MENSTRUAL DISORDERS DYSMENORRHOEA Dysmenorrhea is a menstrual condition characterized by severe & frequent menstrual cramps & pain associated

with menstruation. Pain may occur with menses or precede menses by 1 to 3 days. Pain tends to peak 2 h after onset of menses & subside after 2 to 3 days. !t is usually sharp but may be crampin"# throbbin"# or a dull# constant ache$ it may radiate to the le"s. %hile most women e&perience minor pain durin" menstruation# dysmenorrheal is dia"nosed when the pain is so severe as to limit normal activities# or require medication. Definition Dysmenorrheal literally means painful menstruation. 'ut a more realistic & practical definition includes cases of painful menstruation of sufficient ma"nitude so as to incapacitate say to day activities. Types of dysmenorrhea (here are two types of dysmenorrhea ) primary & secondary dysmenorrhea Primary dysmenorrhea *ften it be"ins soon after a pre+teen or teen starts havin" periods. Pain is severe & frequent menstrual crampin" caused by severe & abnormal uterine contractions. Symptoms include backache# le"pain# nausea# vomitin"# diarrhea# headache & dizziness. Riskfa tors ) early a"e at menarche ,-12 yrs.# nulliparity# heavy or prolon"ed menstrual flow# smokin"# alcohol# positive family history & obesity or over wei"ht. Se ondary dysmenorrhea /econdary dysmenorrhea has causes other than menstruation & the natural production of prosta"landins. /econdary dysmenorrhea is cramps caused by another medical problems such as endometriosis# adenomyosis# pelvic inflammatory disease# uterine fibroids# cervical narrowin"# uterine malposition# tubo+ovarian abscess# ovarian cysts# pelvis tumors or an !0D ,intra uterine device.. (his condition usually occurs in older women. Primary dysmenorrhea may affect up to 123 of women at some time# & 2 +43 may have incapacitatin" pain. (he frequency of cases increases upto a"e 25 & then decreases with a"e. /econdary dysmenorrhea usually be"ins well after the a"e of onset of menstruation# sometimes as late as the third or fourth decade of life. Pathophysio!o"y

Durin" a woman6s menstrual cycle# the endometrium thickens in preparation for potential pre"nancy. 7fter ovuation# if the ovum is not fertilized & there is no pre"nancy# the built+up uterine tissue is not needed & thus shed. 8olecular compounds called prosta"landins are released durin" menstruation# due to the destruction of the endometrial cells# & the endometrial cells# & the resultant release of their contents. 9elease of prosta"landins & other inflammatory mediators in the uterus cause the uterus to contract. (hese substances are thou"ht to be a ma:or factor in primary dysmenorrhea. %hen the uterine muscles contract# they constrict the blood supply to the tissue of the endometrium# which# in turn# breaks down & dies. (hese uterine contractions continue as they squeeze the old# dead endometrial tissue throu"h the cervi& & out of the body throu"h the va"ina. (hese contractions# & the resultin" temporary o&y"en deprivation to nearby tissues are responsible for the pain or ;cramps6 e&perienced durin" menstruation. #!ini a! manifestations <ower abdomen pain+in the umbilical re"ion or the suprapubic re"ion of the abdomen. !t may radiate to the thi"hs & lower back. *ther symptoms may include nausea# vomitin"# diarrhea# constipation# headache# dizziness# disorientation# hypersensitivity to sound# li"ht# smell & touch# faintin" & fati"ue. Dysmenorrhea is often associated with chan"es in hormonal levels in the body that occur with ovulation. Dia"nosti e$a!%ation Dia"nosis be"ins with a "ynecolo"ist evaluatin" a female6s medical history & a comple physical e&aminationincludin" a pelvic e&amination. - 0ltrasound - 8a"netic resonance ima"in" - <aparoscopy - =ysteroscopy - <aboratory studies> o ?'?+ for evidence of infection or neoplastic process o 0rinalysis+=?@level# "onococcalAchlamydial cultures# enzyme immune assay ,B!7. o DC7 probe testin" MANA&EMENT Primary dysmenorrhea+ anti prosta"landin dru"s or C/7!Ds+ aspirin# ibuprofen# ketoprofen or napro&en. (hese dru"s inhibit synthesis of prosta"landins# lessen the contractions of the uterus & reduce the menstrual flow *ral contraceptives are another alternative /econdary dysmenorrhea ) depends on the cause. Bndometriosis is the most common cause

NURSIN& #ARE Dor relief of painful menstrual cramps & their associated discomforts# start with a hot bath. (he water helps rela& the uterus & other tensions that may be contributin" to the problem. Place a heatin" pad on the abdomen. (he flow of heat can provide soothin"# temporary pain relief. B&ercise re"ularly. 7erobic e&ercise such as walin"# swimmin"# runnin"# bicyclin" & aerobic

78BC*99=*B7 7menorrhoea is the medical term for the absence of menstrual periods# either on a permanent or temporary basis in a woman of reproductive a"e. Physiolo"ical states of amenorrhoea are seen durin" pre"nancy & lactation ,breast feedin".# the latter also formin" the basis of a form of contraception known as the lactational amenorrhoea method. *utside of the reproductive years there is absence of menses durin" childhood & after menopause. ?lassification of amenorrhea Primary amenorrhoea Primary amenorrhoea is the absence of menstrual bleedin" & secondary se&ual characteristics ,e.".# breast development & pubic hair. in a "irl by a"e 1 years or the absence of menstrual bleedin" with normal development of secondary se&ual characteristics in a "irl by 14 years. !t may be caused by developmental problems such as the con"enital absence of the uterus# or failure of the ovary to receive or maintain e"" cells. 7lso# delay in pubertal development will lead to primary amenorrhea /econdary amenorrhoea /econdary amenorrhoea is the absence of menstrual bleedin" in a woman who had been menstruatin" but later stops menstruatin" for 3 or more months in the absence of pre"nancy# lactation ,the ability to breastfeed.# cycle suppression with systemic hormonal contraceptive ,birth control. pills# or menopause. !t is often caused by hormonal disturbances from the hypothalamus & the pituitary "land or from premature menopause# or intrauterine scar formation. ?ause of amenorrhoea 7menorrhoea can result because of an abnormality in the hypothalamic pituitary ovarian a&is# anatomical abnormalities of the "enital tract# or functional causes. =ypothalamic causes

?raniopharyn"ioma ,a brain tumor near the pituitary "land. (eratoma ,a tumor made up of a mi&ture of tissues. /arcoidosis ,a chronic disease of unknown cause characterized by the formation of nodules in different parts of the body. Eallmann syndrome ,deficiency of "onadotropins# which are hormones capable of promotin" "rowth & function of reproductive or"ans. Cutritional deficiency <ow body wei"ht

Pituitary causes Prolactinemia ,hi"h blood levels of prolactin# a hormone that stimulates secretion from the breasts durin" breast feedin". ) possibly caused by prolactinoma , a tumor of the pituitary "land secretin" the hormone prolactin. *ther pituitary tumors ,cushin" syndrome# acrome"aly# or thyroid stimulatin" hormone. Post partum pituitary necrosis ,death of pituitary cells after a woman delivers a baby. 7utoimmune hypophysitis ,cells of the pituitary "land destroyed by the body6s own defense system Pituitary radiation /acoidosis *varian causes 7novulation ,lack of the release of an e"". =yperandro"enemia ,hi"h blood levels of male hormones. Polycystic ovary syndrome ,hormonal disorder affectin" women of reproductive a"e. Premature ovarian failure (urner syndrome , a "enetic disorder characterized by underdeveloped ovaries# absence of menstrual onset# & short stature. Pure "onadal dys"enesis ,defective development of the ovary. 7utoimmune oophoritis ,cells of the ovaries destroyed by the body6s own defense system Dra"ile F permutation 9adiation or chemotherapy @alactosemia ,an inherited disorder in which "alactose# a type of su"ar# accumulates in the blood. 7natomical abnormalities of the "enital tract !ntrauterine adhesions ,the opposin" surfaces of the uterine cavity stick to"ether.

!mperforate hymen , a hymen in which there is no openin"# the membrane completely closes off the va"ina. (ransverse va"inal septum ,a dividin" wall or membrane in the va"ina. 7plasia ,absence of an or"an or tissue. of the va"ina# the cervi&# or the uterus

Dunctional causes 7more&iaAbulimia ?hronic diseases ,e.".#('. B&cessive wei"ht "ain or wei"ht loss 8alnutrition Depression or other psychiatric disorders 9ecreational dru" abuse Psychotropic dru" use ,dru"s prescribed to stabilize or improve mood# mental status# or behavior. B&cessive stress B&cessive e&ercise ?ycle suppression with systemic hormonal contraceptive ,birth control. pills /i"ns & symptoms sAs of primary amenorrhoea =eadaches 7bnormal blood pressure Gision problems ) reduced peripheral vision @alactorrhoea 7cne B&cessive hair "rowth ,hirsutism. B&cessive an&iety sAs of secondary amenorrhoea Causea /wollen breasts =eadaches Gision problems 'ein" very thirsty %ei"ht "ain or wei"ht loss may be present @oiter ,an enlar"ed thyroid "land. Darkenin" skin Ga"inal dryness# hot flushes# ni"ht sweats# mood chan"es or disordered sleep may be a si"n of ovarian insufficiency or premature ovarian failure.

Dia"nostic evaluation Physical e&amination includin" pelvic e&amination 'lood tests ) to determine the levels of hormones secreted by the pituitary "land ,D/=# <=# (/=# & prolactin. & the ovaries ,estro"en. 0/@ of the pelvis+to assess the abnormalities of the "enital tract or to loo for polycystic ovaries ?( scan or 89!+to e&clude pituitary & hypothalamic causes of amenorrhoea 7dditional tests (hyroid function tests Determination of prolactin levels =ysterosalpin"o"ram ,&+ray test. or saline infusion sono"raphy =ysteroscopy+visual inspection of uterine cavity 8ana"ement Dopamine a"onists+ bromocriptine ,parlodel. or per"olide ,perma&.# are effective in treatin" hyperprolactinemia =ormonal replacement therapy# consistin" of an estro"en & a pro"estin# is needed for women in whom estro"en insufficiency remains because ovarian function cannot be restored. *ral contraceptives may be prescribed to restore the menstrual cycle & to provide estro"en replacement to women with amenorrhoea who donot wish to become pre"nant

PREMENSTRUAL SYNDROME Premenstrual syndrome ,P8/. or premenstrual tension is a combination of physical# psycholo"ical# emotional & mood disturbances that occur after a woman6s ovulation & typically endin" with the onset of her menstrual flow. (he most common mood+related symptoms are irritability# depression# cryin"# oversensitivity# & mood swin"s with alternatin" sadness & an"er. (he most common physical symptoms are fati"ue# bloatin"# breast tenderness ,mastal"ia.# acne# & appetite chan"es with food cravin"s. ?auses & risk factors ?yclic chan"es in hormones P8/ appears to be caused by multiple endocrine factors ,e.".# hypo"lycemia# other chan"es ?hemical chan"es in the brain

Depression Poor eatin" habits @enetic factors *ther risk factors