DISORDERS OF MENSTRAUATION

These abnormalities of the menstruation include the following;

 Amenorrhea
 Dysmonorrhea
 Metrorrhagia
 Polymenorrhae(Empinorrhoea)
 Oligomenorrhea
 Metrostaxis(persistent slight bleeding from the uterus)
 Dysfunctional Uterine Bleeding.

AMENORRHOEA

This is the absence of menstruation which occurs in females during reproductive

age.

TYPES OF AMENORRHOEA

PRIMARY AMENORRHOEA;- This means that menstruation has never occurred in

a girl of reproductive age.

SECONDARY AMENORRHOEA;- This means that menses where present previously

with normal menstruation and later stopped.

CAUSES OF AMENORRHOEA

HORMONAL CAUSES

 Poorly functioning ovaries

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  Pituitary gland in releasing of FSH and LH-pituitary regulates the production
of hormones that affect many body functions including metabolism and the
reproductive cycle
 Thyroid disorders-overactive/ underactive can cause menstrual
irregularities
 Diabetes mellitus-weight gain can cause irregular periods. When your cyclic
hormonal fluctuations are interrupted you will not ovulate
CONGENITAL ABNORMALITIES

 Imperforate hymen
 Vaginal septum
 Absence of the uterus
 Absence of the ovaries
 Cervical stenosis
 Endometriosis-a disorder in which tissue that normally lines the uterus
grows outside the uterus

NERVEOUS CAUSES

 Change of environment or occupation

 Anxiety and excitement
 Fear and desire for pregnancy
CONSTITUTIONAL CAUSES

 These are due to the debilitating conditions like;- TB, DM

LOCAL CAUSES

 Post hysterectomy
 Bilateral removal of ovaries
 Prolonged exposure to radiations
DRUGS

 Hormonal contraceptives like;-pills, implants and injectable

 Antipsychotic drugs.
MANAGEMENT OF AMENORRHOEA
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  Proper history taking
 Do clinical examination to rule out simple causes like;- pregnancy or
imporforate hymen
 Do investigations like;- HCG, USS, CT SCAN , HORMONAL PROFILE, RBS
TREATMENT

It is prescribed by the gynaecologist depending on the cause and it may be

medical, surgical or psychotherapy.

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DYSMENORRHOEA

This is the pain associated with menstruation

TYPES OF DYSMENORRHOEA

PRIMARY DYSMENORRHOEA;- This is the type of dysmenorrhea which occurs a

few years after puberty and this is the common complaint.

CAUSES;- It is idiopathic but it is associated with the predisposing factors which

include;-

 Narrowing of the cervical os.

 Ischemia due to strong contraction of the uterine muscle
 Hormonal imbalance
 It worsens due to fear.
MANAGEMENT OF PRIMARY DYSMENORRHOEA

 History taking with special reference to severity and duration of pain.

 Physical examination to exclude pelvic tumours.
 Treatment;-
 Mild analgesics but not addictive drugs.
 Health educate the mother and the girl about the causes.
 Contraceptives are given for 4-6 month to suppress ovulation
 Advice the patient to deliver if possible
 Health educate about hygiene, warm bath, sleep and rest.

SECONDARY DYSMENORRHOEA
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This is more severe. It begins 3-4days or sometimes up to a week before
menstruation and may either get better or worse when bleeding starts. It’s felt on
the pelvis, back and made worse by exercises

CAUSES

 Uterine fibroids
 Diseases like;-PIDs
 Endometriosis and Endometritis
Management; - Find out the cause and manage accordingly

MEBRANEOUS DYSMENORRHOEA

This is when the endometrium becomes necrotic and sheds off and it’s usually
painful.

CAUSES

 Infections
 Reduced blood supply
TREATMENT

 Give antibiotics e.g IV Ampicillin1g 6hrly x5/7

 Dilatation and curettage may be done and a tissue may be removed for
histology

MENORRHAGIA

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It is the heavy or prolonged menstrual bleeding OR this is when the menstrual
flow is excessive than usual

CAUSES

Uterine fibroids
Chronic PIDs
Early signs of cacx
Early signs of endometrial cancer
Molar pregnancy
Clotting disorders
Stress
Some drugs
Endocrine disorders like;-
 Hypothyroidism
 Hyperestrogen state
 Perimenopause
 Polycystic ovaries-is adisorder among women of
reproductive age. Women with PCOS have infrequent or
prolonged menstrual periods or excess androgen. The
ovaries develop numerous small collections of fluid
(follicles) and fail to regularly release eggs
 Pituitary tumors
 Anovulatory cycles- Is a cycle xterised by varying
degrees of menstrual intervals and absence of ovulation
and luteal phase
MANAGEMENT

 Proper History taking

 Physical examination
 Investigations;-Hb, Grouping and x-match
-VDRL for syphilis
-USS to rule out any growth and size of uterus
 Treatment may be surgical or medical depending on the cause

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METRORRHAGIA
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This is the irregular uterine bleeding. This bleeding is not menstrual in origin but
patients are not able to distinguish this.

CAUSES

 Cancer of the genital tract

 Uterine prolapse projecting into the vagina
 Incomplete evacuation of the uterus after abortion
 Hydatidform mole
 Cervical erosion
 Threatened abortion
 Retained products of conception
MANAGEMENT

 Thorough history taking and physical examination to detect the cause.

 Digital and speculum examination of the cervix
 Investigations;-
 Cervical smear for histology exam
 Blood for Hb, Grouping and x-match
 Ultra sound scan
 Treatment;- Refer the patient with metrorrhagia to the hospital as soon as
possible

POLYMENORRHOEA

This is when menstruation period occurs at shorter interval than usual.

CAUSES

 Ovarian dysfunction
 Menarche and menopause
 After abortion or normal delivery
 Use of COCs

Treatment;- This depends on the cause

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DYSFUNCTIONAL UTERINE BLEEDING (DUB)

This is the occurrence of irregular, excessive bleeding from the uterus in the
absence of pregnancy, trauma, new growth or hormones and infections

CAUSES

 Hormonal imbalance
MANAGEMENT

 Give COCs for 3-6 months

 D and C may be done in aged women

OLIGOMENORRHOEA

This means little or no menstruation cycle