Menstrual Disorders Mely 1

MENSTRUAL
DISORDERS
GROUP ONE
Felister Nyakundi
Emmanuel Rotich
Charity Ayienda
Serina Mose
Vallery Atieno
Specific Objectives
• By the end of this session the Learner will be able to:
• Define Normal menstruation
• Classify Menstrual Disorders
• Explain characteristics of the different menstrual disorders
• Demonstrate ability to diagnose menstrual disorders
• Apply Knowledge and skills acquired to manage menstrual disorders.
Definition of normal menstruation
• It is the cyclical shading of a functional endometrium; and has the
following characteristics:
• Amount of flow: 25-80 ml average 30 mls
• Cycle length: 21-35 days
• Duration of flow: 2-7 days
• Healthy menstrual blood does NOT coagulate
• It occurs in a cyclic manner and regularly
Classification of menstrual
disorders
• Premenstrual syndrome (PMS)
• Mastodynia
• Abnormal bleeding due to gynecologic and non
gynecologic disorders:
• Amenorrhea, oligomenorhea, hypomenorrhea, menorrhagia,
polymenorrhea, metrorrhagia, etc
• Dysmenorrhoea
• Dysfunctional uterine bleeding (DUB)
• Post menopausal bleeding
CHARACTERISTICS OF MENSTRUAL DISORDERS
Premenstrual syndrome:
• occurs in at least 3 consecutive menstrual cycles

• Symptoms must occur in the 2nd half of the menstrual cycle (luteal
phase)
• There must be a symptom free period of at least 7 days in the 1 st half of
the cycle
• Symptoms must be severe enough to require medical advise or treatment
e.g. oedema, weight gain, restlessness, irritability and increased tension.
Premenstrual syndrome cont’d:
Symptoms include:
• Mood symptoms ( irritability, mood swings, depression, anxiety)
• Physical symptoms ( bloating, breast tenderness, insomnia, fatigue, hot
flushes, appetite change, e.t.c)
• Cognitive changes (confusion and poor concentration)
PMS -Diagnosis
• Mainly based on patient’s history

• Patient charts symptoms for at least 3 symptomatic cycles
• Rule out medical conditions that mimic PMS e.g. thyroid disease and
anemia.
PMS- Management
( Conservative)
• Diet: (limit caffeine, alcohol, tobacco and chocolate intake; eat small
frequent meals
• Decrease sodium intake
• Stress management;
• Aerobic exercises
• Cognitive behavioral therapy
PMS management
(Drug therapy)
• Calcium carbonate (for bloating, pain and food cravings)

• Magnesium ( for water retention)
• Vitamin B6 and vitamin E
• NSAIDs
• Bromocryptine for mastalgia
Mastodynia
• Also termed mastalgia

• Defined as: intolerable breast pain during the second half of the
menstrual cycle.
• caused by edema and engorgement of the vascular and ductal systems
• Occurs cyclically in the luteal phase
Mastodynia -diagnosis
• History and examination

• Can be confirmed by aspiration
• Ultrasound
• Serial mammography
• Excisional biopsy sometimes is necessary
• Rule out: Mastitis, neoplasm
Mastodynia- treatment
• Breast support
• Avoid- coffee, tea, chocolate, cola drinks
• Avoid nicotine
• May occasionally use a mild diuretic
• Drug therapy: topical NSAIDS, Gosarelin (Zoladex),
• Limited success with: tamoxifen, danazol, bromocryptine, oral
contraceptives, vitamins
Menorrhagia (Hypermenorrhea)
• Defined as excessive, heavy or prolonged menstrual flow

• Possible causes include: submucous myomas, adenomyosis, IUDs,
endometrial hyperplasia, malignant tumors e.t.c
Hypomenorrhea
(cryptomenorrhea)
• Defined as unusually light menstrual flow sometimes only spotting
• Possible causes include: hymenal or cervical stenosis, uterine
synechiae (Asherman’s syndrome), occasionally oral contraceptives
Metrorrhagia (intermenstrual bleeding)
• Defined as bleeding occurring any time between the menstrual periods

• Possible causes include: endometrial polyps, CA cervix, CA
endometrium, exogenous estrogen administration
Polymenorrhea
• Describes periods that occur too frequently

• Usually associated with anovulation and rarely with a shortened luteal
phase in the menstrual cycle
Menometrorhagia
• This is bleeding that occurs at irregular intervals and varies in amount

and duration of bleeding
• Caused by any condition that can lead to intermenstrual bleeding
Oligomenorrhea
• Describes menstrual periods that occur more than 35 days apart

• Possible causes: anovulation which may be from endocrine causes
(pregnancy, menopause, pituitary and hypothalamic disorders); or
systemic causes (excessive weight loss); estrogen secreting tumors etc
AMENORRHEA
• No menstrual period for more than 6 months
• Possible causes:
- Congenital uterine absence
- Hormonal disturbances from the hypothalamus and pituitary gland
- Failure of the ovary to receive or maintain egg cells
- Genetic diseases e.g. causes of intersex i.e. 5-alpha-reductase deficiency
Diagnosis in abnormal uterine bleeding
• History and physical examination

• Cytological examination –include biopsy and
histology
• Pelvic ultrasound scan
• Endometrial biopsy
• Hysteroscopy
• Dilatation and curettage
• Hormonal profile
• Blood tests- Haemogram, thyroid function tests e.t.c.
Management of abnormal uterine
bleeding- principles
• Treat cause appropriately
May include
• Hormonal preparations
• Surgery
• Endometrial ablation and endometrial resection, Prostaglandin
synthetase inhibitors,
• Levonogestrel releasing IUDs
Dysmenorrhea
• Definition: Pain associated with menstruation

• Risk factors:
• Menstrual factors (early menarche, menorrhagia)
• Parity (lower in multipara)
• Diet (reduced intake of fish, eggs and fruits)
• Exercise (reduces dysmenorrhoea)
• Cigarette smoking (increases)
• Psychological (emotionally dependent and overprotected
girls, family history,)
Dysmenorrhea- classification
• Primary or spasmodic dysmenorrhea:
• Essential/ intrinsic / functional. Defined as painful
menstruation in absence of pelvic pathology
• Usually starts at puberty
• Follows onset of ovulation and presents throughout period of
bleeding.
• Congestive or secondary dysmenorrhea:
• Underlying pelvic disease e.g. uterine abnormalities,
infections, endometriosis, foreign bodies, iatrogenic
• Membranous dysmenorrhea:
• associated with passage of endometrial cast through an
undilated cervix.
Dysmenorhea- clinical features
• Primary Dysmenorhea:
• Age: Usually seen among younger women
• Time of onset: 2-3 yrs after menarche
• Duration of pain: starts just prior to menses, lasts about 2 days
• Type of pain: cramping pain
• Membranous Dysmenorhea:
• Intense cramping pain associated with passage of an endometrial cast through an
undilated cervix.
Dysmenorhea- clinical features (ctd)
• Secondary Dysmenorhea:
- Associated with specific diseases and disorders e.g.
PID, Uterine fibroids, endometriosis etc
• Usually among older women (3rd to 4th decade)
• Time of onset: follows initial years of normal painless cycles
• Duration of pain: Onset is few days prior to menses and continues throughout
cycle even after cessation of menses
• Type of pain: continuous dull aching or dragging pain
Dysmenorhea -management
Dysmenorhea
Assurance
Laxatives
Analgesics and Antispasmodics

Fails
Contraception not required or OC pills Contraception required or NSAIDS contra
contraindicated indicated
Prostaglandin synthetase inhibitors OC pills
Fails
Laparoscopy to look for causes of secondary Dysmenorhea
No cause found but persistent and Cause found
severe pain
Surgery Treat as appropriate

Dysfunctional Uterine bleeding
(DUB)
• Defined as a symptom complex that includes any condition of abnormal
uterine bleeding in the absence of pathologic cause
• Commonly caused by anovulation as seen in polycystic ovarian disease
and obesity
• May occur in all age groups from prepubertal girls to menopausal
women
DUB management
• Medical management:
• NSAIDS
• Antifibrinolytic agents
• Hormones
• Surgical
• Endometrial resection
• Endometrial ablation
• hysterectomy
Postmenopausal bleeding
• Any vaginal bleeding in a postmenopausal women should be

considered abnormal
• Frequently associated with malignancies of the reproductive tract
• Benign causes include: endometrial /cervical polyps, trauma, senile
vaginitis, vulval dystrophies
• Management depends on the cause.
Thank You

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MENSTRUAL

• occurs in at least 3 consecutive menstrual cycles

• Mainly based on patient’s history

• Calcium carbonate (for bloating, pain and food cravings)

• Also termed mastalgia

• History and examination

• Defined as excessive, heavy or prolonged menstrual flow

• Defined as bleeding occurring any time between the menstrual periods

• Describes periods that occur too frequently

• This is bleeding that occurs at irregular intervals and varies in amount

• Describes menstrual periods that occur more than 35 days apart

• History and physical examination

• Definition: Pain associated with menstruation

Analgesics and Antispasmodics

Surgery Treat as appropriate

• Any vaginal bleeding in a postmenopausal women should be

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