Lectures on menstrual disorders

2021-03-21 12:00 AM

All types of amenorrhea (except physiological amenorrhea) can be considered pathological amenorrhea and need to find a cause for treatment or may not be treated.

Preamble

Menstrual disorders are menstrual abnormalities. Those are the signs and symptoms of one or more different diseases, but menstrual disorders are not diseases.

Research on menstrual disorders: Age of commencement of menstruation, age of menopause, length of menstruation, amount of menstrual blood, ovulation, dysmenorrhea ...

It is a symptom, but sometimes it is necessary to treat although the cause of the disease is unknown, but it causes menstruation, bleeding, prolonged menorrhagia ...

Basic definitions of menstrual disorders

Premature puberty: Menstruation starts at 8 years or younger, normally 13-16 years old.

Late puberty: Begins menstruation after age 18.

Early menopause: No more menstruation before age 40, normally between 45-50 years old.

Late menopause: No more menstruation after age 55.

Sutras: The cycle is longer than 35 days, normally 22-35 days.

Fast: The menstrual cycle is short less than 22 days.

Amenorrhea: No menstruation for 6 months or more.

Menstruation: Menstruation lasts more than 7 days.

Short Sutras: Menstruation is only 2 days or less.

Heavy menstrual period: The total amount of menstrual blood in the whole cycle is over 200 ml, normal: 50-80 ml.

Menstrual sparingly: The amount of menstrual bleeding is very small, no need to freeze, less than 15 ml.

Menstrual period: Menstrual bleeding is large and lasts a day.

Menstruation: Menstrual bleeding is few and short-term.

Dysmenorrhea: Abdominal pain before, during or after menstruation.

No Ovary Loop: The menstrual cycle does not have ovulation in the middle of the normal menstrual cycle.

Amenorrhea

Classification of amenorrhea

Primary amenorrhea: No menstruation when you are over 18 years old.

Secondary amenorrhea: No menstruation after 3 months for regular menstruation and 6 months for irregular menstruation.

Physiological amenorrhea: The phenomenon of amenorrhea during pregnancy or menopause.

Amenorrhea: Also known as menstruation due to menstrual bleeding can not flow out.

All types of amenorrhea (except physiological amenorrhea) can be considered as pathological amenorrhea and need to find a cause for treatment or may not be treated.

Primary amenorrhea

Reason

Due to abnormalities in the genitals, or endocrine glands related to sexual activity such as: no uterus, no vagina, no perforation of the hymen, congenital ovarian atrophy ...

Some syndromes, primary amenorrhea

Turner Syndrome: Described by Turner in 1938 with the following signs: a childish shape, two sides of the neck with a plump skin, a lack of an X chromosome (45, XO) should cause congenital atrophy of the ovaries leading to disorders gonad development. Because of the lack of Estrogen, the parts of the genitals are small, the breasts do not develop, pubic hair, thin armpit hair. Intellectual retardation, no sex, amenorrhea and only treatment with hormone replacement, using artificial menstrual cycle to help develop secondary genitalia and resolve osteoporosis.

Mayer - Rokitansky - Kuster syndrome: The uterus is a small band, congenital vaginal atrophy, normal ovaries, normal female genital properties but not menstruation because of uterine atrophy.

Need differential diagnosis with early uterine tuberculosis causing uterine adhesions. Does not cause menstruation and cannot treat the cause.

Adrenal - genital syndrome: Rare. The adrenal cortex lacks the enzyme hydroxylase 21, so the cortisol is low, the ACTH increases secretion leading to overproduction of the adrenal cortex and increases the secretion of Androgen.

Androgens cause early growth of pubic hair, armpit hair, beard, and large clitoris. The short dwarfs are short because high Androgens quickly close the bones, inhibit the pituitary gland to produce gonadotropic hormones, leading to inactivity of the ovaries.

Treatment with Cortisol both resolves the deficiency of Cortisol and inhibits ACTH, Angroden will decrease, gonadotropin hormones are secreted and the ovaries work again, the patient has menstruation and becomes pregnant.

Feminized testicles: Very rarely, called Moris syndrome, described by Moris in 1953, the patient has the XY chromosome, is actually a male but the perfection resides in the abdomen or groin. The testicles only secrete Estrogen and do not secrete Testosteron, so the female sexual properties develop, so the patient has a female phenotype and personality. No pubic hair, armpit hair, no menstruation. Having no penis should be considered a girl.

Treatment with removal of 2 testicles to prevent cancer after developing full female genital properties. After surgery use Estrogen to maintain women and prevent osteoporosis.

Genital malformations: No vagina, no puncture hymen, vaginal septum.

No period, cyclical monthly abdominal pain, increasing pain with each cycle. Examination of thrombosis in the subframe. If the hymen does not puncture, the vulva is pushed up in the hymen position.

Treatment: Cut asteroid hymen, cut horizontal septum or create vagina but difficult to achieve, both draining menstrual blood and ensuring fertility.

Diagnose

Asked the disease.

Examination: observed to detect genital tract abnormalities.

Undeveloped pubic and breast hair: Ovarian atrophy, congenital atrophy of the pituitary gland.

Pubic and breast development: Abdominal pain may be caused by menstrual bleeding.

No abdominal pain: No uterus.

Test: Depending on the type of cause that should be tested: ultrasound, RIA, laparoscopy, chromosome.

Secondary amenorrhea

Reason:

Hillside area.

Endocrine: pituitary, ovarian failure.

Endocrine dysfunction of the adrenal cortex, thyroid gland, pituitary necrosis due to excessive blood loss (Sheehan's Syndrome).

Lactation amenorrhea due to high Prolactin.

Adhesions of the uterus: due to genital tuberculosis, after abortion, after IUD removal or cervical adhesions.

Due to mental stress and fear.

Sheehan Syndrome: Due to acute and numerous blood loss leading to a decrease in blood supply to the pituitary and anterior pituitary, necrosis of the pituitary gland and hormonal secretion will be lost.

Milk loss is the earliest symptom, then gradually atrophy of the breasts, amenorrhea, loss of armpit hair and pubic hair, atrophy of the genitals, decreased sex drive. The patient is emaciated, tired. More severe, the thyroid gland, adrenal cortex, but the patient does not have dark skin because the pituitary gland does not secrete ACTH, a hormone that causes darkening of the skin.

Direction of treatment

Depends on the type of cause.

Exclude physiological amenorrhea: Pregnancy, menopause.

Due to uterine adhesions: After curettage, dilate the uterus and put a non-stick ring.

Due to cervical adhesions: Cervical angioplasty

Due to genital TB: Treatment of systemic TB

Endocrine: Hormone replacement therapy, treatment of other endocrine diseases, or the use of a menstrual cycle.

Prolactin-induced amenorrhea: Treatment with Parloden.

Eat well, psychotherapy ...

Menorrhagia - blood seaweed

Hemorrhage is bleeding that is not related to a period. Menorrhagia more than 15 days often turn into hemorrhage and called menorrhagia - haemorrhage, if prolonged will cause anemia and can cause inflammation due to blood in the vagina creating a favorable environment for bacteria to grow.

Reason

Endocrine dysfunction in a young age, perimenopause.

Due to inflammation of the uterine lining after childbirth.

Fibroids, uterine polyps.

Disorders of blood clotting: Hemogenia, liver and kidney disease.

Direction of treatment

Treat as soon as possible and depending on the cause.

Youth: Use the female sex hormones estrogen and Progesteron.

Perimenopause: Curvature of the uterus sends disease anatomy, uterine contractions and antibiotics.

Physical causes of the uterus: Diagnosis and treatment of the cause.

Terrible

Called menstruation, the pain is significant, affecting activities and labor.

Primary dysmenorrhea: occurs early, immediately or after the first few menstrual periods, is usually the neuromuscular system.

Secondary dysmenorrhea: occurs many years later. Often there are physical causes such as: the uterus is too posterior, constricting the cervix due to fibroids or part of the cervix, endometriosis.

Treatment

Psychotherapy.

Exercise therapy.

Pain reliever: as directed by your doctor.

Find the entity solver cause.

Other menstrual disorders

Menstruation, haemorrhage, menstruation: Treat early, treat symptoms and find the cause of treatment.

Less business, business, irregular business: If there is a need to give birth, then treat.