Abnormal Menstruation PDF

Abnormal menstruation DR.SARAH ISMAT ALZAEIM ALAZHARY UNIVERSITY Menstrual cycle Menstrual cycle Changes in menstrual cycle Normal menstruation Defnition : Shedding the uterine lining (endometrium) if pregnancy does not occur. Characteristics : Menarche :10-16 years ,average 13 years. Dura...

Abnormal menstruation DR.SARAH ISMAT ALZAEIM ALAZHARY UNIVERSITY Menstrual cycle Menstrual cycle Changes in menstrual cycle Normal menstruation Defnition : Shedding the uterine lining (endometrium) if pregnancy does not occur. Characteristics : Menarche :10-16 years ,average 13 years. Duration :2-7 days. Amount : 30-80 ml ,3 napkins per day. Abnormal menstruation  Amenorrhea : (absence of menstruation )  Hypomenorrhea :( scanty menstruation )  Oligomenorrhea : (infrequent menstruation )more than 35 d apart  Menorrhagia : ( excessive menstruation )  Metrorrhgia : ( bleeding between periods )  Menometrorrhgia : ( heavy bleeding during and between periods ) AMENORRHEA Primary Secondary Fail to menstruate by 16 years of age Absence of menstruation more than 6 months with exclusion of pregnancy ,lactation and menopause. AMENORRHEA CUASES : Hypothalamic Pituitary  Excessive exercise  Adenomas ;prolactinoma  Low body weight  Necrosis ;Sheehan,s syndrome  Stress  Surgery  Drugs  Radiotherapy  Chronic diseases  Hypothalamic lesions AMENORRHEA CUASES : Ovarian (anovulation ) Endometrial  Polycystic ovary syndrome  Mullerian defect ; absent or (PCOS) outflow tract abnormalities  Premature ovarian failure  Scarring (Asherman (POF) syndrome ) Signs and symptoms  Life style ; stress ,weight ,exercise ……hypothalamic  ++Hair growth ; ++weigh ……..PCO  Cyclical pain ……..congenital malformation  Headache ; galactorrhoea ; visual disturbance ……..prolactinoma  Past medical history ;….chronic disease (thyroid ,renal,…..  Past surgical history ; (evacuation curettage) ……Asherman syndrome  Drug history ; ……… hypothalamic Investigations  Pregnancy test.  Hormonal profile …..++FSH;POF …..++LH;PCO.  Prolactine level.  Ultrasound  Thyroid test  X ray of the skull (turcique selle: Pituitary) Pituitary tumor or necrosis  CT scan  Karyotyping Management  Etiologic treatment  Normalize the Body Mass Index (BMI)  Hormonal treatment (Oral Contraceptive Pills) ,HRT, progesterone  Drugs ; Dopamine agonists  Surgical treatment  Polycystic ovary syndrome PCOS is a syndrome of ovarian dysfunction Clinical features Oligomenorrhoea/amenorrhoea hyperandrogenism ultrasound features Subfertility raised insulin resistance Obesity Elevated serum LH levels, Abnormal uterine bleeding AUB  Heavy menstrual bleeding (HMB),  intermenstrual bleeding (IMB),  postcoital bleeding (PCB)  postmenopausal bleeding (PMB) Heavy menstrual bleeding HMB (menorrhagia) Definition : Heavy more than 80 ml Prolong more than 7 days HMB causes infection polyp fibroid Diagnosis in abnormal uterine bleeding History and physical examination Pelvic ultrasound scan Cytological examination –include biopsy and histology Endometrial biopsy Hysteroscopy Dilatation and curettage Hormonal profile Blood tests- Haemogram, thyroid function tests e.t.c. Management of Abnormal Uterine Bleeding Principles Treat cause appropriately May include : Hormonal preparations Surgery Endometrial ablation and endometrial resection, Prostaglandin synthetase inhibitors, Levonogestrel releasing IUDs Dysmenorrhea Definition: Causes : Dysmenorrhea is characterized by: Endometriosis and adenomyosis Pain occurring during menstruation. Pelvic inflammatory disease Cervical stenosis and Types haematometra Primary secondary Dysmenorrhea Investigations Management High vaginal and Non-steroidal anti-inflammatory endocervical swabs. drugs (NSAIDs) TVUSS scan Hormonal contraceptives Diagnostic laparoscopy: LNG-IUS Surgery