1. DISORDERS OF MENSTRUATION
Sherin shana
Govt.College of Nursing
Kozhikode

3. AMENORRHEA
ABSENCE OF MENSTRUATION IN WOMEN IN
REPRODUCTIVE AGE

5. CRYPTOMENORRHEA
• Menstruation occurs but there is obstruction
to the outflow of blood
• CAUSES Congenital: Imperforate hymen
Acquired: Vaginal atresia,
cervical stenosis

6. PATHOPHYSIOLOGY
Accumulation of blood in uterine cavity
Hematocolpos
Hematometra
Hematosalphinx

7. CLINICAL FEATURES
• Amenorrhea
• Lower abdominal pain
• Retention of urine
• Uniform globular mass in the abdomen
• Bulging hymen

8. MANAGEMENT
• Cruciate incision of hymen and drainage of
blood
• Dialatation of cervix in stenosis

9. PRIMARY AMENORRHEA
• Failure of onset of menstruation beyond the
age of 16 in a girl with normal secondary
characteristics

10. CAUSES
Disorders of Hypothalamo Pituitary Ovarian Axis
A. Hypogonadotrophic hypogonadism
- Delayed puberty
- CNS Tumors
- Hypothalamic and pituitary dysfunction

11. B. Hypergonadotrophic hypogonadism
-Primary ovarian failure
-Galactosemia
-17alpha hydroxlase deficiency
 Abnormal chromosomal pattern
eg:Turners syndrome

12.  Developmental defect of genital tract
eg: absence of vagina,absence of uterus
 Dysfunction of thyroid gland
 Metabolic disorders
 Systemic illness

13. INVESTIGATIONS
• History & Physical examination
• Ultrasonography
• Karyotyping
• Hormonal studies
• Blood investigations

14. MANAGEMENT
• Correction of the cause
• Cyclic estrogen and progesterone
• Corticosteroid therapy

15. SECONDARY AMENORRHEA
• Absence of menstruation for 6 months or
more in a women with previous normal
menstrual patterns.

16. ETIOLOGY
• Uterine factors
• Ovarian factors
• Pituitary factors
• Hypothalamic factors
• Systemic
• Adrenal disorders

17. INVESTIGATIONS
• History & physical examination
• Blood investigations
• Hormonal studies

18. MANAGEMENT
1) No abnormality detected
• Assurance
2) Cases with detectable cause
• Treat the underlying cause
3) Polycystic ovarian syndrome
• Weight reduction
• GnRH agonist
• Surgery

19. 4) Hyperprolactinemia
• Bromocriptine
• Surgery
5) Premature ovarian failure
• Hormonal therapy
• Corticosteroids
• IVF

20. 6) Adrenal disorders
• Adrenocorticolytic drug
• Adrenalectomy

21. DYSMENORRHEA
• PAINFUL CRAMPING PAIN ACCOMPNYING
MENSTRUATION

22. CLASSIFICATION
PRIMARY DYSMENORRHEA
SECONDARY DYSMENORRHEA

23. OTHER TYPES
SPASMODIC
CONGESTIVE
MEMBRANOUS

24. PRIMARY DYSMENORRHEA
• Painful menstruation with no pelvic pathology
• Usually starts 2-3 yrs after menarche and
ceases after child birth.
• Begins shortly before or at the onset of
menses and lasts one or three days

25. CAUSES
Psychosomatic factors
Abnormal anatomical and functional aspects
of uterus
-Stenosis at internal oss
- Unequal development of mullerian
duct
-Inappropriate law of polarity
Role of vasopressin

26. PATHOPHYSIOLOGY

27. CLINICAL FEATURES
 Uterine cramping
 Nausea
 Vomiting
 Fatigue
 Diarrhea
 Headache
 Giddiness

28. DIAGNOSIS
• Pelvic sonography
• CT/MRI
• Hysterosalphingography
• Hysteroscopy/Laproscopy

29. TREATMENT
 GENERAL MEASURES
1. Counseling
2. Psychotherapy

30.  DRUGS
1. Prostaglandin synthetase inhibitors:
eg:Mefanamic acid,Ibuprofen,Indomethacin
2. Oral Contraceptives
eg:Dydrogesterone

31.  SURGERY
 Dilatation of cervical canal
 Presacral Neurectomy
 Laser Assisted uterosacral Nerve Ablation

32. SECONDARY DYSMENORRHEA
Associated with presence of pelvic pathology
Cramp starts 3 to 5 days prior to menstruation
and relieves with start of bleeding
Patients are usually thirties

33. CAUSES
Chronic pelvic infection
Endometriosis
Adenomyosis
Uterine fibroid
IUCD in utero
Endometrial polyp

34. PATHOPHYSIOLOGY
 Pain is due to pelvic congestion which is
more marked in the premenstrual period.
Pain increases in its severity as menstruation
approaches and is relieved by the onset of
menstrual flow, due to the diminution of
pelvic congestion.

35. CLINICAL FEATURES
Dull aching lower abdominal pain
accompanied by backache
Dyspareunia
 Infertility
Abnormal bleeding

36. TREATMENT
Treat the cause rather than symptom
Surgical interventions
 Diagnostic hysteroscopy followed by D&C
 Diagnostic laparoscopy
 Laprotomy followed by excision of
adenomyoma
 Hysterectomy in elderly