Amenorrhea

amenorrhea is a condition when female do not have regular mensural cycles by puberty or due to any causes this ppt can help the patient and nurses to gain knowledge about this disease process and apply their knowledge into their clinical practices

1. Amenorrhea DEPARTMENT OF MEDICAL SURGICAL NURSING

2. Learning objectives At the end of the class the students will be able to define amenorrhea. enlist the types of amenorrhea. enumerate etiology of amenorrhea . describe the management of amenorrhea .

3. Amenorrhea Definition : amenorrhea means the absence of menses . Amenorrhea Is the absence or abnormal cessation of the menses. It can be Physiologial Amenorrhea Pathologial Amenorrhea

4. Types Primary Amenorrhea : age 16 years Secondary Amenorrhea : 6 months or 12 months in a women with a history of irregular bleeding.

5. Etiology and risk factors Primary amenorrhea Hypothalamus : anorexia nervosa strenuous exercise GnRH deficiency congenital defects tumor

6. Pituitary : Prolactinoma Hyperprolactinemia Hypopituitarism Thyroid : Hypothyroidism Adrenal : Congenital Adrenal hyperplasia Adenomas/Carcinoma

7. Ovarian : Ovarian Failure Polycystic Ovary Disease Vaginal : Vaginal Agenesis Transverse Vaginal Septum Imperforated hymen

8. Secondary amenorrhea Hypothalamus : Anorexia nervosa Weight loss Strenuous exercise Systemic disease Tumor

9. Pituitary : Prolactinoma Hyperprolactinemia Thyroid : Hypothyroidism Hyperthyroidism Adrenal : Congenital adrenal hyperplasia Adenomas/carcinoma Cushing’s disease

10. Ovarian : Ovarian failure Tumors Extra uterine : Ectopic pregnancy Uterine : Intrauterine pregnancy. Trophoblastic disease.

11. Clinical feature The main sign of amenorrhea is the absence of menstrual periods. Depending on the cause of amenorrhea, you might experience other signs or symptoms along with the absence of periods, such as : Milky nipple discharge Hair loss

12. Headache Vision changes Excess facial hair Pelvic pain Acne

13. Diagnosis evaluation Certain type of primary amenorrhea are of heredofamilial in nature. history collection Physical examination

14. CBC X-ray chest Biopsy USG UPT FSH T 3 T 4 T SH

15. Investigations secondary CT Scan MRI Prolactin test Serum testosterone Laparoscopy (hysteroscopy)

16. Management Primary amenorrhea Medical management Treatment depends on the women's needs and the cause of the amenorrhea.

17. Management No Abnormality Detected The patient is anxious for amenorrhea but not for fertility. The patient is anxious for fertility

18. II. Cases with detectable cause. Anxiety and stress- Systemic illness and malnutrition Exercise induced amenorrhea is cured with limitation of activity and appropriate diet. III. PCOS – management of PCOS Tumor :Appropriate surgery is done.

19. Developmental anomalies Complete agenesis of vagina: Vaginal reconstruction is the accepted form of treatment.

20. Hypothalamo-pituitary ovarian axis defect Hypothalamic-pituitary tumors may need surgical excision or radiotherapy. Thyroid and adrenal dysfunction:

21. Metabolic and nutritional Diabetes and tuberculosis are to be treated by antidiabetic and antitubercular drug respectively. Correction of anemia Correction of malabsorption,.

22. Nursing management Rule out pregnancy – Ask about the presence of manifestations of pregnancy. Provide teaching : teaching opportunities are an important part of nursing care.

23. Summary So far we have discussed about Definition, types, etiology, clinical manifestation, diagnostic evaluation and management of Amenorrhea.

24. Bibliography Lewis et al, Medical Surgical Nursing, Mosby Elsevier,7 th edition. Joyce.M.Black et al, Medical Surgical Nursing, Saunders publication. Brunner and Siddhartha, Medical Surgical Nursing, Lippincott Williams and Wilkins.

25. Thank You