Menstruation Is the endpoint of a cascade of events which begins in the hypothalamus and ends at the...
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Transcript of Menstruation Is the endpoint of a cascade of events which begins in the hypothalamus and ends at the...
MenstruationMenstruation
Is the endpoint of a cascade of events which begins in the hypothalamus and ends at the uterus
AMENORRHOEAAMENORRHOEA
DEFINITIONDEFINITION
Complete absence of menstrual bleeding.
A. Cryptomenorrhoea (False)
B. True Amenorrhoea
• Physiological
• Pathological
Primary Secondary
CLASSIFICATION CLASSIFICATION
Primary: No spontaneous onset of menstruation by the age of 16 years.
Secondary: Absence of menstruation for 6 months or longer if the patient has previously experienced regular menses.
CRYPTOMENORRHOEACRYPTOMENORRHOEA
Regular shedding of endometrium,but there is mechanical obstruction.
CAUSESCAUSES Vagina
1 Imperforate Hymen 2 Non canalisation or absence
of vaginaCervix
1. Congenital 2. Acquired
InfectionTraumaSurgery
CRYPTOMENORRHOEA
Signs 1. Amenorrhea2. Pain3. Retention of urine
Signs1. Secondary sexual characters are present2. Dark bluish membrane (imperforate hymen) 3. Pelvic mass
Treatment
1.Hymenectomy
2.Vaginoplasty
3.Cervical dilatation.
Physiological AmenorrheaPhysiological Amenorrhea
Prepuberty: – Due to low production of gonadotrophic hormones
Pregnancy: – Increased amounts of oestrogens & progesterone by
placenta
Lactation: Increased levels of prolactin
Menopause: ovaries unresponsive to stimulus of gonadotrophins
Constitutional delay:Familial
PATHOLOGICALPATHOLOGICAL
Causes:
Uterus
Ovary
Anterior pituitary
Hypothalamus
Others
Causes of AmenorrheaCauses of Amenorrhea UterusAbsence of Uterus
I. Congenital II.Surgical
Diseases of Endometrium I. T.BII.Destruction of Endometrium
IrradiationAsherman’s Syndrome
Causes of AmenorrheaCauses of AmenorrheaOvaries Absent or Streak Ovaries
Chromosomal Anomalies
I. Turner (XO)II. Trisomy (XXX) III.Gonadal Dysgenesis IV.Androgen insensitivity Syndrome
Bilateral Oophorectomy Irradiation Abnormal production of Hormone – PCOD
Causes of AmenorrheaCauses of Amenorrhea
Neoplasms– Hormone Producing Tumours
– Oestrogen Producing
I. Granulosa Cell
II. Theca Cell
Androgens Producing Tumours I. Arrhenoblastoma
Anterior PituitaryAnterior Pituitary
• Congenital DefectEmpty Sella Syndrome
• Ischemia Damage Sheehan Syndrome
• NeoplasmsCraniopharyngioma
• Hypophysectomy
HypothalamusHypothalamus
Psychological • Excitement, Depression, Anxiety • Change of environment, climate, job • Anorexia nervosa • Pseudocyesis
HypothalamusHypothalamus
Neurological• Inflammatory • Traumatic – Fracture of skull • Neoplasms • Drugs
Other CausesOther Causes
Endocrinal Diseases • Thyroid gland • Adrenal cortex • Diabetes Mellitus
Acute or Chronic Illness• T.B• Malignant diseases • Renal failure
Other CausesOther Causes
• Changes In Weight• Exogenous Hormones• Excessive exercise
MANAGEMENTMANAGEMENT
History of the patient.General physical examination.Pelvic Examination.Investigations.
INVESTIGATIONSINVESTIGATIONS
Blood• Complete picture,BGR.
Urine AnalysisUltrasonographyRadiological
• X-ray of the skull and Chest• Intravenous Urography• CT scan/MRI
Hormone Assay• FSH• LH• Prolactin• Testosterone• SHBG• Thyroid Tests
Endometrial Biopsy
Buccal Smear
Karyotyping
Laparoscopy,Hysteroscopy
Therapeutic Test
TREATMENTTREATMENT
General Measures.
Reassurance and psychotherapy.
Nutrition.
Weight Control.
END OF LESSON END OF LESSON