Management of

Reproductive Health & Dysmenorrhea

dr. Shanty Olivia F.J, SpOG, K.Fer

shantyolivia.fj@gmail.com
 Overview

Reproductive health definition

Components of reproductive health

Reproductive disorders risks factors

Oxydative stress and its role on reproduction

Role of antioxidants in reproductive disorders

Reproductive Health Definition

A state of complete physical, mental, and social

well being and not merely the absence of disease
o r i n f i r m i t y, i n a l l m a t t e rs re l a t e d t o t h e
reproductive system and to its functions and
process – WHO, 2015
Components of Reproductive Health
 Reproductive Life Cycle

A woman's reproductive years, which typically span almost four decades, can be divided in stages
1. Menarche to intercourse
2. Intercourse first birth
3. First birth to attainment of desired family size
4. Attainment of desired family size to menopause
 Menstrual disorders
• Structural problem (~80%)
• Dysmenorrhea (~50%)
• Cycle disturbance (20-40%)
Ovulatory cycle

Irreguler
Menorrhagia Amenorea
bleeding

Anovulatory cycle
Siddiqui et al. Obstet Gynecol Reprod Med, 2007
 Bleeding type
No Definition Description
1 Normal Interval range 21-35 hari, duration 2-7 days. Amount of
blood< 1 pads per 3 hour

2 Acute heavy bleeding Amount of blood> I pads/hour or hemodynamic changes

3 Irreguler bleeding oligomenorrea, intermenstrual bleeding or other irreguler

bleeding

4 Heavy bleeding Reguler heavy bleeding (jamount > 80 ml or more and > 7
days)
 Oligomenorhea
Normal cycle Amenorrhea
spotting
Short follicular phase Anovulation
Short luteal phase Heavy bleeding

Fluker M, Fisher S. Anovulation and ovulatory dysfunction. In Falcone T, Hurd W.

Clinical Reproductive Medicine and Surgery, 2007 : 277 – 296
Pre-ovulatory Post-ovulatory
 1 Hypogonadothropin-hypogonadism
Low FSH and E2

2 Normogonadothropin-normogonadism
Normal FSH & E2 PCOS

Hypergonadothropin-hypogonadism
3
High FSH and low E2

4 Hyperprolactinemia
High PRL

Dhont M. Int Cong Ser, 2005

Abnormal uterine bleeding
principle of care

Stop bleeding
Regulate the cycle
Prevent the recurrence

Cyclical progestin
OCP
PCOS
A diagnosis of PCOS is made when someone experiences at least two
of these signs:
Irregular periods
Rotterdam Excess androgen
criteria
Polycystic ovaries
 Hyperandrogen

FG score > 4-6

 Polycystic ovaries
Follicle size 2-9 mm > 20

Ovarian volume >10ml

 Management target

Obesity
Irreguler and/or
Hyperandrogen infertility
period insulin
resistance

Lifesytle modif Lifestyle modif Lifestyle modif Lifestyle modif

OCP, progestin OCP, progestin Oral ovulation Vit D
Insulin sensitizer Insulin sensitizer induction supplementation
Gonadotropin Insulin sensitzer
LOD
IVF
Insulin sensitizer
Dysmenorrhea

Classification
Primary dysmenorrhea
Is not associated with other disease or pathology

Secondary dysmenorrhea
Usually associated with other pathology inside or outside
the uterus, eg:
- Endometriosis
- Adenomyosis
- fibroid, polyp
- Cervical stenosis
- PID
- IUD
Dysmenorrhea mechanism
 Endometriosis

disease where tissue similar to the lining of the uterus grows outside
the uterus
 Pain in endometriosis

adhesion
Nerve
distruction
Inflammation
Infertility =inability of a couple to conceive naturally after
ONE YEAR of regular unprotected sexual intercourse

>35 unable to conceive in 6 months trying

10-15% of couples in
reproductive age

Speroff L, Glass R, Kase N. Clinical gynecologic endocrinology and infertility, 7th edition, 2005

The variability in patient characteristics and response to ART

dictate the need for proven, personalized diagnostic and therapeutic
approaches to optimize efficacy and safety outcomes
 Basic Infertility Work-Up
HSG, Sono HSG Progesteron midluteal

TUBAL OVULATION
OCCLUSION DISTURBANCE

transvaginal ultrasound

PELVIC
SPERM FACTOR
ABNORMALITIES
INFERTILITY
WHO criteria, 2021

Unexplained
 Life style Folic acid
Intercourse
Counseling Chlamydia prophylaxis
Work Age & fertility

Examination & Treatment Strategy

Idiopathic Male factor Ovulation disorder Endometriosis Tubal factor

Ovulation induction
Ovarian stimulation Surgery

3- 6 times

Intra Uterine Insemination (IUI)

3-4 times

IN VITRO FERTILIZATION
Wiweko et al. Best practices on IMPERIAL, 2012
Reproductive disorders : The Risk Factors

• Environmental
pollutants, Exposure to multicomponent
mixtures of endocrine-disturbing chemicals
(EDC)
• Lifestyle factors
cigarette smoking, alcohol, drug abuse,
sedentary lifestyle, bad nutrition, obesity

Excess pro-oxydant induce oxydative stress

Oxydative stress and cellular damage

Akhigbe and Ajayi Lipids in Health and Disease (2021) 20:23

Oxydative Stress and its Impact on Female Reproduction
Role of Vitamin E in Reproductive Health
 Key Management of Reproductive
Health
• Well informed, educated, counselled
• Good health promotion: healthy lifestyle,
balanced nutrition and prevention of specific
condition
• Early detection of reproductive disorders
• Good referral
• Specific and effective management of
reproductive disorders
THANK YOU