menstruation is the endpoint of a cascade of events which begins in the hypothalamus and ends at the...

MenstruationMenstruation

Is the endpoint of a cascade of events which begins in the hypothalamus and ends at the uterus

AMENORRHOEAAMENORRHOEA

DEFINITIONDEFINITION

Complete absence of menstrual bleeding.

A. Cryptomenorrhoea (False)

B. True Amenorrhoea

• Physiological

• Pathological

Primary Secondary

CLASSIFICATION CLASSIFICATION

Primary: No spontaneous onset of menstruation by the age of 16 years.

Secondary: Absence of menstruation for 6 months or longer if the patient has previously experienced regular menses.

CRYPTOMENORRHOEACRYPTOMENORRHOEA

Regular shedding of endometrium,but there is mechanical obstruction.

CAUSESCAUSES Vagina

1 Imperforate Hymen 2 Non canalisation or absence

of vaginaCervix

1. Congenital 2. Acquired

InfectionTraumaSurgery

CRYPTOMENORRHOEA

Signs 1. Amenorrhea2. Pain3. Retention of urine

Signs1. Secondary sexual characters are present2. Dark bluish membrane (imperforate hymen) 3. Pelvic mass

Treatment

1.Hymenectomy

2.Vaginoplasty

3.Cervical dilatation.

Physiological AmenorrheaPhysiological Amenorrhea

Prepuberty: – Due to low production of gonadotrophic hormones

Pregnancy: – Increased amounts of oestrogens & progesterone by

placenta

Lactation: Increased levels of prolactin

Menopause: ovaries unresponsive to stimulus of gonadotrophins

Constitutional delay:Familial

PATHOLOGICALPATHOLOGICAL

Causes:

Uterus

Ovary

Anterior pituitary

Hypothalamus

Others

Causes of AmenorrheaCauses of Amenorrhea UterusAbsence of Uterus

I. Congenital II.Surgical

Diseases of Endometrium I. T.BII.Destruction of Endometrium

IrradiationAsherman’s Syndrome

Causes of AmenorrheaCauses of AmenorrheaOvaries Absent or Streak Ovaries

Chromosomal Anomalies

I. Turner (XO)II. Trisomy (XXX) III.Gonadal Dysgenesis IV.Androgen insensitivity Syndrome

Bilateral Oophorectomy Irradiation Abnormal production of Hormone – PCOD

Causes of AmenorrheaCauses of Amenorrhea

Neoplasms– Hormone Producing Tumours

– Oestrogen Producing

I. Granulosa Cell

II. Theca Cell

Androgens Producing Tumours I. Arrhenoblastoma

Anterior PituitaryAnterior Pituitary

• Congenital DefectEmpty Sella Syndrome

• Ischemia Damage Sheehan Syndrome

• NeoplasmsCraniopharyngioma

• Hypophysectomy

HypothalamusHypothalamus

Psychological • Excitement, Depression, Anxiety • Change of environment, climate, job • Anorexia nervosa • Pseudocyesis

HypothalamusHypothalamus

Neurological• Inflammatory • Traumatic – Fracture of skull • Neoplasms • Drugs

Other CausesOther Causes

Endocrinal Diseases • Thyroid gland • Adrenal cortex • Diabetes Mellitus

Acute or Chronic Illness• T.B• Malignant diseases • Renal failure

Other CausesOther Causes

• Changes In Weight• Exogenous Hormones• Excessive exercise

MANAGEMENTMANAGEMENT

History of the patient.General physical examination.Pelvic Examination.Investigations.

INVESTIGATIONSINVESTIGATIONS

Blood• Complete picture,BGR.

Urine AnalysisUltrasonographyRadiological

• X-ray of the skull and Chest• Intravenous Urography• CT scan/MRI

Hormone Assay• FSH• LH• Prolactin• Testosterone• SHBG• Thyroid Tests

Endometrial Biopsy

Buccal Smear

Karyotyping

Laparoscopy,Hysteroscopy

Therapeutic Test

TREATMENTTREATMENT

General Measures.

Reassurance and psychotherapy.

Nutrition.

Weight Control.

END OF LESSON END OF LESSON