Menstrual disorder

its include what are the complication related with menstruration and how to manage them.

1. DR.BIJAY KUMAR SAH MBBS(BANGLADESH)

2. MENSTRUATION DISORDERS Menorrhagia Polymenorrhagia Polymenorrhoea Metrorrhagia Menometrorrhagia Hypomenorrhoea Oligomenorrhagia

3. MENORRHAGIA Cyclic uterine bleeding with excessive amount and/or duration. CAUSES:-1) Fibroid uterus 2) Adenomyosis 3)PID 4)DUB 5)IUCD in situ INVESTIGATION:-1)HB% & Blood grouping 2) BT,CT,Platelet count 3)USG 4)PBF(peripheral blood flim ) 5)TFT(if suspected)

4. TREATMENT OF MENORRHAGIA/ OR ABNORMAL HEAVY PERVAGINAL BLEEDING A)General management:- 1)Rest 2)Adequate explanation and reassurance 3)Psychological support 4)Correction of anamie by iron or blood transfusion. B)Treatment according to cause:- if primary cause then hormone therapy ( progesteron ) and if responsive then continue for 3 cycles and if unresponsive then surgical treatment according to severity and priority of patient.

5. POLYMENORRHOEA:- Polymenorrhoea is a cyclic bleeding which is normal in amount but which occurs at too frequent intervals of less than 21 days. CAUSE:- 1)Upset pitutary ovarian relationship. 2)Ovarian hyperaemia as in PID or Ovarian endometrosis . POLYMENORRHAGIA:- Cyclic bleeding which is both too excessive and too frequent. CAUSE:-1)Pelvic infection 2)High pressure stress

6. METRORRHAGIA:- Irregular acyclic bleeding from the uterus is called metrorrhagia . CAUSES:-1)Endometrial polyp 2)Endometrial carcinoma 3)Cervical polyp 4)Cervical carcinoma 5)DUB(Dysfunctional uterine bleeding) MENOMETRORRHAGIA:- Bleeding is so excessive & irrigular that the menses(period) cannot be identified at all. CAUSES:-1)Malignant neoplasia 2)Ectopic pregnancy

7. OLIGOMENORRHOEA:- Menstrual bleeding occuring more than 35 days apart and which remains constant at the frequency is called oligomenorrhoea . CAUSE:-1)during adolescence 2) preceeding menopause 3)obesity 4)tubercular endometritis 5)hyperthyroidism 6)poly cystic ovarian disease HYPOMENORRHOEA:- Bleeding less in amount or short in duration or both. CAUSE:- cryptomenorrhoea,malnutrition etc.

8. DYSMENORRHOEA Painfull menstruation of sufficient magnitude which incapaciate day-to-day activities. TYPES:- 1)Primary:-Pain which is uterine origin and directly linked to menstruation but no visible pelvic pathology. 2)secondary:-Pain which is associated with uterine or pelvic pathology.

9. PRIMARY DYSMENORRHOEA CAUSE:-1)Hormonal imbalance 2)Uterine hyperactivity 3) Anxity and tenson 4)Increase vasopression level SYMPTOMS:-a)Pain(colicky in nature) b)vomiting c)nauseas d)sweating. SIGN:- i.patient looks anxious and pale. ii.physical examination reveals nothing. INVESTIGATION:-Not required but USG,hysteroscopy or laparoscopy can be done to exclude secondary cause.

10. TREATMENT:- Reassurance and counsealing . Bed rest and hot compression. Physical exercise. Analgesis and antispasmodic like Acetaaminophen , mefenamic acid,hyoscine butyl bromide,NSAID etc. Hormonal therapy:-Oral contraceptive(5 th -25 th day of cycle) for 3-6 cycles. Surgical treatment:-Only when pain is proven to true spasmodic and all medical treatment fail then- i )Dilatation of the cervix ii)Bilateral block of pelvic plexus

11. SECONDARY DYSMENORRHOEA CAUSE:- TREATMENT:-General management as primary and definite management according to cause. Fibroid Adenomyosis Endometriosis PID E.Congenital anamoly * Bicornuate uterus * Septate uterus P . IUCD

12. THANK YOU