AMENORRHE

A
Prepared by Group 11
 AMENORRHE
A
Amenorrhea is a medical term used to describe
the absence or cessation of menstruation in
women of reproductive age
 TYPES OF AMENORRHEA

PRIMARY AMENORRHEA​ SECONDARY AMENORRHEA

This refers to the cessation of
This occurs when a girl has not
menstrual periods in a woman
started menstruating by the age of
who previously had regular
15, despite normal growth and
menstruation. Secondary
development of secondary sexual
amenorrhea is diagnosed
characteristics like breast
when a woman who has been
development and pubic hair
menstruating regularly stops
growth.​
having periods for three
months or more.

3 Presentation title 20XX

STATISTICS AND
INCIDENCE
Primary Amenorrhea: The incidence of primary amenorrhea is
relatively rare, estimated to affect about 1-3% of women.

Secondary Amenorrhea: Secondary amenorrhea is more common and

can affect up to 5-15% of women at some point in their reproductive
years.

Age and Menopause: Amenorrhea is also common during pregnancy,

breastfeeding, and menopause. However, these are temporary
conditions related to normal reproductive processes rather than
pathological causes of amenorrhea.
 Hormonal
Imbalance

Structural
Abnormalities

ETIOLOGY Functional
Causes

Chronic
Illnesses

Genetic Factors
 ETIOLOG
Y
Hormonal Imbalances: Disruptions in the normal hormonal balance can lead
to amenorrhea. This can include:

 Hypothalamic dysfunction: Stress, excessive exercise, low body weight,

and eating disorders can all affect the hypothalamus, leading to
disruptions in hormone production.
 Pituitary disorders: Tumors, injuries, or other abnormalities affecting the
pituitary gland can disrupt the production and release of hormones that
regulate menstruation.
 Thyroid disorders: Both hypothyroidism (underactive thyroid) and
hyperthyroidism (overactive thyroid) can disrupt menstrual cycles .
 ETIOLOG
Y
Structural Abnormalities: Anatomical issues within the reproductive system
can interfere with menstruation. This may include:

 Congenital abnormalities: Some women may be born with structural

abnormalities of the reproductive organs that can affect menstruation.
 Asherman's syndrome: Scarring or adhesions within the uterus, often
due to previous surgeries or infections, can interfere with menstrual flow.
 Polycystic ovary syndrome (PCOS): PCOS is a hormonal disorder
characterized by cysts on the ovaries, insulin resistance, and irregular
menstrual cycles. It is a common cause of menstrual irregularities,
including amenorrhea.
 ETIOLOG
Y
Functional Causes: Certain lifestyle factors or temporary conditions can also
cause amenorrhea, such as:

 Extreme weight loss or low body weight: Significant weight loss or

being underweight can disrupt hormone production and lead to
amenorrhea.
 Excessive exercise: Intense physical activity, especially in athletes, can
affect hormone levels and menstrual regularity.
 Stress: Emotional or physical stress can disrupt the normal functioning of
the hypothalamus, leading to menstrual irregularities.
 Medications: Some medications, such as certain antidepressants,
antipsychotics, and chemotherapy drugs, can interfere with menstruation.
 ETIOLOG
Y
Chronic Illnesses: Certain chronic medical conditions can contribute to
amenorrhea, including:

 Diabetes
 Celiac disease
 Autoimmune disorders
 Chronic kidney disease

Genetic Factors: In some cases, genetic factors may play a role in

amenorrhea, particularly in cases of congenital abnormalities or conditions
like Turner syndrome.
 Absence of
Menstruation

Changes in Characteristics Secondary

Sexual

CLINICAL Hormonal Imbalance

MANIFESTATION Symptoms

Infertility

Underlying conditions
 Metabolic
Changes

Other
Symptoms

CLINICAL
MANIFESTATION
 CLINICAL
MANIFESTATION
Absence of Menstruation: The primary clinical manifestation of
amenorrhea is the absence of menstrual periods. Depending on the
underlying cause, this absence can be temporary or permanent.

Changes in Secondary Sexual Characteristics: In some cases,

particularly if the onset of amenorrhea occurs before puberty or
during adolescence, there may be delays or abnormalities in the
development of secondary sexual characteristics such as breast
development and pubic hair growth.
 CLINICAL
MANIFESTATION
Hormonal Imbalance Symptoms: Amenorrhea often occurs due to
hormonal imbalances. Depending on the specific hormones involved,
symptoms may include:

 Changes in libido (sex drive)

 Hot flashes
 Vaginal dryness
 Mood swings
 Headaches
 Changes in breast size or tenderness

Infertility: Amenorrhea can lead to infertility, particularly if

ovulation is not occurring. This can be distressing for
individuals who desire to conceive.
 CLINICAL
MANIFESTATION
Underlying Conditions: Amenorrhea can be a symptom of various
underlying conditions, such as:

 Polycystic ovary syndrome (PCOS)

 Thyroid disorders
 Pituitary gland disorders
 Premature ovarian failure
 Structural abnormalities in the reproductive organs
 Extreme stress or emotional trauma
 CLINICAL
MANIFESTATION
Metabolic Changes: In some cases, amenorrhea may be associated
with metabolic changes, such as changes in weight (either
significant weight loss or weight gain), which can affect hormone
levels and disrupt the menstrual cycle.

Other Symptoms: Depending on the cause of amenorrhea,

individuals may experience additional symptoms related to the
underlying condition. For example, in PCOS, symptoms may
include acne, hirsutism (excessive hair growth), and insulin
resistance
 Medical History

Physical
Examination

ASSESSMENT
AND Laboratory Tests
DIAGNOSTIC
FINDINGS
Imaging
Studies

Additional
Test
ASSESSMENT AND DIAGNOSTIC
TEST
Medical History: A thorough medical history is essential to identify any
potential contributing factors, such as age of onset, menstrual history,
reproductive history, medications, past medical conditions, and lifestyle
factors.

Physical Examination: A physical examination may include assessing

secondary sexual characteristics, signs of hormonal imbalances (e.g., acne,
hirsutism), and signs of underlying conditions such as thyroid enlargement
or ovarian abnormalities.
 ASSESSMENT AND DIAGNOSTIC
TEST
Laboratory Tests:
 Pregnancy Test: To rule out pregnancy, a common cause of secondary amenorrhea.
 Hormone Levels:
 Follicle-Stimulating Hormone (FSH) and Luteinizing Hormone (LH): To
evaluate ovarian function and diagnose conditions like premature ovarian failure
or polycystic ovary syndrome (PCOS).
 Prolactin: Elevated levels may indicate a prolactinoma or other pituitary
disorders.
 Thyroid-Stimulating Hormone (TSH): To assess for thyroid dysfunction
(hypothyroidism or hyperthyroidism).
 Estradiol: To evaluate ovarian estrogen production.
 Androgens (Testosterone, DHEA-S): Elevated levels may suggest PCOS or
adrenal hyperplasia.
 Complete Blood Count (CBC) and Metabolic Panel: To identify underlying
systemic conditions.
 ASSESSMENT AND DIAGNOSTIC
TEST
Imaging Studies:
 Pelvic Ultrasound: A pelvic ultrasound may be performed to evaluate the
structure of the reproductive organs, including the uterus, ovaries, and
fallopian tubes. This can help identify any structural abnormalities or
ovarian cysts.
 MRI or CT Scan: These imaging studies may be used if there is suspicion
of pituitary or hypothalamic disorders.

Additional Tests:
 Genetic Testing: In cases of suspected genetic disorders or chromosomal
abnormalities, genetic testing may be indicated.
 Endometrial Biopsy: If amenorrhea is associated with abnormal uterine
bleeding or concerns about endometrial pathology, an endometrial biopsy
may be performed to evaluate the uterine lining.
 MEDICAL
MANAGEMEN
T

20
 MEDICAL
MANAGEMENT
HORMONAL THERAPY: Hormonal therapy may be prescribed to
regulate the menstrual cycle and induce menstruation in cases where
hormonal imbalances are identified. This may include:

 Combined Oral Contraceptives (COCs): COCs containing estrogen and

progestin can regulate menstrual cycles by providing a regular hormonal
pattern.
 Progestin Therapy: Progestin-only medications, such as
medroxyprogesterone acetate (Provera), may be used to induce
withdrawal bleeding in women with hypothalamic amenorrhea or as part
of hormone replacement therapy.
 Estrogen Therapy: Estrogen therapy may be prescribed in cases of
estrogen deficiency, such as in premature ovarian failure or menopausal
women, to restore hormone levels and induce menstruation.
 MEDICAL
MANAGEMENT
TREATMENT OF UNDERLYING CONDITIONS:

 Thyroid Disorders: Treatment with thyroid hormone replacement

therapy may be indicated for hypothyroidism.
 Pituitary Disorders: Management of pituitary disorders may involve
medications, surgery, or radiation therapy, depending on the specific
diagnosis.
 Polycystic Ovary Syndrome (PCOS): Lifestyle modifications, such as
weight loss and dietary changes, along with medications like oral
contraceptives, anti-androgens, and insulin-sensitizing agents, may be
recommended.
 Hyperprolactinemia: Treatment may involve medications such as
dopamine agonists (e.g., cabergoline) to reduce prolactin levels and
restore normal menstrual function.
 MEDICAL
MANAGEMENT
SURGICAL INTERVENTION: In cases where structural abnormalities
of the reproductive organs are identified (e.g., uterine fibroids, ovarian
cysts), surgical intervention may be necessary to correct the underlying
pathology.

LIFESTYLE MODIFICATIONS: Lifestyle modifications may be

recommended, especially in cases where factors such as excessive
exercise, stress, or extreme weight loss are contributing to amenorrhea.
Counseling on healthy lifestyle habits, stress management techniques,
and appropriate exercise may be beneficial.
 MEDICAL
MANAGEMENT
FERTILITY TREATMENT: For women experiencing amenorrhea
related to infertility, assisted reproductive technologies such as in vitro
fertilization (IVF) may be considered, depending on the underlying
cause and fertility status.

PSYCHOLOGICAL SUPPORT: Psychological support and

counseling may be important, particularly in cases where emotional
stress or psychiatric disorders contribute to amenorrhea. Addressing
underlying psychological factors can be integral to the overall
management approach.
 NURSING
MANAGEMEN
T

25
 NURSING MANAGEMENT
Assessment and Education:
 Conduct a comprehensive assessment to gather information about the
individual's menstrual history, medical history, lifestyle factors, and
psychosocial concerns.
 Educate the individual about the possible causes and contributing factors of
amenorrhea, emphasizing the importance of seeking medical evaluation for
proper diagnosis and treatment.

Supportive Counseling:
 Offer emotional support and counseling to individuals experiencing distress
related to amenorrhea. Address concerns, fears, and misconceptions they
may have about their condition.
 Provide information about coping strategies, stress management techniques,
and healthy lifestyle habits that may help manage symptoms and improve
overall well-being.
 NURSING MANAGEMENT
Collaborative Care:
 Collaborate with other healthcare providers, such as physicians,
gynecologists, endocrinologists, and mental health professionals, to ensure
comprehensive assessment and management of the individual's condition.
 Participate in interdisciplinary care planning and coordination to address
the underlying cause of amenorrhea and develop an individualized
treatment plan.
Medication Management:
 Administer prescribed medications as ordered, ensuring proper dosage,
administration, and monitoring for adverse effects.
 Educate individuals about the purpose, expected benefits, and potential side
effects of medications used to manage amenorrhea, such as hormone
replacement therapy or ovulation-inducing medications.
 NURSING
MANAGEMENT
Health Promotion and Lifestyle Modification:

 Provide education on the importance of maintaining a healthy

lifestyle, including regular exercise, balanced nutrition, adequate
sleep, and stress reduction techniques.
 Offer guidance on achieving and maintaining a healthy weight, as
excessive weight loss or obesity can contribute to menstrual
irregularities.
 Encourage individuals to avoid smoking, excessive alcohol
consumption, and illicit drug use, as these can negatively impact
hormonal balance and menstrual function.
 NURSING MANAGEMENT
Follow-Up and Monitoring:
 Schedule regular follow-up appointments to monitor the individual's
progress, assess treatment response, and address any concerns or questions
they may have.
 Monitor menstrual patterns, hormone levels, and any changes in symptoms
to evaluate the effectiveness of treatment and make adjustments as needed.

Patient Advocacy:
 Advocate for individuals' rights to receive timely and appropriate
healthcare services, including access to diagnostic testing, treatment
options, and supportive resources.
 Collaborate with healthcare team members to address any barriers to care
and ensure that individuals receive the support and assistance they need.
POSSIBLE
NURSING
DIANOSES

30
POSSIBLE NURSING
DIANGNOSES
ALTERED HORMONAL FUNCTION
Related to: Hypothalamic-pituitary-ovarian axis dysfunction,
polycystic ovary syndrome (PCOS), thyroid disorders.
Evidenced by: Absence of menstruation, abnormal hormone levels
on diagnostic tests.

IMBALANCED NUTRITION: LESS THAN BODY

REQUIREMENTS
Related to: Eating disorders, excessive exercise, malnutrition.
Evidenced by: Low body weight, reported restrictive eating habits,
electrolyte imbalances.
POSSIBLE NURSING
DIANGNOSES
DISTURBED BODY IMAGE
Related to: Changes in physical appearance or function, perception of femininity.
Evidenced by: Verbalization of dissatisfaction with body, anxiety about physical
changes.

ANXIETY
Related to: Uncertainty about health, fear of infertility, concern about underlying
conditions.
Evidenced by: Restlessness, verbal expressions of worry, increased heart rate.

DEFICIENT KNOWLEDGE
Related to: Lack of information about menstrual health, causes of amenorrhea, and
treatment options.
Evidenced by: Questions about condition, misconceptions about causes and
treatment.
 NURSING
INTERVENTIO
NS

33
 NURSING
INTERVENTIONS
INTERVENTION FOR ALTERED HORMONAL FUNCTION:

• Monitor hormone levels as prescribed by the healthcare provider.

• Educate the patient about the importance of adhering to prescribed

medications or hormonal treatments.

• Assess the patient's dietary intake and nutritional status.

• Collaborate with a dietitian to develop an appropriate meal plan.

NURSING
INTERVENTIONS
INTERVENTION FOR DISTURBED BODY IMAGE:

• Provide a supportive environment for the patient to

express feelings about body changes.

• Refer to a counselor or support group if needed.

• Provide information about the condition and possible

causes of amenorrhea.
 NURSING
INTERVENTIONS
INTERVENTION FOR DEFICIENT KNOWLEDGE:

• Teach relaxation techniques such as deep breathing

exercises.

• Educate the patient about the menstrual cycle, factors

affecting menstruation, and potential treatments for
amenorrhea.

• Provide written materials or reliable online resources for

further reading.
THANK
YOU!

37