ovulation occurs when the dominant follicle ruptures around day 14. In the post-ovulatory phase, the corpus luteum forms and secretes progesterone to prepare the uterus for potential implantation. The cycle repeats if implantation does not occur.
The menstrual cycle in human females involves both an ovarian cycle and uterine cycle. The ovarian cycle involves the release of a mature egg once every 28 days, while the uterine cycle prepares the uterus for potential pregnancy. There are four phases of the menstrual cycle: menstruation, follicle, ovulation, and corpus luteum. The menstruation phase involves bleeding and shedding of the uterine lining. The follicle phase stimulates follicle development through FSH. Ovulation occurs during the ovulation phase when LH causes the release of an egg. During the corpus luteum phase, the ruptured follicle forms the corpus luteum which produces progesterone to maintain the uterine lining if fertilization occurs.
Physiology of menstruation by av sharmaajay sharma
The document summarizes the physiology of menstruation. It describes the hypothalamic-pituitary-ovarian axis that regulates the menstrual cycle. The cycle consists of two concurrent cycles - the ovarian cycle and the uterine cycle. The ovarian cycle includes the follicular phase where a follicle is selected for ovulation, and the luteal phase where the corpus luteum forms. The uterine cycle includes the proliferative phase where the endometrium thickens in response to estrogen, and the secretory phase where it is remodeled by progesterone in preparation for implantation. If implantation does not occur, hormone levels drop and the endometrium breaks down and is shed, resulting in menstruation.
Top Five Problems You Have with Ovulation Induction and How to Solve ThemSandro Esteves
The document discusses the top five problems with ovulation induction and how to solve them. It addresses whether protocols need to be individualized, how long clomiphene citrate should be used, the advantages of recombinant versus urinary gonadotropins, the advantages of recombinant versus urinary hCG, and whether LH supplementation is needed. It provides evidence-based recommendations including that protocols should be tailored based on biomarkers and individual factors, clomiphene citrate is usually first-line for up to 3 cycles, and recombinant gonadotropins yield higher pregnancy rates than clomiphene without increased risks.
Menstrual disorders are common reasons for women to see their doctor. They include menorrhagia (excessive bleeding), dysmenorrhea (painful periods), and amenorrhea/oligomenorrhea (absent or infrequent periods). Menorrhagia is defined as blood loss over 80ml and affects around 5% of women annually. It can be caused by pelvic issues, systemic diseases, or dysfunctional uterine bleeding. Treatment involves addressing the underlying cause, using medications like NSAIDs or hormonal drugs, or pursuing surgical options like endometrial ablation or hysterectomy if medications fail. A thorough history, examination, and testing are required to diagnose the cause and properly manage menorrhagia.
Implantation of the blastocyst in the uterine lining leads to formation of the placenta and fetal membranes. The ovarian cycle results in follicular development and ovulation. The decidua forms from secretory endometrium under the influence of estrogen and progesterone. Implantation involves apposition, adhesion and invasion of the trophoblast into the decidua. The placenta develops from chorionic villi and undergoes remodeling of the maternal spiral arteries to establish maternal blood flow to the intervillous space. The fetal membranes, including the amnion and chorion, develop and enclose the developing embryo.
The document summarizes the physiology of the human menstrual cycle. It describes the hormonal interplay between the hypothalamus, pituitary gland, and ovaries that regulates the cycle. Key points include:
- The hypothalamus secretes GnRH in pulses, stimulating the pituitary to release FSH and LH. These regulate follicle development and ovulation.
- Estrogen levels rise in the follicular phase, triggering the LH surge and ovulation. After ovulation, the corpus luteum forms and secretes progesterone to prepare the uterus if implantation occurs.
- If implantation does not occur, progesterone levels drop and menstruation begins, restarting the cycle. A complex feedback system precisely regulates hormone production throughout
This document summarizes the female reproductive cycle. It describes the ovarian cycle and uterine cycle, which include hormonal changes and cyclical changes in the breasts and cervix. The reproductive cycle has four phases - menstrual, pre-ovulatory, ovulatory, and post-ovulatory. During the menstrual phase, the endometrium is shed. In the pre-ovulatory phase, a dominant follicle develops under rising estrogen levels. Ovulation occurs when the dominant follicle ruptures around day 14. In the post-ovulatory phase, the corpus luteum forms and secretes progesterone to prepare the uterus for potential implantation. The cycle repeats if implantation does not occur.
The menstrual cycle in human females involves both an ovarian cycle and uterine cycle. The ovarian cycle involves the release of a mature egg once every 28 days, while the uterine cycle prepares the uterus for potential pregnancy. There are four phases of the menstrual cycle: menstruation, follicle, ovulation, and corpus luteum. The menstruation phase involves bleeding and shedding of the uterine lining. The follicle phase stimulates follicle development through FSH. Ovulation occurs during the ovulation phase when LH causes the release of an egg. During the corpus luteum phase, the ruptured follicle forms the corpus luteum which produces progesterone to maintain the uterine lining if fertilization occurs.
Physiology of menstruation by av sharmaajay sharma
The document summarizes the physiology of menstruation. It describes the hypothalamic-pituitary-ovarian axis that regulates the menstrual cycle. The cycle consists of two concurrent cycles - the ovarian cycle and the uterine cycle. The ovarian cycle includes the follicular phase where a follicle is selected for ovulation, and the luteal phase where the corpus luteum forms. The uterine cycle includes the proliferative phase where the endometrium thickens in response to estrogen, and the secretory phase where it is remodeled by progesterone in preparation for implantation. If implantation does not occur, hormone levels drop and the endometrium breaks down and is shed, resulting in menstruation.
Top Five Problems You Have with Ovulation Induction and How to Solve ThemSandro Esteves
The document discusses the top five problems with ovulation induction and how to solve them. It addresses whether protocols need to be individualized, how long clomiphene citrate should be used, the advantages of recombinant versus urinary gonadotropins, the advantages of recombinant versus urinary hCG, and whether LH supplementation is needed. It provides evidence-based recommendations including that protocols should be tailored based on biomarkers and individual factors, clomiphene citrate is usually first-line for up to 3 cycles, and recombinant gonadotropins yield higher pregnancy rates than clomiphene without increased risks.
Menstrual disorders are common reasons for women to see their doctor. They include menorrhagia (excessive bleeding), dysmenorrhea (painful periods), and amenorrhea/oligomenorrhea (absent or infrequent periods). Menorrhagia is defined as blood loss over 80ml and affects around 5% of women annually. It can be caused by pelvic issues, systemic diseases, or dysfunctional uterine bleeding. Treatment involves addressing the underlying cause, using medications like NSAIDs or hormonal drugs, or pursuing surgical options like endometrial ablation or hysterectomy if medications fail. A thorough history, examination, and testing are required to diagnose the cause and properly manage menorrhagia.
This document outlines the key stages of fetal development from conception to birth. It describes the processes of conception, fertilization and implantation that occur in the first 4 weeks. The major developmental changes that happen in each trimester are then outlined, including the formation of major organs in the first trimester, rapid growth and development in the second trimester, and further physical maturation in the third trimester as the fetus prepares for birth. Factors that can influence normal fetal growth rates are also briefly discussed.
The document provides an overview of normal labour, including definitions, criteria, components, anatomy, onset, stages, monitoring and management. It defines labour and normal labour. The criteria for normal labour includes spontaneous expulsion of a single, full-term fetus presented by vertex within 3-18 hours without complications. The components are the passage (birth canal), passenger (fetus), and power (uterine contractions and abdominal muscles). It describes the anatomy of the female pelvis and fetal skull, as well as the onset, three stages and mechanism of labour. Intrapartum monitoring includes monitoring the mother's temperature, pulse, blood pressure and urine as well as fetal monitoring. Management includes pain relief, hydration, fetal monitoring and managing
The document summarizes the development of the female reproductive system. It begins with the formation of the genital ridge in the intermediate mesoderm at 3 weeks. At 5-6 weeks, primordial germ cells form the indifferent gonad. In the absence of the Y chromosome, the gonad develops into an ovary with cortical cords and primordial follicles. The ovaries descend into the pelvis guided by the gubernaculum. Meanwhile, the paramesonephric ducts form the fallopian tubes, uterus and upper vagina. The vagina develops from the sinovaginal bulbs and vaginal plate. Remnants of the mesonephric ducts include the epoophoron and
This document discusses uterine compression sutures as a technique to control postpartum hemorrhage. It begins by explaining that postpartum hemorrhage is the leading cause of maternal mortality worldwide. Uterine compression sutures involve applying sutures externally to the uterus in various patterns to promote uterine contraction and compression of blood vessels, similar to manual compression. The sutures act as a brace for the uterus. Indications for uterine compression sutures include atonic PPH, abnormal placentation, coagulopathy, and as prophylaxis for high risk patients. Both absorbable and non-absorbable suture materials can be used.
Luteal Phase Support: Key Variables to Achieve Success in ARTSandro Esteves
This document discusses luteal phase support in assisted reproductive technology cycles. It covers:
1. The pathophysiology of the luteal phase defect in stimulated cycles and the role of progesterone supplementation.
2. Different luteal phase support protocols after hCG trigger in fresh embryo transfer cycles, including progesterone alone versus progesterone plus hCG or GnRH agonist.
3. Luteal phase support considerations for frozen embryo transfer cycles, including the type and timing of estrogen and progesterone administration.
The document discusses female reproductive physiology, describing the stages from puberty through menopause. It focuses on the menstrual cycle, explaining the hormonal regulation of the hypothalamic-pituitary-ovarian axis and the cyclic changes that occur in the ovaries and endometrium under the influence of estrogen and progesterone. During the proliferative phase, estrogen stimulates endometrial growth, while the secretory phase is characterized by the effects of progesterone on the endometrium to prepare for potential implantation.
1) ART pregnancies have some differences from natural pregnancies that require special care and monitoring, such as progesterone and estrogen supplementation due to the absence of a corpus luteum in some cases.
2) Multiple pregnancies are a major risk factor for ART pregnancies and require close monitoring due to higher risks of preterm birth and low birth weight.
3) While antenatal care is largely the same for ART and natural pregnancies, ART pregnancies have slightly higher risks of complications like preterm birth and birth defects, so careful screening and management is important.
Recent advances in endometriosis were discussed. Endometriosis is a chronic disease where endometrial tissue grows outside the uterus, affecting around 10% of women. Dienogest, a progestin, was shown to be effective in reducing endometriosis-associated pelvic pain in randomized controlled trials. Dienogest 2mg daily for 24 weeks provided pain relief similar to leuprolide acetate but with fewer side effects. Long-term use of dienogest for 65 weeks maintained pain relief with a favorable safety profile. Dienogest was as effective as goserelin in reducing postoperative recurrence of endometriosis at 24 months.
Ovulation Stimulation Protocols for IUI - Dr Dhorepatil BharatiBharati Dhorepatil
What are important factors to be considered important
Ovarian reserve
Previous ovarian response
Basic hormone profile
Role of LH
Trigger
Luteal phase support
Pregnancy rate/cycle
ATOSIBAN Update In Preterm Labor Dr. Sharda Jain Lifecare Centre
PRETERM BIRTH
As defined by the WHO,
Preterm is defined as babies born alive before 37 weeks of
pregnancy are completed.
Sub-categories of preterm birth:
Extremely preterm (<28><32><34><37 weeks).
PHYSIOLOGY OF MENSTRUATION
Introduction :
Typically, a woman of childbearing age should menstruate every 28 days or so unless she's pregnant or moving into menopause. But numerous things can wrong with the normal menstrual cycle.
Definition:
Menstruation means cyclic uterine bleeding caused by shedding of progestational endometrium it occurs between menarche and menopause
Menstruation (also called menstrual bleeding, menses, or a period)
Characteristics of normal menstruation
1-Menarche: 10-16 years. average 13 years.
2-Duration: 2-7 days (<2days>7 days is menorrhagia
3-Amount: 30-80 ml., uses 3 napkins per day, >80 ml. is menorrhagia and < 30 ml. is hypomenorrhea.
4-Normally menstrual blood doesn’t coagulate as a result of secretion of fibrinolysin enzyme (plasmin) secreted by the endometrium.
5-Menstrual molimina refers to mild symptoms of 7-10 days before menstruation relieved once menstruation occurs exaggerated condition called (premenstrual syndrome).
The hypothalamic-pituitary-ovarian axis:
There are two main components of the menstrual cycle,
1. the changes that happen in the ovaries in response to pituitary hormones (the ovarian cycle)
2. and the variations that take place in the uterus,
but it is important to remember that both cycles work together simultaneously to produce the menstrual cycle.
Changes in cervical mucus also take place during the course of the menstrual cycle.
Laparoscopic ovarian drilling (LOD) is an alternative treatment for women with polycystic ovarian syndrome (PCOS) who are resistant to clomiphene citrate ovulation induction. LOD involves using electrocautery or laser energy to create multiple small openings in the ovarian capsule. This surgical trauma restores hypothalamic-pituitary-ovarian function and results in ovulation rates of 50-90% and pregnancy rates of 64-76%. LOD avoids risks of multiple pregnancy and ovarian hyperstimulation syndrome associated with gonadotropin treatments, and results in sustained fertility benefits for several years with minimal risks. Guidelines recommend LOD as a first-line treatment alternative to gonadotrop
The menstrual cycle involves two main phases - the follicular phase and luteal phase. In the follicular phase, hormones stimulate the growth of follicles in the ovaries and thickening of the uterine lining. This culminates in a surge of LH which causes ovulation of an egg. In the luteal phase, the corpus luteum forms and produces progesterone and estrogen to prepare the uterus for potential implantation. If implantation does not occur, hormone levels fall and menstruation begins, restarting the cycle.
Role of Dydrogesterone in Threatened Abortion Dr Sharda Jain Lifecare Centre
*EXPERINCE SHARING By EXPERTS*
Dr Uma Rai(DGF *E*)
Dr Sangeetaa Gupta(DGF *E*)
Dr Neerja Varshney(DGF *E*)
Dr Surjeet Kapoor(DGF *E*)
Dr Rupam arora(DGF *E*)
Dr Meenakshi Ahuja(DGF *S* )
Dr.Harsha khullar(DGF *C* )
Dr Mamta mittal(DGF *N*)
Dr Leena Sreedhar(DGF *D*)
Dr.Dipti Nabh(DGF *E*)
Dr. Shama Batra(DGF *E*)
Dr Poonam Paul(DGF *SW*)
PAN DGF ( DELHI GYNAECOLOGIST FORUM) CME ON DYDROGESTERONE ON 3/2 /22
The menstrual cycle consists of four phases - menstruation, the follicular phase, ovulation, and the luteal phase. It is controlled by hormones produced by the hypothalamus and pituitary glands. During the follicular phase, FSH stimulates follicle growth in the ovaries. Ovulation occurs when an LH surge causes the release of an egg. In the luteal phase, the corpus luteum produces progesterone and estrogen to prepare the uterus for potential pregnancy. Common issues include painful or heavy periods, which can be caused by hormonal imbalances or underlying conditions.
In ART, GnRH antagonists are effective in preventing a premature LH surge and induce a shorter and more cost-effective ovarian stimulation compared to the long agonist protocol.
The menstrual cycle is regulated by the hypothalamus, pituitary gland, and ovaries. It typically lasts 28 days and is divided into the follicular phase and luteal phase. During the follicular phase, follicles in the ovaries mature under the influence of hormones like FSH. Around day 14, ovulation occurs when a dominant follicle ruptures to release an egg. After ovulation, the ruptured follicle develops into the corpus luteum which secretes progesterone to prepare the uterus for potential implantation. If implantation does not occur, progesterone and estrogen levels fall, causing menstruation and the start of a new cycle.
This document discusses different types of abnormal uterine bleeding including menorrhagia, metrorrhagia, polymenorrhagia, and dysfunctional uterine bleeding. It defines each term and discusses their causes and treatments. The main causes of abnormal uterine bleeding include underlying pelvic pathologies, systemic diseases, endocrine disorders, and dysfunctional bleeding due to issues with the hypothalamic-pituitary-ovarian axis. Treatment depends on identifying and addressing the underlying cause in each case.
The document discusses the physiology of the menstrual cycle. It begins with an introduction to menstruation and the hypothalamic-pituitary-ovarian axis that regulates the cycle. It then describes the three phases of the ovarian cycle (follicular, ovulatory, luteal) and the corresponding four phases of the uterine cycle (menstrual, proliferative, secretory, ischemic). It also discusses cervical mucus changes, abnormalities in menstruation, and some comfort measures during menstruation.
This document outlines the key stages of fetal development from conception to birth. It describes the processes of conception, fertilization and implantation that occur in the first 4 weeks. The major developmental changes that happen in each trimester are then outlined, including the formation of major organs in the first trimester, rapid growth and development in the second trimester, and further physical maturation in the third trimester as the fetus prepares for birth. Factors that can influence normal fetal growth rates are also briefly discussed.
The document provides an overview of normal labour, including definitions, criteria, components, anatomy, onset, stages, monitoring and management. It defines labour and normal labour. The criteria for normal labour includes spontaneous expulsion of a single, full-term fetus presented by vertex within 3-18 hours without complications. The components are the passage (birth canal), passenger (fetus), and power (uterine contractions and abdominal muscles). It describes the anatomy of the female pelvis and fetal skull, as well as the onset, three stages and mechanism of labour. Intrapartum monitoring includes monitoring the mother's temperature, pulse, blood pressure and urine as well as fetal monitoring. Management includes pain relief, hydration, fetal monitoring and managing
The document summarizes the development of the female reproductive system. It begins with the formation of the genital ridge in the intermediate mesoderm at 3 weeks. At 5-6 weeks, primordial germ cells form the indifferent gonad. In the absence of the Y chromosome, the gonad develops into an ovary with cortical cords and primordial follicles. The ovaries descend into the pelvis guided by the gubernaculum. Meanwhile, the paramesonephric ducts form the fallopian tubes, uterus and upper vagina. The vagina develops from the sinovaginal bulbs and vaginal plate. Remnants of the mesonephric ducts include the epoophoron and
This document discusses uterine compression sutures as a technique to control postpartum hemorrhage. It begins by explaining that postpartum hemorrhage is the leading cause of maternal mortality worldwide. Uterine compression sutures involve applying sutures externally to the uterus in various patterns to promote uterine contraction and compression of blood vessels, similar to manual compression. The sutures act as a brace for the uterus. Indications for uterine compression sutures include atonic PPH, abnormal placentation, coagulopathy, and as prophylaxis for high risk patients. Both absorbable and non-absorbable suture materials can be used.
Luteal Phase Support: Key Variables to Achieve Success in ARTSandro Esteves
This document discusses luteal phase support in assisted reproductive technology cycles. It covers:
1. The pathophysiology of the luteal phase defect in stimulated cycles and the role of progesterone supplementation.
2. Different luteal phase support protocols after hCG trigger in fresh embryo transfer cycles, including progesterone alone versus progesterone plus hCG or GnRH agonist.
3. Luteal phase support considerations for frozen embryo transfer cycles, including the type and timing of estrogen and progesterone administration.
The document discusses female reproductive physiology, describing the stages from puberty through menopause. It focuses on the menstrual cycle, explaining the hormonal regulation of the hypothalamic-pituitary-ovarian axis and the cyclic changes that occur in the ovaries and endometrium under the influence of estrogen and progesterone. During the proliferative phase, estrogen stimulates endometrial growth, while the secretory phase is characterized by the effects of progesterone on the endometrium to prepare for potential implantation.
1) ART pregnancies have some differences from natural pregnancies that require special care and monitoring, such as progesterone and estrogen supplementation due to the absence of a corpus luteum in some cases.
2) Multiple pregnancies are a major risk factor for ART pregnancies and require close monitoring due to higher risks of preterm birth and low birth weight.
3) While antenatal care is largely the same for ART and natural pregnancies, ART pregnancies have slightly higher risks of complications like preterm birth and birth defects, so careful screening and management is important.
Recent advances in endometriosis were discussed. Endometriosis is a chronic disease where endometrial tissue grows outside the uterus, affecting around 10% of women. Dienogest, a progestin, was shown to be effective in reducing endometriosis-associated pelvic pain in randomized controlled trials. Dienogest 2mg daily for 24 weeks provided pain relief similar to leuprolide acetate but with fewer side effects. Long-term use of dienogest for 65 weeks maintained pain relief with a favorable safety profile. Dienogest was as effective as goserelin in reducing postoperative recurrence of endometriosis at 24 months.
Ovulation Stimulation Protocols for IUI - Dr Dhorepatil BharatiBharati Dhorepatil
What are important factors to be considered important
Ovarian reserve
Previous ovarian response
Basic hormone profile
Role of LH
Trigger
Luteal phase support
Pregnancy rate/cycle
ATOSIBAN Update In Preterm Labor Dr. Sharda Jain Lifecare Centre
PRETERM BIRTH
As defined by the WHO,
Preterm is defined as babies born alive before 37 weeks of
pregnancy are completed.
Sub-categories of preterm birth:
Extremely preterm (<28><32><34><37 weeks).
PHYSIOLOGY OF MENSTRUATION
Introduction :
Typically, a woman of childbearing age should menstruate every 28 days or so unless she's pregnant or moving into menopause. But numerous things can wrong with the normal menstrual cycle.
Definition:
Menstruation means cyclic uterine bleeding caused by shedding of progestational endometrium it occurs between menarche and menopause
Menstruation (also called menstrual bleeding, menses, or a period)
Characteristics of normal menstruation
1-Menarche: 10-16 years. average 13 years.
2-Duration: 2-7 days (<2days>7 days is menorrhagia
3-Amount: 30-80 ml., uses 3 napkins per day, >80 ml. is menorrhagia and < 30 ml. is hypomenorrhea.
4-Normally menstrual blood doesn’t coagulate as a result of secretion of fibrinolysin enzyme (plasmin) secreted by the endometrium.
5-Menstrual molimina refers to mild symptoms of 7-10 days before menstruation relieved once menstruation occurs exaggerated condition called (premenstrual syndrome).
The hypothalamic-pituitary-ovarian axis:
There are two main components of the menstrual cycle,
1. the changes that happen in the ovaries in response to pituitary hormones (the ovarian cycle)
2. and the variations that take place in the uterus,
but it is important to remember that both cycles work together simultaneously to produce the menstrual cycle.
Changes in cervical mucus also take place during the course of the menstrual cycle.
Laparoscopic ovarian drilling (LOD) is an alternative treatment for women with polycystic ovarian syndrome (PCOS) who are resistant to clomiphene citrate ovulation induction. LOD involves using electrocautery or laser energy to create multiple small openings in the ovarian capsule. This surgical trauma restores hypothalamic-pituitary-ovarian function and results in ovulation rates of 50-90% and pregnancy rates of 64-76%. LOD avoids risks of multiple pregnancy and ovarian hyperstimulation syndrome associated with gonadotropin treatments, and results in sustained fertility benefits for several years with minimal risks. Guidelines recommend LOD as a first-line treatment alternative to gonadotrop
The menstrual cycle involves two main phases - the follicular phase and luteal phase. In the follicular phase, hormones stimulate the growth of follicles in the ovaries and thickening of the uterine lining. This culminates in a surge of LH which causes ovulation of an egg. In the luteal phase, the corpus luteum forms and produces progesterone and estrogen to prepare the uterus for potential implantation. If implantation does not occur, hormone levels fall and menstruation begins, restarting the cycle.
Role of Dydrogesterone in Threatened Abortion Dr Sharda Jain Lifecare Centre
*EXPERINCE SHARING By EXPERTS*
Dr Uma Rai(DGF *E*)
Dr Sangeetaa Gupta(DGF *E*)
Dr Neerja Varshney(DGF *E*)
Dr Surjeet Kapoor(DGF *E*)
Dr Rupam arora(DGF *E*)
Dr Meenakshi Ahuja(DGF *S* )
Dr.Harsha khullar(DGF *C* )
Dr Mamta mittal(DGF *N*)
Dr Leena Sreedhar(DGF *D*)
Dr.Dipti Nabh(DGF *E*)
Dr. Shama Batra(DGF *E*)
Dr Poonam Paul(DGF *SW*)
PAN DGF ( DELHI GYNAECOLOGIST FORUM) CME ON DYDROGESTERONE ON 3/2 /22
The menstrual cycle consists of four phases - menstruation, the follicular phase, ovulation, and the luteal phase. It is controlled by hormones produced by the hypothalamus and pituitary glands. During the follicular phase, FSH stimulates follicle growth in the ovaries. Ovulation occurs when an LH surge causes the release of an egg. In the luteal phase, the corpus luteum produces progesterone and estrogen to prepare the uterus for potential pregnancy. Common issues include painful or heavy periods, which can be caused by hormonal imbalances or underlying conditions.
In ART, GnRH antagonists are effective in preventing a premature LH surge and induce a shorter and more cost-effective ovarian stimulation compared to the long agonist protocol.
The menstrual cycle is regulated by the hypothalamus, pituitary gland, and ovaries. It typically lasts 28 days and is divided into the follicular phase and luteal phase. During the follicular phase, follicles in the ovaries mature under the influence of hormones like FSH. Around day 14, ovulation occurs when a dominant follicle ruptures to release an egg. After ovulation, the ruptured follicle develops into the corpus luteum which secretes progesterone to prepare the uterus for potential implantation. If implantation does not occur, progesterone and estrogen levels fall, causing menstruation and the start of a new cycle.
This document discusses different types of abnormal uterine bleeding including menorrhagia, metrorrhagia, polymenorrhagia, and dysfunctional uterine bleeding. It defines each term and discusses their causes and treatments. The main causes of abnormal uterine bleeding include underlying pelvic pathologies, systemic diseases, endocrine disorders, and dysfunctional bleeding due to issues with the hypothalamic-pituitary-ovarian axis. Treatment depends on identifying and addressing the underlying cause in each case.
The document discusses the physiology of the menstrual cycle. It begins with an introduction to menstruation and the hypothalamic-pituitary-ovarian axis that regulates the cycle. It then describes the three phases of the ovarian cycle (follicular, ovulatory, luteal) and the corresponding four phases of the uterine cycle (menstrual, proliferative, secretory, ischemic). It also discusses cervical mucus changes, abnormalities in menstruation, and some comfort measures during menstruation.
The menarche is one of the later stages of puberty in girls. The first period is called menarche . The average age of menarche in humans in 12years, but is normal anywhere between ages 8-16.
A number of physical and psychological changes take place at puberty:- The uterus , the uterine tubes and the ovaries reach maturity.
The menstrual cycle and ovulation begin {menarche},The breast develop and enlarge,Pubic and auxiliary hair begins to grow, Increases in height and widening of the pelvis. Increased fat deposited in the subcutaneous tissue especially at the hips and breasts. The cessation of menstrual cycles at the end of a woman's reproductive life is termed menopause. The average age of menopause in women is 51 years, with anywhere between 40-58 being common.
Menstruation is the periodic discharge of blood and sloughed endometrium (collectively called menses or menstrual flow) through the vagina.
The menstrual cycle is the regular natural change that occur in the female reproductive system (specially the ovaries and uterus) that makes pregnancy possible. This cycle is controlled by hormones, The menstrual cycle occurs because of a complex relationship between hormones from the brain and ovaries. This leads to the development and release of an egg from the ovary (ovulation) and growth of the internal lining (endometrium) of the uterus, to prepare it for pregnancy
Menarche is the first menstrual cycle, or first menstrual bleeding, in female human beings.
The average age of menarche is 11.75 years.
Menopause is the permanent cessation of menses.
Menopause typically (but not always) occurs in women during their late 40s or early 50s, and signals the end of the fertile phase of a woman's life.
The menarche is one of the later stages of puberty in girls. The first period is called menarche . The average age of menarche in humans in 12years, but is normal anywhere between ages 8-16.
A number of physical and psychological changes take place at puberty:- The uterus , the uterine tubes and the ovaries reach maturity.
The menstrual cycle and ovulation begin {menarche},The breast develop and enlarge,Pubic and auxiliary hair begins to grow, Increases in height and widening of the pelvis. Increased fat deposited in the subcutaneous tissue especially at the hips and breasts. The cessation of menstrual cycles at the end of a woman's reproductive life is termed menopause. The average age of menopause in women is 51 years, with anywhere between 40-58 being common.
Menstruation is the periodic discharge of blood and sloughed endometrium (collectively called menses or menstrual flow) through the vagina.
The menstrual cycle is the regular natural change that occur in the female reproductive system (specially the ovaries and uterus) that makes pregnancy possible. This cycle is controlled by hormones, The menstrual cycle occurs because of a complex relationship between hormones from the brain and ovaries. This leads to the development and release of an egg from the ovary (ovulation) and growth of the internal lining (endometrium) of the uterus, to prepare it for pregnancy
menstrual cycle in females subject gyanecologyjaimahakal2305
This document provides information about the menstrual cycle and menstrual irregularities. It describes how the ovarian and uterine cycles work together over approximately 28 days to make pregnancy possible. It then discusses various types of menstrual irregularities including amenorrhea, dysmenorrhea, menorrhagia, polymenorrhea/epimenorrhea, metrorrhagia, oligomenorrhea, and cryptomenorrhea. For each type, it provides the definition and some common causes. The document also provides details on the hormonal changes that occur over the follicular and luteal phases of the menstrual cycle.
Abnormal uterine bleeding can have various causes and presentations. It includes heavier or longer than normal periods, bleeding between periods or after menopause. Evaluation involves history, examination, and tests to identify potential issues like fibroids, pregnancy complications, or endocrine disorders. Treatment depends on the underlying cause but may involve hormonal therapy, surgical procedures like endometrial ablation, or hysterectomy in some cases.
The menstrual cycle describes the monthly changes women's bodies go through from the start of menstruation to ovulation and then back to menstruation. It involves both ovarian and uterine cycles controlled by hormones. The ovarian cycle consists of the follicular phase where an egg develops and is released at ovulation, and the luteal phase where the corpus luteum forms. The uterine cycle involves changes to the endometrium driven by hormones, from proliferation to secretion to menstruation. Key events include the development and rupture of the ovarian follicle, formation and regression of the corpus luteum, and shedding of the uterine lining if implantation does not occur.
The document discusses etiology and management of female sub-fertility. It covers various ovarian, tubal, uterine and cervical factors that can cause sub-fertility. It describes diagnostic tests and investigations for evaluating each factor, including basal body temperature, ultrasound, hormone levels and HSG. Treatment options discussed include ovulation induction drugs, surgery and correction of underlying conditions.
This document summarizes the ovarian and uterine cycles in women. It describes how the hypothalamus and pituitary gland regulate hormone production, including follicle-stimulating hormone and luteinizing hormone, which stimulate changes in the ovaries and uterus. These include follicle development, ovulation, formation of the corpus luteum, and changes to the endometrium under the influence of estrogen and progesterone in a typical 28-day cycle. Fertilization results in implantation and continuation of the corpus luteum and menstrual cycle. Non-fertilization leads to menstruation.
This document discusses normal menstruation and dysfunctional uterine bleeding (DUB). It begins by explaining the hormonal changes that cause normal menstruation. It then defines DUB as abnormal bleeding in the absence of pathology or pregnancy. The main types of DUB are anovulatory and ovulatory bleeding. Treatment options for DUB include estrogen therapy, progestins, oral contraceptive pills, antifibrinolytics, NSAIDs, and surgical procedures like endometrial ablation or hysterectomy. The goal of treatment is to control bleeding and prevent long term risks of unopposed estrogen stimulation.
The document summarizes key aspects of the menstrual cycle, including its phases and the hormonal influences that regulate it. The menstrual cycle occurs in monthly cycles and involves changes to the endometrium under the influence of hormones like estrogen and progesterone. It consists of a proliferative phase where the endometrium thickens, a secretory phase where glands develop further in preparation for potential pregnancy, and a menstrual phase where the endometrium is shed if implantation does not occur. Precise timing of ovulation is important to determine the fertile window and for contraception.
3 Hormonal regulation of menstrual cycle.pptxAditiShah380128
The menstrual cycle is regulated by hormones from the hypothalamus, pituitary gland, and ovaries. It involves the proliferative phase where the endometrium thickens under estrogen, and the secretory phase where progesterone further thickens the endometrium to prepare for potential implantation. If implantation does not occur, menstruation begins and the cycle repeats.
This document discusses dysfunctional uterine bleeding (DUB), its classification, causes, and pathophysiology. It begins by defining DUB as abnormal uterine bleeding without identifiable organic disease. DUB is classified as primary or secondary to conditions like thyroid dysfunction. The document then covers characteristics of normal menstruation versus abnormal bleeding patterns like menorrhagia, hypomenorrhea, and others. It details the role of hormones in the normal menstrual cycle and how imbalances can lead to DUB, discussing mechanisms like estrogen withdrawal, breakthrough, and progesterone breakthrough bleeding. The document concludes by outlining several mechanisms through which DUB can occur, such as hyper-estrogenic states and impaired haemostatic and re-epithelialization
Menstrual cycle is a cyclic event that takes place in rhythmic fashion during reproductive period in women's life.
This content will suffice students of first and third year physiotherapy. I hope this helps you clearing your exams. Thank you in spending your precious time in referring the same.
This document provides information on the menstrual cycle including its definition, typical duration, and the ovarian and uterine cycles. It describes in detail the follicular phase of the ovarian cycle including the development of primordial follicles into preantral and preovulatory follicles. Ovulation and the subsequent luteal phase are also explained. The uterine cycle and its four phases of regeneration, proliferation, secretion, and menstruation are defined. Characteristics of each phase such as endometrial thickness and histology are outlined. Cervical and vaginal changes throughout the cycle are also summarized.
The document summarizes the female menstrual cycle, which occurs approximately every 28 days. It describes the ovarian and uterine cycles, including the follicular phase where an egg matures and is released (ovulation), the luteal phase where the corpus luteum forms, and the proliferative and secretory phases in the uterus. Key hormones like FSH, LH, estrogen, and progesterone regulate the cycle through feedback mechanisms between the hypothalamus, pituitary gland, and ovaries. Abnormalities in the cycle can occur if ovulation does not take place.
The three main hormones involved in the female menstrual cycle are estrogen, progesterone, and luteinizing hormone (LH). Estrogen causes the thickening of the uterine lining and development of female secondary sex characteristics. Progesterone maintains the thickened uterine lining to prepare for potential implantation. If implantation does not occur, decreasing progesterone levels cause the uterine lining to shed through menstruation. LH surges near ovulation to trigger the release of a mature egg. Together, these hormones regulate the monthly changes in a woman's reproductive system through menarche, menstruation, and menopause.
This document discusses hormonal contraception, including oral contraceptives. It covers the hormonal regulation of the menstrual cycle, types of hormonal contraception including oral contraceptives, and considerations for initiating and choosing oral contraceptives. The key topics covered are the hormonal control of the menstrual cycle, mechanisms of action and types of combined and progestin-only oral contraceptives, considerations for initiating oral contraceptive use, and factors to consider when choosing an oral contraceptive.
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তাই একজন নাগরিক হিসাবে এই তথ্য গুলো আপনার জানা প্রয়োজন ...।
বিসিএস ও ব্যাংক এর লিখিত পরীক্ষা ...+এছাড়া মাধ্যমিক ও উচ্চমাধ্যমিকের স্টুডেন্টদের জন্য অনেক কাজে আসবে ...
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Main Java[All of the Base Concepts}.docxadhitya5119
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it describes the bony anatomy including the femoral head , acetabulum, labrum . also discusses the capsule , ligaments . muscle that act on the hip joint and the range of motion are outlined. factors affecting hip joint stability and weight transmission through the joint are summarized.
2. Learning Objectives
1.Brief description on physiology of menstruation
2.Definition of the various terms used to describe abnormal menstruation
3. Causes of heavy menstrual bleeding (HMB) (menorrhagia)
4. Symptomatology of heavy menstrual bleeding including assessment of the
severity
5. Investigations in patients with HMB
6. Drugs used for treatment of HMB
7. Basic principles of management of HMB including treatment options
3. PHYSIOLOGY OF MENSTRUAL CYCLE
• A tightly coordinated cycle of 28 days with stimulatory and inhibitory effects that result in the
release of single mature oocyte from multiple primordial follicles
• Normal menstrual cycle
o Flow of 2-6 days
o Cycle length of 21-35 days
o Amount of blood less than 80 ml
• This occurs as a result of the shedding of endometrial lining due to
• Failure of fertilization of the oocyte.
• Failure of implantation.
• The cycle depends on changes occur after puberty within ovaries and fluctuation in ovarian
hormone levels.
• Ovarian hormone levels are controlled by the pituitary and hypothalamus within the
hypothalamo-pituitary-ovarian axis(HPO)
4. • Hyphothalamus
Secretes GnRH which will stimulate the
basophil cells in anterior pituitary gland for
hormone synthesis and secretion
• Pituitary gland
Releases FSH and LH
Controlled by ovarian sex steroid
hormones(oestrogen and progesterone)
• Oestrogen
-low: Negative feedback on LH production
-High: positive feedback on LH production by
increasing receptors on pituitary gland
• Progesterone
Low: Positive feedback on FSH and LH
secretion
High: negative feedback, inhibit FSH and LH
production
5. •Physiological events of menstrual cycle can be described as
o Ovarian cycle -changes that occur in the follicles of the ovary
o Uterine cycle - changes in the endometrial lining of the uterus
•Ovarian cycle
• Follicular phase
• Ovulation
• Luteal phase
•Uterine cycle
• Proliferative phase
• Secretory phase
• Menstrual phase
6. Ovarian cycle
• Follicular phase
➢ First day of menstrual cycle :
o Oestrogen, progesterone and inhibin
levels are low.
o Increase of follicle stimulating
hormone (FSH)
○ will stimulates small antral follicles on
the ovaries to grow (Folliculogenesis)
➢ The follicles that reaches maturity is
called a graafian follicle
➢ Within the follicles there are two cell types
that are involved in processing steroids
○ Theca
○ Granulosa cells
7. ➢ LH stimulates production of androgen from cholesterol within the theca
cells
➢ These androgens are converted into oestrogens under the influence of
FSH
➢ As the follicles grow and oestrogen secretion increases.
○ This will cause negative feedback on pituitary gland.
○ Assist in selection of one follicle to continue its development towards ovulation
(dominant follicle).
➢ Dominant follicle
○ The most efficient aromatase activity.
○ The highest concentration of FSH-induced LH receptors.
➢ Smaller follicle will undergo atresia
➢ At the end of this phase, ovulation occurs
8. Ovulations
• During the follicular phase, oestrogen suppress
production of LH from pituitary gland
• As the ovum nearly mature, oestrogen level
increases above threshold and cause a positive
feedback on hypothalamus and pituitary.
• This will cause the LH level increases sharply .
• Physical ovulation of oocyte after breakdown of
follicular wall takes place under the influence of :
• LH
• FSH
• Proteolytic enzymes (plasminogen activators and
prostaglandin)
9. Luteal phase
• The remaining granulosa and theca cells form the
corpus luteum.
○ The corpus luteum undergoes extensive vascularization
to supply granulosa cells with rich blood supply for
continued steroidogenesis.
○ This is aided by vascular endothelial growth factor
(VEGF).
• Ongoing pituitary LH secretion and granulosa cell
activity ensure a supply of progesterone, which
stabilizes the endometrium in preparation for
pregnancy.
• Progesterone levels are at their highest in the cycle
during the luteal phase.
• This also has the effect of suppressing FSH and LH
secretion to a level that will not produce further
follicular growth in the ovary during that cycle.
10. • In the absence of beta- human chorionic gonadotrophin (βhCG) being produced from
an implanting embryo, the corpus luteum will regress in a process known as luteolysis.
• With the disintegration of corpus luteum, causes sharp decline of progesterone
• The withdrawal of progesterone due to absence of corpus luteum has the effect on
the uterus of causing shedding of the endometrium and thus menstruation.
• Reduction in levels of progesterone, oestrogen and inhibin feeding back to the pituitary
cause increased secretion of gonadotrophic hormones, particularly FSH.
• New preantral follicles begin to be stimulated and the cycle begins anew.
11. Menstrual phase
• Menstruation is the shedding of the dead
endometrium ceases as the endometrium
regenerate.
• A fall in circulating levels of oestrogen and
progesterone approximately 14 days after
ovulation. This leads to:
A. Loss of tissue fluid
B. Vasoconstriction of spiral arteriole and
causes endometrial ischemia
• Vaginal bleeding will cease after 5-10 days
• This results in tissue breakdown and loss of the
upper layers along with bleeding fragments of
the remaining arterioles, seen as menstrual
bleeding
• Enhanced fibrinolysis reduces clotting
12. Uterine cycle
• Proliferative phase
➢ Starts after menstruation
○ Glandular and stromal growth
start.
➢ The epithelium lining the endometrial
glands changes from a single layer of
columnar cells to a pseudostratified
epithelium.
○ From 0.5 mm at menstruation to
3.4-5 mm at the end of
proliferative phase.
13. •SECRETORY PHASE
➢ Occur after ovulation (generally
around day 14).
➢ LH surge, the oestrogen-induced
cellular proliferation is inhibited.
➢ Endometrial glands will become more
tortuous, spiral arteries will grow and
fluid is secreted into glandular cells
and into the uterine lumen.
➢ Later in the secretory phase,
progesterone induces the formation
of a temporary layer.
14.
15. DEFINITION OF THE VARIOUS TERMS USED TO DESCRIBE ABNORMAL MENSTRUATION
Term Definition
Amenorrhea Absence of menstrual bleeding
Menorrhagia Excessive (>80 ml) or prolonged menstruation at regular
intervals.
Metrorrhagia Heavy bleeding at irregular times
Menometrorrhagia Combination of Metrorrhagia and Menorrhagia
Polymenorrhea Frequent and regular heavy bleeding with interval of 21
days or fewer
Oligomenorrhea Reduced frequency with frequency of menstruation is
greater than 45 days
Dysmenorrhea Lower abdominal pain or pelvic pain associate with
menstruation
17. Pathophysiology of Menorrhagia
1. Anatomical alterations of uterus
a. E.g. fibroids (30%), endometrial polyps, endometrial hyperplasia
b. Growths → blood supply is greater → impede venous return → heavy pooling →
endometrium weaken
c. Growths → inhibit muscle contracture → poor haemostasis
d. Clinical presentation depends on the location and size of lesion
2. Anovulation
a. E.g. polycystic ovary syndrome(PCOS)
b. No ovulation → no corpus luteum → no progesterone → oestrogen unopposed →
excessive endometrial thickening → blood supply outgrow → asynchronous
breakdown of the endometrial lining at different levels
3. Coagulation disorders
a. e.g. von Willebrand disease, thrombocytopenia
b. Deficiencies of platelets and fibrin → less thrombi (acts as ‘plugs’) → blood overflow
18. FIGO System classification (PALM-COEIN)
PALM (Structural causes) COEIN (Non-structural causes)
● Polyp
● Adenomyosis
● Leiomyoma
○ Submucosal myoma
○ Other myoma
● Malignancy and hyperplasia
● Coagulopathy
● Ovulatory dysfunction
● Endometrial
● Iatrogenic
● Not defined (dysfunctional uterine
bleeding)
Aetiologies of HMB - Structural & Non-Structural
20. Endometrial Polyps
● Also known as uterine polyps, overgrowths
of cells that usually benign.
● Uterine polyps are oestrogen-sensitive,
meaning they grow in response to circulating
oestrogen
● Clinical features : Bleeding between
menstrual periods (intermenstrual bleeding),
Excessively heavy menstrual periods
(menorrhagia), Vaginal bleeding after
menopause, Infertility
Adenomyosis
● Tissue that normally lines the uterus (endometrial
tissue) grows into the muscular wall of the uterus. The
displaced tissue continues to act normally thickening,
breaking down and bleeding during each menstrual
cycle.
● Clinical features : heavy or prolonged menstrual
bleeding (menorrhagia), severe cramping or sharp,
knifelike pelvic pain during menstruation
(dysmenorrhea), chronic pelvic pain, painful
intercourse (dyspareunia)
21. Uterine fibroids
● Benign tumour of uterus which consists of
smooth muscle and fibrous tissues which
arises from muscular wall of the uterus
● Clinical features : heavy menstrual bleeding
(duration or amount), post coital bleeding,
dysmenorrhea, palpable mass and pressure
symptoms, pelvic pain
Cervical carcinoma
● Cervical cancer is a type of cancer that occurs in the
cells of the cervix. Various strains of the human
papillomavirus (HPV), a sexually transmitted
infection, play a role in causing most cervical
cancer.
● Clinical features : vaginal bleeding after
intercourse, between periods or after menopause,
watery, bloody vaginal discharge that may be heavy
and have a foul odour, pelvic pain or pain during
intercourse
22. Polycystic Ovarian Syndrome (PCOS)
● A hormonal disorder common among women of
reproductive age. Women with PCOS may have
infrequent or prolonged menstrual periods or
excess male hormone (androgen) levels.
● The ovaries may develop numerous small
collections of fluid (follicles) and fail to regularly
release eggs.
● Clinical features : Irregular periods. Infrequent,
irregular or prolonged menstrual cycles are the
most common sign of PCOS. For example, you might
have fewer than nine periods a year, more than 35
days between periods and abnormally heavy
periods.
Coagulation disorder (Von
Willebrand disease)
● A lifelong bleeding disorder in which blood doesn't
clot well. People with the disease have low levels of
von Willebrand factor, a protein that helps blood clot,
or the protein doesn't perform as it should.
● Clinical features : Excessive bleeding from an injury
or after surgery or dental work, nosebleeds that
don't stop within 10 minutes, heavy or long
menstrual bleeding (menorrhagia), blood in urine or
stool, easy bruising or lumpy bruises
23. Drug therapy
● Certain medications, including anti-inflammatory
medications, hormonal medications such as
oestrogen and progestins, and anticoagulants such
as warfarin (Coumadin, Jantoven) or enoxaparin
(Lovenox), can contribute to heavy or prolonged
menstrual bleeding
Intrauterine contraceptive
device
● Intrauterine contraceptive device is an
intrauterine device (IUD) that can provide
long-term birth control (contraception).
It's sometimes referred to as a
non-hormonal IUD option
● Clinical features : bleeding between
periods, cramps, severe menstrual pain and
heavy bleeding
25. Symptoms
● Soaking through one or more sanitary pads or
tampons every hour for several consecutive hours
● Needing to use double sanitary protection to
control your menstrual flow
● Needing to wake up to change sanitary protection
during the night
● Bleeding for longer than a week
● Passing blood clots larger than a quarter
● Restricting daily activities due to heavy menstrual
flow
● Symptoms of anaemia, such as tiredness, fatigue
or shortness of breath
26. Related Pathologies Towards Menorrhagia
Associated symptoms Suggestive of
Irregular bleeding
Endometrial or cervical polyp or other cervical abnormality
Intermenstrual bleeding
Postcoital bleeding
Excessive bruising/bleeding from other sites
Coagulation disorder (coagulation disorders will be present in 20% of those
presenting with ‘unexplained’ heavy menstrual bleeding)
History of post partum haemorrhage
Excessive postoperative bleeding
Excessive bleeding with dental extractions
Family history of bleeding problems
Unusual vaginal discharge Pelvic inflammatory disease
Urinary symptoms, abdominal mass or fullness Pressure from fibroids
Weight change, skin changes, fatigue Thyroid disease
27. History Taking
1. Quantity and quality of bleeding
a. For how many day does the bleeding last?
b. How many day is bleeding heavy?
c. What type and how much sanitary
protection is needed?
d. Does she experience flooding?
e. Does she pass clots of blood? If so, what
size?
f. Does it affect her daily activities or work?
g. Is there anything mixed with blood?
2. Symptoms of anaemia
3. Menses pattern from menarche
4. Pain associated
Physical Examination
1. Signs of anaemia.
2. Abdominal examination
a. Pelvic masses
3. Pelvic examination
a. Bimanual examination
i. tenderness, uterine size, adnexal
masses
b. Speculum examinations
i. Visualized for polyps/carcinoma
4. An enlarged, ‘bulky’ uterus suggests
uterine fibroids, and tenderness
suggests endometriosis, pelvic
inflammatory disease or adenomyosis.
29. ❖ Full blood count
➢ To determine in need of iron therapy or blood transfusion
in worse case
❖ Coagulation screen
➢ In patient with heavy menstrual bleeding since menarche
❖ Family history of coagulation defects
➢ Transvaginal ultrasound scan
➢ In patient with postcoital bleeding, intermenstrual
bleeding, pain/pressure symptoms or enlarged uterus or
vaginal mass is palpable on pelvic examination
❖ High vaginal endocervical swabs
➢ To test for presence of vaginal thrush, bacterial vaginosis
and trichomonas vaginalis
High vaginal swabs
30. ❖ Pipelle endometrial biopsy
➢ Age over 45 years old
➢ High risk for endometrial pathology
❖ Thyroid function test
➢ Only when history is suggestive of a thyroid disorder
❖ Hysteroscopy
➢ Endometrial biopsy attempt fail
➢ Endometrial biopsy sample is insufficient for
histopathology assessment
➢ There is an abnormality on transvaginal ultrasound scan
suggesting endometrial polyp or submucosal fibroid
31. Basic principle of management of HMB including
treatment options
Prior to management;
1. Patient’s Preference
2. Risk or Benefits of each option
3. Contraceptive Requirements
4. Past Medical History
5. Past Surgical History
Can be divided into :
● Medical
● Surgical
Medical Surgical
Levonorgestrel
Intrauterine System
Endometrial ablation
Tranexamic acid Umbilical artery embolization
Norethisterone Myomectomy
GnRH Agonist Transcervical Resection of
Fibroid
Hysterectomy
32. Levonorgestrel intrauterine system (LNG IUS)
● T shaped intrauterine device that releases the
hormone levonorgestrel into the uterus.
● First option for treatment of heavy periods
● The most effective medical treatment and suitable
for most women.
● It is used for heavy menstrual periods, birth controls
and to prevent excessive build of the lining of the
uterus in those on estrogen replacement therapy.
● It provides long-term use of at least 12 months
33. Tranexamic acid (TXA)
● Red blood cells and platelets bound together
with fibrin make blood clots.
● Plasmin, which breaks down the fibrin and
allows the clots to break up.
● Tranexamic acid inhibits activation of
plasminogen, thereby reducing conversion of
plasminogen to plasmin.
● Tranexamic acid interferes with the
fibrinolytic process. This reduces the
breakdown of fibrin and stops clots
dissolving, which in turn helps to reduce
bleeding.
● Risk of DVT
34. Mefenamic acid and other NSAIDS
● Endometrial prostaglandins are elevated with excessive menstruation, and NSAIDS reduce
prostaglandin levels through the inhibition of the cyclooxygenase enzyme.
● Reduce blood loss by 30 %.
● These drugs are also taken just at the time of menstruation
35. Combined oral
contraceptive pills (COCP)
● 50% reduction in menstrual blood loss.
● Shorten the menstrual period
● The main side effects can include irregular
vaginal bleeding, mood changes and breast
tenderness.
Gonadotropin-releasing
hormone (GnRH) agonist
● Only used in the short term due to the resulting
hypoestrogenic state that predisposes to
osteoporosis.
● May be used preoperatively to shrink fibroids or
cause endometrial suppression to enhance
visualization at hysteroscopy.
● In severe HMB, they allow the patient to improve
their Hb by allowing respite from bleeding
36. Injectable Progestogens
● Progestogen causes atrophy of
endometrium lining.
● Depot medroxyprogesterone acetate
(DMPA) can induce amenorrhea in up to 50%
of users after 1 year and 80 % after 1 year
● Side effects: weight gain, acne, bloating.
Progestins therapy
● Taken 15 mg daily in cyclical pattern from
day 6 to day 26 of the menstrual cycle.
● Safe and effective oral preparation, can
regulate bleeding pattern.
● Can cause breakthrough bleeding
● Eg: Norethisterone
37. Endometrial ablation
● Endometrial ablation is a surgical procedure that is used to remove (ablate) or destroy the
endometrial lining of the uterus to prevent regeneration of endometrium
● Should never be performed on women who wish to have children.
● Most often employed in women who suffer from excessive menstrual bleeding, who have
failed medical therapy and do not wish to undergo a hysterectomy.
● Useful in adenomyosis,uterine fibroids.
● The first generation techniques have now largely been replaced by newer second
generation techniques.
39. Hysterectomy
● Hysterectomy is the surgical removal of the
uterus.
● Indicated for older women who have completed
their their family
● The surgery is normally recommended only
when other treatment options are not available
or have failed.
● Tx for adenomyosis , fibroid, cervical ca
40. Laparoscopic Myomectomy
● HMB secondary to large fibroid with pressure symptoms who wish
to conceive
● Contraindication:Pregnant, malignancy, Asymptomatic fibroids
(medical tx)
● Complication : Bleeding, infection, visceral damage,
thromboembolism and fever.
Uterine Artery Embolization
● Useful HMB associated with fibroids, adenomyosis
Transcervical Resection of Fibroid
● May reduce HMB and appropriate to women wishing to conceive.
41.
42. Other disease causes menorrhagia:
1. Thyroid disease: Medication (Carbimazole/ Levothyroxine)
2. PID: Antibiotics, Treatment for your partner, Temporary abstinence
3. Drugs : Change the medication/dose.
43. Treatment in Amenorrhea
Need of the treatment depends on;
Underlying Causes
● Turner Syndrome: HRT
● Imperforate hymen :Surgery
● Thyroid disease: appropriate
medical treatment
● PCOS: appropriate treatment
Trying to conceive
● Anovulation : respond well with
ovulation induction treatment
● PCOS: ovulation may resume with
weight reduction
Want a regular period
● OCP
● HRT
Need a contraception
● Confirmed ovarian failure does not
need contraception
● Women requiring contraception -
OCP methods of choice.
44. Treatment in Dysmenorrhea
1. NSAIDs are 1st line treatment
○ Propionic acid derivatives ( Ibuprofen, Naproxen)
○ Fenamates Mefenamic acid)
2. OCP
○ If NSAIDs is not effective/ contraindicated
○ 90% effective within 3 4 months used
3. Some patients require combining both drugs
45. Treatment in Polymenorrhea
Treatment depends on the underlying causes.
● If no underlying causes, no need for tx
● If a woman is bothered by her polymenorrhea but is not trying to conceive, then contraceptive
pills to lengthen her cycle can be a good option.