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Menstrual Disorders

Menstrual Cycle Disorders discusses common menstrual disorders including amenorrhea, dysmenorrhea, and dysfunctional uterine bleeding. It defines key terms like menorrhagia and oligomenorrhea. Causes of disorders include problems with the ovaries, pituitary, hypothalamus, as well as endometriosis. Evaluation involves hormonal testing and challenges. Treatment depends on the specific disorder but may include hormones, NSAIDs, surgery, or lifestyle changes.

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Jesse Estrada
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239 views29 pages

Menstrual Disorders

Menstrual Cycle Disorders discusses common menstrual disorders including amenorrhea, dysmenorrhea, and dysfunctional uterine bleeding. It defines key terms like menorrhagia and oligomenorrhea. Causes of disorders include problems with the ovaries, pituitary, hypothalamus, as well as endometriosis. Evaluation involves hormonal testing and challenges. Treatment depends on the specific disorder but may include hormones, NSAIDs, surgery, or lifestyle changes.

Uploaded by

Jesse Estrada
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPT, PDF, TXT or read online on Scribd
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Menstrual Cycle Disorders

Karen Estrella H.
Pediatric PGY-2 SBH
Nov/2010

Introduction
Menarche:

Median age: 12.7 yrs


African-american earlier than Caucasian
2-2.5yrs after breast development
Anovulatory cycles: 1st 1-2yrs of onset (55-82%)
For 5 yrs (10-20%)

Duration:
Between 21 and 35 days (mode: 28)
Lasting: 3-7days
Blood lost: 30-40ml

Definition
Menstrual cycle disorder or dysfunction
uterine bleeding is an abnormal menstrual
bleeding on prolonged cycle, mestruation, and
amount of bleeding.

Menstrual disorders on reproductive


period
Prolonged cycle and amount of bleeding
- Hypermenorhe ( menorrhagia )
- Hypomenore
Menstrual cycle disorders
- Polymenorrhea
- oligomenorrhea
- Amenorrhea

Outside of the menstrual cycle


- Menometrorrhagia
On menstrual cycle
- Dismenorrhea
- PMS

Physiology

Physiology

Definitions
Amenorrhea:
Primary: absence of menarche by age 16 in the presence
of normal pubertal development (Tanner 4-5)
Or: lack of menses by age 14 in absence of pubertal development

Secondary: absence of 3 consecutive menstrual cycles or 6


months of amenorrhea

Menorrhagia: normal intervals with excessive flow


Cycles more than 8days, > 80ml

Metrorrhagia: irregular intervals with excessive flow


Oligomenorrhea: menstruation ocurring more than
every 35 days to 6 months

Hypomenorrhea
Less menstrual bleeding or the menstrual
cycle less than normal.
Etiology: organic causes or endocrinology.
Polimenorrhea
Menstrual cycle <21 days
Etio : endocrinologic causes

Etiology of menstrual disorder


- Myoma uteri
- polyp of endometrium
- hyperplasia of endometrium
- infection of cervix, endometrium, uterine
- Trauma
- Endometriosis
- Arterio-venous malformation of the uterine
- hemostasis disorders
- endocrinologic problem

Amenorrhea
Classification:
1.
2.
3.
4.

With pubertal delay


With normal pubertal development
Genital abnormalities
Hyperandrogenic anovulation

Amenorrhea
1. With pubertal delay

A. Hypergonadotropic hypogonadism
OVARIAN FAILURE
Turner
XY gonadal dysgenesis
Autoinmmune oophoritis
Exposure to chemo or
RT(alkylating)
17 alpha hydroxylase
deficiency
Elevated FSH

Amenorrhea
1. With pubertal delay
B. Hypogonatropic hypogonadism
PITUITARY:

Adenoma

Prolactinoma

Craniopharyngioma

Hemochromatosis

Hypothyroidism

Breast stimulation

Sx

Phenothiazines, opiates
(-PRL inhibitor factor)

Low or normal FSH

HYPOTHALAMIC:
Suppresion:
Stress
Malnourishment
Wt loss < 15% of ideal body
wt

Strenous exercise
Body fat < 22%
If prior to menarche, each yr
of training delays onset by 5
months

Prader-Willi
Kallman
Migration olfatory and GnRH
neurons)

Amenorrhea
2. with normal pubertal development
Pregnancy
Chronic diseases
Exc IBD, DM, hypothyroidism, anorexia
Use of hormonal contraceptive
Progestational effect
Uterine synechiae (Asherman sd)
Sheehan sd.

Amenorrhea
3. Genital tract abnormalities
Outflow tract-related:
Imperforate hymen
Transverse vaginal septum

Agenesis of the vagina, uterus:


Mullerian Agenesis: breasts, (+) pubic and axillary hair
Testicular feminization (x-linked defect androgen receptor): breast,
(-) pubic axillary hair

Amenorrhea
4. Hyperandrogenic anovulation
Hirsutism, acne, rarely
clitoromegaly
To be r/o:
1. PCOS (polycystic ovarian
syndrome)
Most common

2.
3.

Ovarian and adrenal tumor or


adrenal enzyme deficiency
Obesity

EVALUATION

Primary amenorrhea
Presence of breasts

TSH
PRL
MRI brain

testosterone

Enzymatic defect

Hormone replacement

Surgery

Secondary amenorrhea

>100ng/ml

DHEAS: > 700ng/ml


Testosterone >90ug/ml

Asherman

Abd-pelvic MRI
17OH progesterone

Hirsutism: spirinolactone 50mg po TID

Evaluation: Secondary amenorrhea


Progesterone challenge test:
Oral medroxyprogesterone acetate for 5-10 mg QD for 510 days), or IM 200mg x1.
POSITIVE TEST: withdrawal bleeding 2-7 days after
+uterus
+estrogen stimulation: ovaries ok

Estrogen-progesterone challenge test:


Oral conjugated estrogen (1.25 mg) or 2 mg estradiol qd
for days 1 through 21 with oral medroxyprogesterone
acetate (10 mg) on days 17 through 21.
POSITIVE TEST: withdrawal bleeding 2-7 days after
+uterus
Insufficient estrogen stimulation

Dysfunctional Uterine Bleeding

Dysfunctional Uterine Bleeding


Prolonged # of days of bleeding or excessive
bleeding
Most common: anovulation
the lack of progesterone secretion increases risk
of endometrial hyperplasia
High estrogen levels
Bleeding is prolonged,
irregular and
sometimes profuse
Adolescents
Obese

DUB:
Treatment

Treatment of DUB
Acute bleeding
and excessive
bleeding

Irreguler
bleeding

estrogen
progestin

- Kombinasi
estrogen
progestin

- Estrogen

- Progestin

- Kombinasi

- Progestin

Dilatasi &
kuretase

- Ablasi
endometrium

- Reseksi
histereskopi dan
histerektomi

Menorrhagia

- Kombinasi
estrogen
progestin
- Progestin
- NSAID
- AKDR berisi
Levonorgestrel

DYSMENORRHEA

Dysmenorrhea
(painful menses)
Primary:
Decrease of progesterone
levels al end of luteal phase:
lysosomal membranes are
unstable::::release enzymes
formation:
Prostaglandins
Keep increasing during luteal and
menstrual phases
Uterine hypercontractibility
Tissue ischemia
Nerve hypersensitivity
(just before or 1st days of menses)

Secondary:
Associated with pelvic
pathology:
Endometriosis
Miomas
PID
STD
Genital tract obstruction
(Later age, Menorrhagia,
Dyspareunia, Pain with defecation,
worsening with every cycle or midcycle, symptoms that persist after
menses have finished)

Dysmenorrhea: Treatment
Inhibiting prostaglandin synthesis:
Ibuprofen: 400-600mg po q4-6hrs
Naproxen 500mg load then 250mg po q6-8hrs
Started on 1st day of bleeding

Prevent ovulation and decrease endometrial


growth
Oral contraceptives
30-35mcg combined estrogen-progestin x4-6months

Laparoscopy

SUMMARY

References

http://pedsinreview.aappublications.org/cgi/reprint/13/2/43?maxtoshow=&hits=1
0&RESULTFORMAT=&fulltext=menstrual+disorders&searchid=1&FIRSTINDEX=0&so
rtspec=relevance&resourcetype=HWCIT
http://www.aafp.org/afp/2006/0415/p1374.html
http://www.wrongdiagnosis.com/symptoms/missed_period/book-causes-10a.htm
http://pedsinreview.aappublications.org/cgi/reprint/18/1/17?maxtoshow=&hits=1
0&RESULTFORMAT=&fulltext=menstrual+disorders&searchid=1&FIRSTINDEX=0&so
rtspec=relevance&resourcetype=HWCIT
http://pedsinreview.aappublications.org/cgi/reprint/13/3/83?maxtoshow=&hits=1
0&RESULTFORMAT=&fulltext=menstrual+disorders&searchid=1&FIRSTINDEX=0&so
rtspec=relevance&resourcetype=HWCIT
http://courses.washington.edu/conj/bess/reproductive/pcos2.png
http://img.medscape.com/article/720/869/720869-box2.jpg
http://www.theberries.ca/archives/dub1.html
http://www.medicine4faith.net/wp-content/uploads/2010/08/ovarCon.jpg

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