MENSTRUAL

IRREGULARITIES
CRYPTOMENORRHOEA(CONCEALED)
THERE IS PERIODIC SHEDDING OF THE
ENDOMETRIUM AND BLEEDING BUT
THE MENSTRUAL BLOOD FAILS TO
COME OUT FROM THE GENITAL
TRACT DUE TO OBSTRUCTION IN THE
PASSAGE .


PRIMARY AMENORRHOEA
DEFINITION
A YOUNG GIRLWHO HAS NOT YET
MENSTRUATED BY HER 16 Yrs OF AGE IS
HAVING PRIMARY AMENORRHOEA RATHER
THAN DELAYED MENARCHE.THE NORMAL
UPPER AGE LIMIT FOR MENARCHEIS 15 Yrs
CAUSES
A) HYPOGONADOTROPHIC HYPOGONADDISM
DELAYED PUBERTY
HYPOTHALAMIC AND PITUITARY DYSFUNCTION
KALLMANNS SYNDROME
CENTRAL NERVOUS SYSTEM TUMOURS
CAUSES
B) HYPERGONADOTROPHIC HYPOGONADDISM
PRIMARY OVARIAN FAILURE
RESISTENT OVARIAN SYNDROME
GALACTOCEMIA

C) ABNORMAL CHROMOSOMAL FACTORS
TURNERS SYNDROME
VARIOUS MOSAIC STATUS
ANDROGEN INSENSITIVITYSYNDROME
CAUSES
D) DEVELOPMENTAL DEFECT OF GENITAL TRACT
IMPERFORATE HYMEN
TRANSVERSE VAGINAL SEPTUM
ATRESIA UPPER-THIRED OF VAGINA AND CERVIX
COMPLETE ABSENCE OF VAGINA
CAUSES
CAUSES
E) DYSFUNCTION OF THYROID AND ADRENAL
CORTEX
ADRENOGENITAL SYNDROME
CRETINISM
F) METABOLIC DISORDERS
JUVENILE DIABETES
CAUSES
G) SYSTEMIC ILLNESS
H) UNRESPONSIVE ENDOMETRIUM




















ETIOLOGY OF SECONDARY
AMENORRHOEA
TUBERCULAR ENDOMETRITIS
PCOD
PREMATURE OVARIAN FAILURE
RESISTANT OVARIAN SYNDROME
ADRENAL TUMOURS
CUSHING SYNDROME
HYPOTHYROIDISM
GENERAL DISEASE
CAUSES
PSYCHOMOTOR FACTORS
ABNORMAL ANATOMICAL AND FUNCTIONAL
ASPECT OF UTERUS
ROLE OF VASOPRESSIN
ROLE OF PROSTAGLANDINS
OTHERS
TREATMENT
DRUGS
PROSTAGLANDIN SYNTHETASE INHIBITORS
Fenamate group-mefenamic acid 250-500gm
Propionic acid derivatives-ibuprofen 8
th
hourly
or naproxen 250 mg 6
th
hourly
Endomethacin 25 mg 8
th
hourly

TREATMENT
SURGERY
DILATATION OF THE CERVICAL CANAL
BILATERAL BLOCK OF THE PELVIC PLEXUS
PRESACRAL NEURECTOMY ( LAPROSCOPIC)
CERVICAL DILATATION RELIEVES PAIN BY THE
STRETCHING OF THE FIBROMUSCULAR TISSUES
AT THE LEVEL OF INTERNAL OS

LOSS OF TONE

BY CAUSING INJURY TO THE SENSORY NERVE
ENDINGS AND CUT DOWN THE PAIN PATHWAY
TYPES OF SECONDARY
DYSMENORRHOEA
MEMBRANOUS DYSMENORRHOEA
Shedding of big endometrial casts during
period.
OVARIAN DYSMENORRHOEA
Pain is continuous and dull and is distributed
to either on or both quadrants innervated by
T 10 to L 1 segment
TYPES
OVULAR PAIN ( MITTELSCHMERZS SYNDROME)
The pain usually situated in the hypogastrium or one
illiacfossa. The pain is usually located on one side and
does note change fro side to side according to which
ovary is ovulating.
PELVIC CONGESTION SYNDROME
There is the disturbance in the autonomic nervous
system which may lead to gross vascular congestion
with pelvic varicosities.


PREMENSRUAL SYNDROME (PMS)
It is a psychoneuro endocrine disorders of
unknown etiology often noticed just prior to
the menstruation the appearance of
symptoms during the last 7-10 days of the
menstrual cycle.
TREATMENT
GENERAL
NONPHARMACOLOGICAL
a) Assurance, yoga, diet manipulation
b) Avoid caffeine and alcoholism
NONHORMONAL
Pyridoxine 100 mg twice daily help full by the
tryptophan metabolism
Diuretic Frusamide 20 mg daily to reduce fluid
retention
TREATMENT
Alprazolam 0.25mg twice daily to reduce the
anxiety and depression
HORMONES
Bromocriptine 2.5 mg daily
Progesterone- Dydrogesterone 10 mg daily