menstrual irregularities menstruation mentrsual bleeding

menstrual irregularities menstrual hygiene, menstruation.

1. MENSTRUAL IRREGULARITIES

2. INTRODUCTION Menstruation is the visible manifestation of cyclic physiologic uterine bleeding due to shedding of the endometrium following invisible interplay of hormones mainly through hypothalamo - pituitary- ovarian axis.

3. The development and maturation of a follicle, ovulation and formation of corpus luteum and its degeneration constitute an ovarian cycle. All these events occur within 4 weeks. The ovarian cycle consists of: Recruitment of groups of follicles. Selection of dominant follicle and its menstruation. Ovulation Corpus luteum formation Demise of corpus luteum .

4. Menstrual irregularities C ommon abnormalities of a woman’s menstrual cycle. Menstrual irregularities include a variety of conditions in which menstruation is irregular, heavy, painful, or does not occur at all.

5. Common types of menstrual irregularities include: Amenorrhea Dysmenorrhea Menorrhagia Oligomenorrhea Polymenorrhea Spotting Pre-menstrual syndrome Menopause Metrorrhagia Dysfunctional uterine bleeding.

6. AMENORRHOEA Amenorrhoea means absence of menstruation. It is not a symptom and not a disease. 5 basic factors involved in the onset and continuation of normal menstruation. These are: Normal female chromosomal pattern(46XX). Co- ordinate hypothalamo -pituitary ovarian axis. Anatomical presence and patency of the outflow tract. Responsive endometrium. Active support of thyroid and adrenal

7. CLINICAL TYPES Physiological Primary (before puberty) Secondary -during pregnancy -during lactation -following menopause. Pathological Concealed ( cryptomenorrhoea ) Congenital Acquired real (true) primary secondary

8. PRIMARY AMENORRHOEA A  young girl who has not yet menstruated by her 16 years of age is giving primary amenorrhoea rather than delayed menarche. The normal upper age limit for menarche is 15 years.

9. CAUSES 1. Hypogonadotrophic hypogonadism Delayed puberty – delayed Gn RH pulse reactivation. Hypothalamic & pituitary dysfunction Kallmann’s syndrome – inadequate Gn RH pulse secreation - reduced FSH & LH. CNS tumors- craniopharyngioma - reduce Gn RH- Reduce FSH & LH.

10. 2. Hypergonadotrophic hypogonadism Primary ovarian failure Resistant ovarian syndrome Galactosemia Enzyme edficiency (17 alpha hydroxylase deficiency) Others- gonadotrophin receptors mutations

11. 3. Abnormal chromosomal pattern Turner’s syndrome(45X) Pure gonadel dysgenesis (46XX or 46 XY) Androgen insensitivity syndrome ( testicular feminization syndrome) Partial deletion of X chromosome (46XX)

12. 4. Developmental defect of genital tract Imperforate hymen Transverse vaginal septum Atresia upper third of vagina and cervix Complete absence of vagina

13. 5. Dysfuction of thyroid and adrenal cortex Adrenogenital syndrome cretinism 6. Metabolic disorders Juvenile diabetes 7. Systemic illness Malnutrition, anemia Weight loss Tuberculosis 8. Unresponsive endometrium Congenital (uterine synechiae )

14. SPECIAL INVESTIGATIONS OF  PRIMARY AMENORRHOE Mullerian agenesis USG Laproscopy Karyotype Unresponsive endometrium Progesterone challenge test HSG/ Hysteroscopy Hormonal studies

15. Uterine synchiae Progesterone challenge test HSG Hysteroscopy Tubercular blood- ESR X ray- chest Mantaoux test Endometrial biopsy

16. Hypogonadotrophic gonadism Progesterone challenge test Serum gonadotrophins Serum oestradiol Primary ovarian failure Karyotype Serum oestradiol Serum gonadotrophin Ovarian biopsy

17. Tumor Laproscopy Serum gonadotrophins Karyotype Androgen insensitivity syndrome Laproscopy Serum testosterone Karyotype Gonadal biopsy

18. Adrenogenital syndrome Karyotype Serum 17 hydroxy -progesterone Urinary pregnanetriol Thyroid dysfunction (hypo) Serum TSH T3, T4 Diabetes RBS

19. MANAGEMENT OF PRIMARY AMENORRHOA In primary amenorrhea: Correct the underlying cause Estrogen replacement therapy If pituitary tumor: treatment with surgical resection, radiation and drug therapy Surgery to correct abnormalities of genital tract

20. SECONADARY AMENORRHEA Secondary  amenorrhea: is the absence of menses for 3 cycles or 6 months in women who have previously menstruated regularly.

21. Causes Breast feeding Emotional stress Mal nutrition, tuberculosis Pregnancy PCOS Premature ovarian failure Pituitary , ovarian, or adrenal tumour Depression Hyper thyroid or hypothyroid Diabetes Hyper prolactinemia Rapid wt gain or loss related to amenorrhoea

22. Kallmann syndrome Post pill amenorrhoea Chemotherapy or radiotherapy Aneroxia nervosa Hypothalamic dysfunction- stress, exercise, rapid wt. gain or loss. Vigorous excrete Kidney failure Tranquilizers or antidepressant , anti hypertensives Post partum pituitary necrosis Early menopause