Disorders of menstruation.pdf

Disorders of menstruation

1. DISORDERS OFMENSTRUATION
MRS. DEEPTI KUKRETI
PG NURSING TUTOR
OBSTETRICS & GYNAECOLOGY
SGRRCON

2. AMENORRHEA
➢ABSENCE OF MENSTRUATION IN WOMEN IN
REPRODUCTIVEAGE

4. CRYPTOMENORRHEA
•Menstruation occurs but there is obstruction
to the outflow ofblood
•CAUSES Congenital: Imperforatehymen
Acquired: Vaginalatresia,
cervicalstenosis

5. PATHOPHYSIOLOGY
Accumulation of blood in uterinecavity
Hematocolpos(accumulation of blood in the vagina)
Hematometra (collection of blood in uterus due to an imperforate hymen)
Hematosalphinx(accumulationofbloodinfallopiantubes)

6. CLINICAL
FEATURES
•Amenorrhea
•Lower abdominalpain
•Retention ofurine
•Uniform globular mass in theabdomen
•Bulginghymen

7. MANAGEMENT
•Cruciate incision of hymen and drainage of
blood
•Dialatation of cervix instenosis

8. PRIMARYAMENORRHEA
•Failure of onset of menstruation beyond the
age of 16 in a girl with normal secondary
characteristics

9. CAUSES
➢Disordersof Hypothalamo Pituitary OvarianAxis
A.Hypogonadotrophichypogonadism( male testes
or the female produce little or no sex
hormones)
-Delayedpuberty
-CNSTumors
-Hypothalamic and pituitary dysfunction

10. B. Hypergonadotrophichypogonadism
-Primary ovarianfailure
-Galactosemia
-17alpha hydroxlasedeficiency
➢Abnormal chromosomal pattern
eg:Turnerssyndrome

11. ➢Developmental defect of genitaltract
eg: absence of vagina,absence ofuterus
➢Dysfunction of thyroidgland
➢Metabolicdisorders
➢Systemicillness

12. INVESTIGATIONS
•History & Physicalexamination
•Ultrasonography
•Karyotyping(examining
chromosomes)
•Hormonalstudies
•Bloodinvestigations

13. MANAGEMENT
•Correction of thecause
•Cyclic estrogen andprogesterone
•Corticosteroidtherapy

14. SECONDARY
AMENORRHEA
•Absence ofmenstruationfor6 monthsor
more in a women with previous normal
menstrualpatterns.

15. ETIOLOGY
•Uterinefactors
•Ovarianfactors
•Pituitaryfactors
•Hypothalamicfactors
•Systemic
•Adrenaldisorders

16. INVESTIGATIONS
•History & physicalexamination
•Bloodinvestigations
•Hormonalstudies

17. MANAGEMENT
1)No abnormalitydetected
•Assurance
2) Cases with detectablecause
•Treat the underlyingcause
3) Polycystic ovariansyndrome
•Weightreduction
•GnRHagonist
•Surgery

18. 4)Hyperprolactinemia
•Bromocriptine
•Surgery
5) Premature ovarianfailure
•Hormonaltherapy
•Corticosteroids
•IVF

19. 6) Adrenaldisorders
•Adrenocorticolyticdrug
•Adrenalectomy

20. DYSMENORRHEA
•PAINFUL CRAMPING PAINACCOMPNYING
MENSTRUATION

21. CLASSIFICATION
➢PRIMARYDYSMENORRHEA
➢SECONDARYDYSMENORRHEA

22. OTHERTYPES
➢SPASMODIC
➢CONGESTIVE
➢MEMBRANOUS

23. PRIMARYDYSMENORRHEA
•Painful menstruation with no pelvicpathology
•Usually starts 2-3 yrs after menarche and
ceases after childbirth.
•Begins shortly before or at the onset of
menses and lasts one or threedays

24. CAUSES
➢Psychosomaticfactors
➢Abnormal anatomical and functional aspects
ofuterus
-Stenosis at internaloss
-Unequal development of mullerian
duct
-Inappropriate law ofpolarity
➢Role ofvasopressin

25. PATHOPHYSIOLOGY

26. CLINICALFEATURES
➢Uterinecramping
➢Nausea
➢Vomiting
➢Fatigue
➢Diarrhea
➢Headache
➢Giddiness

27. DIAGNOSIS
•Pelvicsonography
•CT/MRI
•Hysterosalphingography
•Hysteroscopy/Laproscopy

28. TREATMENT
➢GENERALMEASURES
1.Counseling
2.Psychotherapy

29. ➢DRUGS
1.Prostaglandin synthetase
inhibitors:
eg:Mefanamicacid,Ibuprofen,Indomethacin
2.Oral Contraceptives
eg:Dydrogesterone

30. ➢SURGERY
▪Dilatation of cervicalcanal
▪PresacralNeurectomy
▪Laser Assisted uterosacral NerveAblation

31. SECONDARY
DYSMENORRHEA
➢Associated with presence of pelvicpathology
➢Cramp starts 3 to 5 days prior to menstruation
and relieves with start ofbleeding
➢Patients are usuallythirties

32. CAUSES
➢Chronic pelvicinfection
➢Endometriosis
➢Adenomyosis
➢Uterine fibroid
➢IUCD inutero
➢Endometrialpolyp

33. PATHOPHYSIOLOGY
➢Painisduetopelviccongestionwhichismore
markedinthepremenstrualperiod.
➢Painincreasesinitsseverityasmenstruation
approachesandisrelievedbytheonsetof
menstrualflow,duetothediminutionof
pelviccongestion.

34. CLINICAL
FEATURES
➢Dullaching lower abdominal pain
accompanied bybackache
➢Dyspareunia
➢Infertility
➢Abnormalbleeding

35. TREATMEN
T
➢Treat the cause rather thansymptom
➢Surgicalinterventions
▪Diagnostic hysteroscopy followed byD&C
▪Diagnosticlaparoscopy
▪Laprotomy followed by excision of
adenomyoma
▪Hysterectomy inelderly