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Menstrual Disorders

The Normal menstrual cycle<br>Amenorrhea<br>Dysmenorrhea<br>Abnormal Uterine bleeding (AUB)—Previously DUB

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Menstrual Disorders

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  1. Menstrual Disorders

  2. Outline • The Normal menstrual cycle • Amenorrhea • Dysmenorrhea • Abnormal Uterine bleeding (AUB)—Previously DUB

  3. Amenorrhea • Definitions • Classification of Amenorrhea • Aetiology and Pathophysiology • Clinical Approach • Investigations • Management

  4. Definitions • Absence of menstrual Bleeding. • Amenorrhea is normal in Pre-pubertal, Pregnant, Post-Menopausal and Women on hormonal contraception.

  5. Classification I of Amenorrhea Primary Amenorrhea- • Failure of menses to occur by age 16 years, in the presence of normal growth and secondary sexual characteristics. • If by Age 13 menses have not occurred and the onset of puberty, such as breast development, is absent, investigations for Primary Amenorrhea should start. Secondary Amenorrhea- • Defined as cessation of menses sometime after menarche has occurred. • Oligomenorrhea is defined as menses occurring at intervals longer than 35 days apart

  6. Classification II Anatomic

  7. HORMONAL/ENDOCRINOLOGIC Hypergonadotropic hypogonadism (pOF) Inherited/congenital • Chromosomal (gonadal dysgenesis) • Single gene disorders Acquired • Infectious • Autoimmune • Iatrogenic • Environmental • Idiopathic Eugonadotropicamenorrhea Inherited • Polycystic ovarian syndrome • Adult-onset congenital adrenal hyperplasia Acquired • Hyperprolactinemia • Thyroid disease • Cushing syndrome • Acromegaly • Ovarian tumors (steroid producing)

  8. Hypogonadotropichypogonadism Disorders of the hypothalamus • Inherited/congenital • Idiopathic hypogonadotropic hypogonadism (IHH) • Kallmann syndrome • Acquired • Hypothalamic amenorrhea (“functional”) • Eating disorders • Excessive exercise • Stress • Destructive processes • Tumor • Radiation • Trauma • Infection • Infiltrative disease • Pseudocyesis Disorders of the anterior pituitary gland • Inherited/congenital • Pituitary hypoplasia • Acquired • Macroadenoma • Metastases • Radiation • Trauma • Infarction (Sheehan syndrome) • Infiltrative disease

  9. CAUSES OF AMENORRHOEA-simply A. Disorder of outflow tract and or uterus B. Disorders of ovary C. Disorders of Ant. Pituitary D. Disorders of Hypothalamus

  10. Anatomic defects that may lead to Amenorrhea

  11. CRYPTOMENORRHOEA Vaginal atresia or imperforate hymen prevent menstrual loss from escaping. FEATURES:  Prim. Amenorrhoea in a teenage girl with normal sexual development present Complaining of: • Intermittent lower abd. Pain. • Possible difficulty of mict. • Palpable lower abd. swelling (Haematometra) • Bulging, bluish membrane at lower end of vagina (Haematocolpus).

  12. ABSENCE OR HYPOPLASIA OF VAGINA: FEATURES: • Growth, developt, and ovarian function are usually normal. • Uterus may be normal or rudimentary • Renal anomalies (in 30%) or skeletal defects (in 10%) may be present. MANAGEMENT: Create a functional vagina by surgery or dilators

  13. TESTICULAR FEMINIZATION: (Androgen Insensitivity) Phenotype is woman. Genotype is man (xy) testes are present. Inherited by an X-linked recessive gene… (familial) Resulting in absence of cytosol androgen receptor

  14. Evaluation of Amenorrheaic patients- Investigations

  15. Treatment • Depends on Aetiology Treatment of amenorrhea depends on its etiology and patient goals such as a desire to treat hirsutism or seek pregnancy. • Anatomic abnormalities often require surgical correction, if possible. • Estrogen replacement • PCOS • Infertility • Patient Education

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