Transcript
DISORDERS OF MENSTRUATION
Sherin shana Govt.College of Nursing
Kozhikode
AMENORRHEA
ABSENCE OF MENSTRUATION IN WOMEN IN
REPRODUCTIVE AGE
CRYPTOMENORRHEA
• Menstruation occurs but there is obstruction
to the outflow of blood
• CAUSES Congenital: Imperforate hymen
Acquired: Vaginal atresia,
cervical stenosis
PATHOPHYSIOLOGY
Accumulation of blood in uterine cavity
Hematocolpos
Hematometra
Hematosalphinx
CLINICAL FEATURES
• Amenorrhea
• Lower abdominal pain
• Retention of urine
• Uniform globular mass in the abdomen
• Bulging hymen
MANAGEMENT
• Cruciate incision of hymen and drainage of
blood
• Dialatation of cervix in stenosis
PRIMARY AMENORRHEA
• Failure of onset of menstruation beyond the
age of 16 in a girl with normal secondary
characteristics
CAUSES
Disorders of Hypothalamo Pituitary Ovarian Axis
A. Hypogonadotrophic hypogonadism
- Delayed puberty
- CNS Tumors
- Hypothalamic and pituitary dysfunction
B. Hypergonadotrophic hypogonadism
-Primary ovarian failure
-Galactosemia
-17alpha hydroxlase deficiency
Abnormal chromosomal pattern
eg:Turners syndrome
Developmental defect of genital tract
eg: absence of vagina,absence of uterus
Dysfunction of thyroid gland
Metabolic disorders
Systemic illness
INVESTIGATIONS
• History & Physical examination
• Ultrasonography
• Karyotyping
• Hormonal studies
• Blood investigations
MANAGEMENT
• Correction of the cause
• Cyclic estrogen and progesterone
• Corticosteroid therapy
SECONDARY AMENORRHEA
• Absence of menstruation for 6 months or
more in a women with previous normal
menstrual patterns.
ETIOLOGY• Uterine factors• Ovarian factors• Pituitary factors• Hypothalamic factors• Systemic• Adrenal disorders
INVESTIGATIONS
• History & physical examination
• Blood investigations
• Hormonal studies
MANAGEMENT
1) No abnormality detected• Assurance2) Cases with detectable cause• Treat the underlying cause3) Polycystic ovarian syndrome• Weight reduction• GnRH agonist• Surgery
4) Hyperprolactinemia• Bromocriptine• Surgery5) Premature ovarian failure• Hormonal therapy• Corticosteroids• IVF
6) Adrenal disorders
• Adrenocorticolytic drug
• Adrenalectomy
DYSMENORRHEA
• PAINFUL CRAMPING PAIN ACCOMPNYING
MENSTRUATION
CLASSIFICATION
PRIMARY DYSMENORRHEA
SECONDARY DYSMENORRHEA
OTHER TYPES
SPASMODIC
CONGESTIVE
MEMBRANOUS
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
CAUSES
Psychosomatic factorsAbnormal anatomical and functional aspects
of uterus -Stenosis at internal oss - Unequal development of mullerian
duct -Inappropriate law of polarityRole of vasopressin
PATHOPHYSIOLOGY
CLINICAL FEATURES
Uterine cramping
Nausea
Vomiting
Fatigue
Diarrhea
Headache
Giddiness
DIAGNOSIS
• Pelvic sonography
• CT/MRI
• Hysterosalphingography
• Hysteroscopy/Laproscopy
TREATMENT
GENERAL MEASURES
1. Counseling
2. Psychotherapy
DRUGS
1. Prostaglandin synthetase inhibitors:
eg:Mefanamic acid,Ibuprofen,Indomethacin
2. Oral Contraceptives
eg:Dydrogesterone
SURGERY
Dilatation of cervical canal
Presacral Neurectomy
Laser Assisted uterosacral Nerve Ablation
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
CAUSES
Chronic pelvic infection
Endometriosis
Adenomyosis
Uterine fibroid
IUCD in utero
Endometrial polyp
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.
CLINICAL FEATURES
Dull aching lower abdominal pain
accompanied by backache
Dyspareunia
Infertility
Abnormal bleeding
TREATMENT
Treat the cause rather than symptomSurgical interventions Diagnostic hysteroscopy followed by D&C Diagnostic laparoscopy Laprotomy followed by excision of
adenomyoma Hysterectomy in elderly
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