menstruation is the endpoint of a cascade of events which begins in the hypothalamus and ends at the...
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MenstruationMenstruation
Is the endpoint of a cascade of events which begins in the hypothalamus and ends at the uterus
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AMENORRHOEAAMENORRHOEA
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DEFINITIONDEFINITION
Complete absence of menstrual bleeding.
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A. Cryptomenorrhoea (False)
B. True Amenorrhoea
• Physiological
• Pathological
Primary Secondary
CLASSIFICATION CLASSIFICATION
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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.
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CRYPTOMENORRHOEACRYPTOMENORRHOEA
Regular shedding of endometrium,but there is mechanical obstruction.
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CAUSESCAUSES Vagina
1 Imperforate Hymen 2 Non canalisation or absence
of vaginaCervix
1. Congenital 2. Acquired
InfectionTraumaSurgery
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CRYPTOMENORRHOEA
Signs 1. Amenorrhea2. Pain3. Retention of urine
Signs1. Secondary sexual characters are present2. Dark bluish membrane (imperforate hymen) 3. Pelvic mass
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Treatment
1.Hymenectomy
2.Vaginoplasty
3.Cervical dilatation.
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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
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PATHOLOGICALPATHOLOGICAL
Causes:
Uterus
Ovary
Anterior pituitary
Hypothalamus
Others
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Causes of AmenorrheaCauses of Amenorrhea UterusAbsence of Uterus
I. Congenital II.Surgical
Diseases of Endometrium I. T.BII.Destruction of Endometrium
IrradiationAsherman’s Syndrome
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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
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Causes of AmenorrheaCauses of Amenorrhea
Neoplasms– Hormone Producing Tumours
– Oestrogen Producing
I. Granulosa Cell
II. Theca Cell
Androgens Producing Tumours I. Arrhenoblastoma
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Anterior PituitaryAnterior Pituitary
• Congenital DefectEmpty Sella Syndrome
• Ischemia Damage Sheehan Syndrome
• NeoplasmsCraniopharyngioma
• Hypophysectomy
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HypothalamusHypothalamus
Psychological • Excitement, Depression, Anxiety • Change of environment, climate, job • Anorexia nervosa • Pseudocyesis
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HypothalamusHypothalamus
Neurological• Inflammatory • Traumatic – Fracture of skull • Neoplasms • Drugs
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Other CausesOther Causes
Endocrinal Diseases • Thyroid gland • Adrenal cortex • Diabetes Mellitus
Acute or Chronic Illness• T.B• Malignant diseases • Renal failure
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Other CausesOther Causes
• Changes In Weight• Exogenous Hormones• Excessive exercise
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MANAGEMENTMANAGEMENT
History of the patient.General physical examination.Pelvic Examination.Investigations.
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INVESTIGATIONSINVESTIGATIONS
Blood• Complete picture,BGR.
Urine AnalysisUltrasonographyRadiological
• X-ray of the skull and Chest• Intravenous Urography• CT scan/MRI
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Hormone Assay• FSH• LH• Prolactin• Testosterone• SHBG• Thyroid Tests
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Endometrial Biopsy
Buccal Smear
Karyotyping
Laparoscopy,Hysteroscopy
Therapeutic Test
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TREATMENTTREATMENT
General Measures.
Reassurance and psychotherapy.
Nutrition.
Weight Control.
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END OF LESSON END OF LESSON