Disorders of menstruation

disorders of menstruation

1. DISORDERS OF MENSTRUATION Sherin shana Govt.College of Nursing Kozhikode

2. AMENORRHEA ABSENCE OF MENSTRUATION IN WOMEN IN REPRODUCTIVE AGE

3. CRYPTOMENORRHEA Menstruation occurs but there is obstruction to the outflow of blood CAUSES Congenital: Imperforate hymen Acquired: Vaginal atresia, cervical stenosis

4. PATHOPHYSIOLOGY Accumulation of blood in uterine cavity Hematocolpos Hematometra Hematosalphinx

5. CLINICAL FEATURES Amenorrhea Lower abdominal pain Retention of urine Uniform globular mass in the abdomen Bulging hymen

6. MANAGEMENT Cruciate incision of hymen and drainage of blood Dialatation of cervix in stenosis

7. PRIMARY AMENORRHEA Failure of onset of menstruation beyond the age of 16 in a girl with normal secondary characteristics

8. CAUSES Disorders of Hypothalamo Pituitary Ovarian Axis Hypogonadotrophic hypogonadism - Delayed puberty - CNS Tumors - Hypothalamic and pituitary dysfunction

9. B. Hypergonadotrophic hypogonadism -Primary ovarian failure - Galactosemia -17alpha hydroxlase deficiency Abnormal chromosomal pattern eg:Turners syndrome

10. Developmental defect of genital tract eg : absence of vagina,absence of uterus Dysfunction of thyroid gland Metabolic disorders Systemic illness

11. INVESTIGATIONS History & Physical examination Ultrasonography Karyotyping Hormonal studies Blood investigations

12. MANAGEMENT Correction of the cause Cyclic estrogen and progesterone Corticosteroid therapy

13. SECONDARY AMENORRHEA Absence of menstruation for 6 months or more in a women with previous normal menstrual patterns.

14. ETIOLOGY Uterine factors Ovarian factors Pituitary factors Hypothalamic factors Systemic Adrenal disorders

15. INVESTIGATIONS History & physical examination Blood investigations Hormonal studies

16. MANAGEMENT No abnormality detected Assurance 2) Cases with detectable cause Treat the underlying cause 3) Polycystic ovarian syndrome Weight reduction GnRH agonist Surgery

17. 4) Hyperprolactinemia Bromocriptine Surgery 5) Premature ovarian failure Hormonal therapy Corticosteroids IVF

18. 6) Adrenal disorders Adrenocorticolytic drug Adrenalectomy

19. DYSMENORRHEA PAINFUL CRAMPING PAIN ACCOMPNYING MENSTRUATION

20. CLASSIFICATION PRIMARY DYSMENORRHEA SECONDARY DYSMENORRHEA

21. OTHER TYPES SPASMODIC CONGESTIVE MEMBRANOUS

22. PRIMARY DYSMENORRHEA Painful menstruation with no pelvic pathology Usually starts 2-3 yrs after menarche and ceases after child birth. Begins shortly before or at the onset of menses and lasts one or three days

23. CAUSES Psychosomatic factors Abnormal anatomical and functional aspects of uterus -Stenosis at internal oss - Unequal development of mullerian duct -Inappropriate law of polarity Role of vasopressin

24. PATHOPHYSIOLOGY

25. CLINICAL FEATURES Uterine cramping Nausea Vomiting Fatigue Diarrhea Headache Giddiness

26. DIAGNOSIS Pelvic sonography CT/MRI Hysterosalphingography Hysteroscopy/ Laproscopy

27. TREATMENT GENERAL MEASURES Counseling Psychotherapy

28. DRUGS Prostaglandin synthetase inhibitors: eg:Mefanamic acid,Ibuprofen,Indomethacin 2. Oral Contraceptives eg:Dydrogesterone

29. SURGERY Dilatation of cervical canal Presacral Neurectomy Laser Assisted uterosacral Nerve Ablation

30. SECONDARY DYSMENORRHEA Associated with presence of pelvic pathology Cramp starts 3 to 5 days prior to menstruation and relieves with start of bleeding Patients are usually thirties

31. CAUSES Chronic pelvic infection Endometriosis Adenomyosis Uterine fibroid IUCD in utero Endometrial polyp

32. PATHOPHYSIOLOGY Pain is due to pelvic congestion which is more marked in the premenstrual period. Pain increases in its severity as menstruation approaches and is relieved by the onset of menstrual flow, due to the diminution of pelvic congestion.

33. CLINICAL FEATURES Dull aching lower abdominal pain accompanied by backache Dyspareunia Infertility Abnormal bleeding

34. TREATMENT Treat the cause rather than symptom Surgical interventions Diagnostic hysteroscopy followed by D&C Diagnostic laparoscopy Laprotomy followed by excision of adenomyoma Hysterectomy in elderly