1. OBESTRICTIC PROBLEM Patch16-Group4 ezpaseva

2. AMENORRHEA

DEFINTION Absence of menstruation

Types

There are 3types1-1ry and 2ry

2-true and false

3-physiology and pathology

DIAGNOSIS

History

Examination

Investigation

TREATMENT

3. oligomenorrhea

DEFINTION

Is infrequent or light menstruation

Menstrual duration : greater than 35day

Mean:4-9 period/day

Common at extremes age of reproductive life (ovulation often does not occur)

oligomenorrhea 4.

CAUSES

1. emotional or physiological stress

2. chronic illness

3. increase level oestrogen

4. eating disorder

DIAGNOSIS

TREATMENT

5. DYSMENORRHEA

DEFINTION

Painful menstruation

PREVALENCE

45%-95% ofwomen in reproductive age

CLASSIFICATION

1-primary

2-secondary

6.

AETIOLOGY

(1) PRIMARY

Duration of menstrual flow of>5days

Younger than normal age of menarche

Cigarette smoking

(2) SECONDARY

endometriosis

Pelvic inflammatory disease

Adenomyosis

( rarely ) cervical stenosis

7.

C/F: crampy supra pubic pain

INVESTIGATION: history

Endocervical swab

Pelvic ultrasound

Laparoscopy

TREATMENT: Medical treatment NSAIDs

Oral contraceptive

Nifedipine

Surgical treatment

8. MENORRHAGIA

DEFINTION

Blood loss of greater than 80ml/period

PREVALENCE

Extremely common

CLASSIFICATION

1-idiopathic: No organic pathology ( DUB )

2-secondary: fibroid .

9.

AETIOLOGY

1. DUB; unclear but disordered endometrial prostaglandin production has been implicated in the aetiology

2 . secondary;fibroid 10.

OTHER PHYSIOLOGYVonWillebrands disease

Fibroid uterus

Endometrial polyp

Thyroid disease

Drug therapy

Bleeding in pregnancy

11.

C/F:HISTORY

C/examenation

~ physical examenation

~ cervical smear

~ suggest an organic cause

~ Initial investigation {full blood count}

12.

TREATMENT

MEDICALtreatment

Mephanamic acid

DANAZOL

GESTRINONE

GnRHanalogues

SURGICALtreatment

Endometrial ablation

Hysterectomy

13. ABNORMAL PUBERTY Puberty and pubertal changes may occur earlies than normal menstruation + secondary sexual characters become early in life8-9years or even3-4years of age Puberty and pubertal changes has not developed on16-17 years old DEFINITION Precocious puberty Delayed puberty Subjective 14. 1. Idiopathic 2. Intracranial lesion 3. Adrenal gland ,ovarian and Thyroid problem 4. Drugs Either constitutional or pathological The pathological causes: 1- chromosomal abnormalities 2- Hypothalamic ,pitutary, Thyroid,Adrenal gland, Ovarian and Uterine causes CAUSES PRE puberty D puberty Subjectives 15. The Idiopathic treated by:- 1- proestrogens 2- Danazol 3- Cyproteroneac- etate 4- LHRHanalogues ----- TREATMENT PRE puberty D puberty Subjectives 16. Sex Hormones & Function

GnRH.

FSH&LH.

Progesterone & Estrogen .

17. GnRH 18. FSH & LH 19. Progesterone & Estrogen

Estrogens: 3types estradiol (it is the main estrogen produced by the ovary) ,estriol and esterone.

It is a dominant hormone at follicular phase of menstrual cycle.

Two cell Theory for estradiol production:

-1 LH (low level) stimulate Theca cells

20.

Cholesterolandrogens

2- FSH (high level) stimulate granulosa cellsandrogensestrogens

Action:1-secondary sex characteristics of female.

2-proliferation of endometrim during proliferative phase.

3-increase uterine blood flow .

4-development of breast duct.

Progesterone:mainly synthesized in the corpus lutumand so it is the dominant hormone in the luteal phase of menstrual cycle.

Action : 1-resposible for glandular secretory activity during secretory phase. .

21. Progesterone & Estrogen

Estrogens: 3types estradiol (it is the main estrogen produced by the ovary) ,estriol and esterone.

It is a dominant hormone at follicular phase of menstrual cycle.

Two cell Theory for estradiol production:

-1LH (low level) stimulate Theca cells

22.

2-deciduatization of endometrium in the late lutealphase.

3-devlopment of breast alveoli.

23. Menstrual cycle

-Menstruation: means a periodic discharge of sanguineous fluid and a sloughing of uterine lining.

-Parameters: frequency - length and amount of the menstrual flow.

A- average of menstrual cycle is frequently quoted to be 28 + 2days.

B- average of menstrual 5days.

C- average of frequency of blood flow is 60 ml.

24.

-Endocrine controlof MC.

-component of MC.

-Role of prostaglandin.

-Mechanism of uterine bleeding.

-Homeostasis in menstrual endometrium.

25. Androgen Excess

-Sources of androgen: 1-endocrine gland.

2- peripheral tissue.

3-liver and gut.

-androgen excess mains: Abnormalsecretion of adrenal and ovarian androgen.

-causes: 1-ovarian tumor.

2 -adrenal tumor.

3 -CAH.

4-decreas SHBG.

5-Pcos.

6-cushing syndrome.

7-pregnacy.

8-idiopathaic.

26.

-Symptom:1- general appearance :obesity; muscular male body.

2-miscllenous change.

3- menstrual irregulatory.

4- endocrine change.

5- skin changes.

6- acanthosis Nigricans.

-Diagnosis:

-History.

-Lab finding: testosterone ,17hydroxy progesterone, DHEA, dexamethazone, LH,FSH, lipid.

27. 2-Anti androgen. 3-corticosteroids. 4-promocriptin. 5-Insulin sensitive drugs. 6-surigcal . 7-diet. Treatment: 1- oral contraceptive. 28. Pre menstrual Syndromes PMS or PMTS

Definition.

Prevalence.

Etiology: hormonal, social, genetic, vitamin deficiency, others.

C/f :nervous,GIT,mastalgia,Fluid retention.

D/D .

Treatment.

29. Delay or absent Puberty

When the menarche has failed to occur at age of 17years old.

Failure of menstruation due to pan hypopitutrism is associated with dwarf +endocrine abnormality patient with XO chromosomal pattern and gonadal dysgensis =dwarf.

In some patient puberty delayed even the gonads are present +other endocrine function are normal =primary amenorrhea.

30. Precocious & Delayed puberty

It is early but normal pattern of puberty due to an early of gonadotrpin secretion form pituitary it is most frequent endocrine symptom of hypothalmic disease.

Abnormal exposure to estrogen lead early development of secondary sexual characteristics without gametogensis .

Classification of causes precocious puberty:

A- true precocious puberty:

31.

Cerebral e.g.: disorder involve posterior hypothalamus

tumors .

Infection.

developmental abnormalities.

B- precocious pseudo puberty:

-no ovarian development.

-Adernal:1- congenital virilizing adrenal hyperplasia .

2- esterogen secreting tuomers.

-gonadal: granulosa cell tumors of the ovary.

pineal tumor may associated with precocious puberty but

associated when there is secondary damage to

hypothalamus .

32. Hyper prolactinemia

-prolactin contain 199 a.a secreted by endometrium and placenta.

Action:

1causes milk secretion from the breast after estrogen and progesterone priming.

Has role in preventing ovulation in lactating mother.

3 Inhibit the effect gonadotropins by an action at level of ovary.

-normal plasma prolactin conc is approximately 5ng/ml in men and 8ng/ml in women.

33.

Hyper prolactinemia: in up to 70% of patient with chromophobe adenomas of anterior pituitary have elevated plasma prolactin levels, in some . instances, the elevation may be due to damage of pituitary stalk but in some cases the tumor cells are actually secreting the hormone .

Hyper prolactinemia may cause glactorrhea, conversely most women with glactorrhea have normal prolactin levels.

Observation that 15-20% of women with secondary amenorrhea have elevated prolactin (by blocking action of gonadotropinsin ovaries) when the level decrease the normal menstrual cycle and fertility return.

-surgical.

- Radio therapy.

34. -Hypogondism produce by prolactinomasis associatedwithosteoporosis due to estrogen deficiency. Treatment : Bromocriptine or other dopamine agonist - surgical. -Radio therapy. 35.

CAST

Aml Alnor

Razan M Jafer

Ejlal Abd Mohamed

Marwa Mohamed

Eman Abd elrahman

Arig Sorage

Hana Abdelhafeez

Nahlaa Marqani

Roqia Solima

Wedad A Ahmed

Shaza Abdelmonem

Rehab Alser

Fatma Aalim

Alaa Abdella

Nada

Reem

Taqwa Bashir

AND

Shadin Awad Ahmed

EZPASEVA 2008

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