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menstruation in a woman.
It normally occurs in:
The period before puberty
Pregnancy and breastfeeding
After menopause



Amenorrhoea itself is divided into two, namely:

1. Primary Amenorrhoea
is the absence of menstruation in women aged 18 years
and over, never getting menstruation.
occurs in 0.1 - 2.5% of women of reproductive age.
usually caused by hormonal disorders or growth
problems can also be caused by low GnRH, stress,
anorexia, weight loss is extreme, thyroid disorders,
strenuous exercise, birth control pills and ovarian cysts.

2. Secondary Amenorrhoea
is the absence of menstruation after menarche or
ever having periods but stopped successively for 3
months (in the case of oligomenorrhea), or 6 cycles
after getting the menstrual cycle regular for 6
months or more.
not on women who are not pregnant, breastfeeding
or menopause
the incidence rate ranged between 1-5%

Causes of Amenorrhea
A.Reproductive Tract Disorders
1.Agglutination labia (labia lips clotting)
2.Congenital abnormalities of the vagina
imperforate hymen (hymen does not have holes)
septa vagina (vaginal has a barrier in between)

3.Syndrome Mayer-Rokitansky-Kuster-Hauser.
Women who have normal ovaries but does not have
a uterus and a vagina or have both but little or shrink.

4.Testicular feminization syndrome.

Occur in patients with chromosome 46, XY
karyotype, and have X-linked dominant
Causing disruption of the hormone testosterone
These patients have testes with normal function
without the female reproductive organs (ovaries,
Physically vary from woman without armpit and
pubic hair growth until the appearance like a
man but infertile.

B.Ovarian Disorders
1. Gonadal dysgenesis
Gonadal dysgenesis is not the presence of the egg by the
ovaries are replaced by scar tissue.

2. Ovari premature failure

This is a failure of ovarian function before age 40 years.
The cause is expected to damage the egg due to infection
or autoimmune process

3. Ovarian tumors
Ovarian tumors may interfere with normal egg cells

C.CNS disorders
1.Pituitary disorders.
Pituitary tumor or inflammation can lead to
Hyperprolactinemia (prolactin hormone excess)
due to tumor, drug, or other abnormalities may
lead to disruption of the hormone gonadotropin.
2.Hypothalamic disorders.
Polycystic ovary syndrome, thyroid dysfunction,
and Cushing's syndrome is a disorder that causes
disruption of the hypothalamus.

Treatment of Amenorrhea
Handling amenorrhea depends on the cause.
Treatment can include birth control pills, use of certain medications, or
Surgery is only done if the cause is a tumor or abnormality in the
structure of the reproductive organs.

Prevention Amenorrhea
Amenorrhea caused by lifestyles can be treated with lifestyle changes.
Do not forget to rest after hard work. Do not exercise excessive or
appetite. Do not get affected by bulimia or anorexia.
Control stress in a healthy way. Take note also experienced menstrual
Note if there are abnormalities in menstruation.


Dysmenorrhea is a term used to describe

pain when a woman enters a particular
menstrual cycle.

Type of Dysmenorrhea
Based on the presence
gynecological disorders.




a. Primary dysmenorrhea
dysmenorrhea happens without gynaecologic problems.
easily occurs on women who are emotionally unstable.
arise since menarche
occurs between the ages of 15-25 years and later will be
lost at the age of late 20s or early 30s.
The pain usually occurs several hours before and after
the menstrual period
sometimes accompanied by nausea, vomiting, diarrhea,
headache, lower back pain, fatigue and so on.

b. Secondary dysmenorrhea
is pain associated with gynecological disorders,
both anatomical and pathological processes and
usually happens some time after menarche.
Can also be started after the age of 25 years.
The pain started 1-2 weeks before menstruation
and continued until a few days after menstruation.
encountered gynecological disorders such as
endometritis, adenomyosis, ovarian cysts, uterine
fibroids, pelvic inflammation and others.

Based on the intensity of pain.

a. Mild dysmenorrhea
dysmenorrhea with pain that lasts a while so we need a
short break to relieve pain, without the use of drugs.

b. Moderate dysmenorrhea
dysmenorrhea requiring the drug to relieve pain without
the need to leave the daily activities.

c. Severe dysmenorrhea
which is dysmenorrhea who need a break for so long with
the result leaving day-to-day activities during the day even

Causes of Dysmenorrhea
Primary dysmenorrhea
Causes of menstrual pain is not be found exactly despite
much research was done to find the cause. Etiology of
primary dysmenorrhea are:
Psychological factors
It usually occurs in adolescents with emotional instability

Endocrine factors
In general, it is related with intestinal contractions were not
It is very closely related to hormonal influences.
Increased production of prostaglandins will cause
uncoordinated contractions of the uterus, causing pain.

Secondary dysmenorrhea
In secondary dysmenorrhea, etiology that may occur are:
Constitutional factors
anemia, the use of IUD, bump that causes bleeding, tumors
or fibroids.
Congenital uterine anomalies
the inverted uterus, inflammation of the mucous membrane of the


Treatment of Dysmenorrhea
Primary Dysmenorrhea

Adequate rest
Exercise regularly
Warm compresses diarea around the belly
Drink lots of water, avoid excessive salt intake and caffeine
to prevent swelling and fluid retention.
Eat foods rich in iron, calcium, vitamin B complex such as
milk, green vegetables.
Elevate hip position exceeds the shoulder when sleeping
on your back to help relieve dysmenorrhea.

Secondary dysmenorrhoea
depends on the underlying cause