Scribd Logo
Upload

Welcome to Scribd!

  • 114 views

    Menstrual Disorders

    Uploaded by

    Kiran
    Menstrual disorders include premenstrual syndrome, dysmenorrhea, amenorrhea, and abnormal uterine bleeding. Premenstrual syndrome involves physical and emotional symptoms that occur before menstruation. Dysmenorrhea is painful periods, which can be primary or secondary. Amenorrhea is the absence of periods, and can be primary or secondary. Abnormal uterine bleeding involves changes in bleeding patterns. These disorders are usually treated through lifestyle changes, medications, and sometimes surgery depending on the underlying cause.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd

    Menstrual Disorders

    Uploaded by

    Kiran
    114 views47 pages
    Menstrual disorders include premenstrual syndrome, dysmenorrhea, amenorrhea, and abnormal uterine bleeding. Premenstrual syndrome involves physical and emotional symptoms that occur before menstruation. Dysmenorrhea is painful periods, which can be primary or secondary. Amenorrhea is the absence of periods, and can be primary or secondary. Abnormal uterine bleeding involves changes in bleeding patterns. These disorders are usually treated through lifestyle changes, medications, and sometimes surgery depending on the underlying cause.

    Original Description:

    Kiran

    Original Title

    menstrual disorders

    Copyright

    © © All Rights Reserved

    Available Formats

    PPT, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Menstrual disorders include premenstrual syndrome, dysmenorrhea, amenorrhea, and abnormal uterine bleeding. Premenstrual syndrome involves physical and emotional symptoms that occur before menstruation. Dysmenorrhea is painful periods, which can be primary or secondary. Amenorrhea is the absence of periods, and can be primary or secondary. Abnormal uterine bleeding involves changes in bleeding patterns. These disorders are usually treated through lifestyle changes, medications, and sometimes surgery depending on the underlying cause.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    114 views47 pages

    Menstrual Disorders

    Uploaded by

    Kiran
    Menstrual disorders include premenstrual syndrome, dysmenorrhea, amenorrhea, and abnormal uterine bleeding. Premenstrual syndrome involves physical and emotional symptoms that occur before menstruation. Dysmenorrhea is painful periods, which can be primary or secondary. Amenorrhea is the absence of periods, and can be primary or secondary. Abnormal uterine bleeding involves changes in bleeding patterns. These disorders are usually treated through lifestyle changes, medications, and sometimes surgery depending on the underlying cause.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 47

    Menstrual disorders

    Menstrual disorders
    Menstrual disorders may include –
    1. Premenstrual syndrome
    2. Dysmenorrhea
    3. Amenorrhea
    4. Abnormal bleeding disorders
    Premenstrual Syndrome

    Symptoms and
    Treatments
    Different Faces of Premenstrual Disorders
    Premenstrual Syndrome
     This disorder refers to a variety of
    symptoms that some females experience
    before their menstrual periods and subside
    with the onset of menstrual flow.
     Symptoms include nervous tension, anxiety,
    irritability, eating, weight gain, mood
    swings, depression and fatigue.
     Not all women experience PMS
    Premenstrual Disorders
    Etiology
     Cause is unknown!

     Interactions of ovarian hormones with neurotransmitters –


    Alterations of serotoninergic activity in the brain.
     Imbalance between Estrogen and Progesterone levels

     Serotonin deficiency

     Biologic, physiologic, environmental and social factors all


    seems to be contributory
     Genetic factors seems to play a role.
    Most Common Symptoms:
    . EMOTIONS
    1
     Anxiety
     Mood Swings
     Irritability
     Nervous Tension
     Sadness
     Anger
    2. Physical-Nervous System
     Headache
     Cravings – sweet and salty
     Increased Appetite
     Fatigue
     Dizziness or Fainting
     Heart Pounding
     Agitation
    3. Physical
     Weight Gain
     Swelling of Extremities
     Breast Swelling & Tenderness
     Abdominal Bloating
     Joint and Muscle Pain
    4. Behavioral
     Depression
     Forgetfulness
     Crying
     Confusion
     Insomnia
    Premenstrual Disorders
    Diagnosis
     Exclude medical, physical and psychiatric problems

     TSH, Blood glucose level etc.

     Keep symptoms calendar.

    - At least two consecutive menstrual cycles

    - Nature, and timing

     Exclude simple Menstrual symptoms like breast


    tenderness and bloating, not affecting daily activities.
    Treatment

     Cut down on the amount of salt and refined sugar you


    use.

     Don’t use caffeine—


    Found in coffee, tea, chocolate,
    cola and some energy drinks.
     Get regular exercise

     Take Calcium Carbonate


    daily.
     This will help make your
    bones strong.
     Increase Carbohydrates
     Bread, cereal,
    vegetables

     Increase Vitamin B6

     Reduce Stress
     Prostaglandin
    Inhibitors
     – like Ibuprofen can
    help

     Selective serotonin
    reuptake inhibitors
    e.g. fluoxetine
     Antianxiety drugs.
    DYSMENORRHEA
     WHAT IS DYSMENORRHEA?
    Painful menstruation

     WHAT IS ITS INCIDENCE?


    50-75 %

     WHAT ARE THE TWO MAIN CATEGORIES?


    1- Primary painful menstruation without associated pelvic
    disease
    2-Secndary  painful menstruation caused by
    pelvic pathology
    PRIMARY DYSMENORRHEA
     Usually begins few hrs before or with the
    onset
    of menstruation then gradually decrease

     +ve family history.

     The pain is crampy/ colicky , in the lower


    abdomen

     most intense in the midline lasts for 12-72 hr


     Associated symptoms
    -Back pain & pain in the upper thighs 60%
    -Nausea /vomiting 90%
    -Diarrhea 60%
    -Fatigue / malaise 85%
    -Headache (tension or migraine) 45%
    -Dizziness, nervousness, fainting in sever
    cases
    CAUSES OF 1ry DYSMENORRHEA

     It result from excessive production of


    prostaglandins, which causes painful
    contraction of the uterus .

     Behavioral, cultural & psychological factors


    may also contribute to Dysmenorrhea.
    TREATMENT OF 1RY DYSMENORRHEA

     Psychological support
     Non-pharmacological treatment
     Hot water bottles
     Pharmacological treatment-

    1-NSAID  1st line 80% effective


    *Propionic derivatives  Ibuprofen

    *Fenamates  Mefenamic acid “Ponstan”


    2RY DYSMENORRHEA
     Painful menstruation caused by pelvic
    pathology
     Recurrent pelvic infections
     IUCD
     Recent pelvic surgery
     Heavy periods
     Irregular cycles
    CAUSES OF 2RY DYSMENORRHEA
     Endometriosis: Ectopic endometrial tissue
     Endometritis: Endometrial tissue in the myometrium
     Adhesions
     Endometrial polyp
     Submucous fibroid
     Cervical stenosis
     Pelvic congestion
     Conditioned behavior
     Stress & tension
    2RY DYSMENORRHEA
    HOW TO EVALUATE PT WITH 2RY DYSMEN ?
     CBC
     Cultures for STD
     USG
     HSG  if intrauterine scarring or fibroid is
    suspected
     Laparoscopy
     Hysteroscopy

    TREATMENT OF 2RY DYSMENORRHEA


    Treat the cause
    Amenorrhea
    • Transient, intermittent, or permanent
    cessation of bleeding.

    • Results from dysfunction of the


    hypothalamus, pituitary, ovaries,
    uterus, or vagina.
    Primary vs. Secondary Amenorrhea
     Primary: Absence of menarche by the age of 16
    but show evidence of secondary sex
    characteristics or without secondary sex
    characteristics.

     Secondary: absence of menses for more


    than three cycle intervals or six months in
    women who were previously menstruating.
    Causes of Primary Amenorrhea

     Chromosomal abnormalities — 45%


     Physiologic delay of puberty — 20%
     Transverse vaginal septum— 5%
     Absent hypothalamic production of GnRH -
    5%
     Anorexia nervosa and bulimia— 2%
    Diagnostic Evaluation for
    Primary Amenorrhea:

     Normal pubertal development?

     Was pt’s neonatal/childhood health normal?

     Family history of delayed/absent menarche?


    More history questions…
     Any recent increase in stress, or change in
    weight, diet, or exercise habits?

     Is pt taking any medicines or drugs?

     Short stature compared to family members?

     Any symptoms of other hypothalamic-


    pituitary disease.
    Secondary Amenorrhea
     Main cause is pregnancy, followed by….
     Ovarian disease — 40%
     Hypothalamic dysfunction — 35%
     Pituitary disease — 19%
     Uterine disease — 5%
     Other — 1%
    History in secondary amenorrhea

     Recent stress, wt loss, diet or exercise


    changes, or illness?
     Meds (Recent OCP initiation, danazol, meto-
    clopramide, anti-psychotics?)
     Symptoms of other hypothalamic-pituitary
    disease, including headaches, visual field
    defects, fatigue, or polyuria and polydypsia?
    Treatment of amenorrhea

     Treatment is according to underline


    disorders.
    Abnormal uterine bleeding

     Change in frequency, duration and


    amount of menstrual bleeding.
    Normal menstruation
    Rhythm: regular from 21-35
    days
    Duration: 3-7 days
    Amount: between 30-50 ml
    Flow: non clotted fluid blood
    Disorders in rhythm, amount or
    duration

    Menorrhagia

    Postmenopausal bleeding
    Oligomenorrhea

    Metrorrhagia

     Amenorrhea
    Menorrhagia
     Prolonged bleeding
     > 7 days or > 80 cc
     occurring at regular intervals.
    Metrorrhagia:
    • Vaginal bleeding between regular menstrual
    periods.

    • Significant form of menstrual disorders


    because it may signal cancer, benign tumors
    of the uterus other gynae problems.
    Oligomenorrhea
     Oligomenorrhea is a condition in which
    menstrual cycles are infrequent, greater
    than 35 days apart.

     It is very common in early adolescence and


    does not usually indicate a medical problem.
    Menometorrhagia:
     Uterine bleeding that is prolonged and
    occurs at completely irregular intervals.
    Postmenopausal bleeding

     Uterine bleeding that occurs more than 1


    year after the last menses in a woman with
    ovarian failure.
    Causes
     The main cause of DUB is anovulation
    resulting from altered neuroendocrine and/or
    ovarian hormonal events.

     Uterine Fibroids

     Structural problems or other abnormalities

     Cancer. Rarely, uterine, ovarian, and cervical


    cancer can cause excessive bleeding
     Infection. Infection of the uterus
    or cervix can cause bleeding

     Pregnancy or Miscarriage
    Sign and symptoms
     Vaginal bleeding
     Lower back pain
     Pain in the back of the legs
     An appearance of noticeable weight
    gain
     Excessive or prolonged fatigue resulting
    from blood loss
     Anemia
     Nausea and vomiting
    Treatment of DUB
     Medical management before Surgical
     effective methods include:
     estrogens, progestin, or both
     NSAID’s
     antifibrinolytic agents
     danazol
     GnRH agonists
    OCPs

     Oral contraceptive pills (OCPs)


    suppress endometrial development,
    decrease menstrual flow, and lower the
    risk of iron deficiency anemia.
    Surgical management
     According to disease condition like-
    If uterine adhesion- uterine curettage
    Uterine fibroids or polyps - fibrectomy or
    hysterectomy

    You might also like