gangguan siklus menstruasi.pptx
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ABNORMALITY OF MENSTRUAL CYCLE
Abnormality :
Cycles
Period
Amount of bleeding
Pain associated with menses
Disorders of the Menstrual Cycle
AmenorrheaDysmenorrheaPremenstrual SyndromeAbnormal Uterine Bleeding
Abnormal Uterine Bleeding: Definitions
Menorrhagia: Heavy or prolonged uterine bleeding that occurs at regular intervals. Some sources define further as the loss of ≥ 80 mL blood per cycle or bleeding > 7 days.Hypomenorrhea: Periods with unusually light flow, often associated with hypogonadotropic hypogonadism (athletes, anorexia). Also may be associated with Asherman’s syndromeMetrorrhagia: Irregular menstrual bleeding or bleeding between periodsMenometrorrhagia: Metrorrhagia associated with > 80 mLPolymenorrhea: Frequent menstrual bleeding. Strictly, menses occur q 21 d or lessOligomenorrhea: Menses are > 35 d apart. Most commonly caused by PCOS, pregnancy, and anovulation
Abnormal Uterine Bleeding: Differential DiagnosisStructural
Cervical or vaginal lacerationUterine or cervical polypUterine leiomyomaAdenomyosisCervical stenosis/Asherman’s (hypomenorrhea)
HormonalAnovulatory bleedingHypogonadotropic hypogonadismPregnancyHormonal Contraception (i.e. OCPs, Depo-Provera)Thyroid disordersHyperprolactinemia
MalignancyUterine or Cervical cancerEndometrial hyperplasia (potentially pre-malignant)
Bleeding disordersvon Willebrand’s Disease, Hemophilia/Factor deficiencies, platelet disorders
How to approach the diagnosis ?
Anamnesis :- Chief complain- History of menstrual cycles- Family history of abnormality of menstruation- Developmental disorders- History of other disease- History of medication including contraception- Psychological disorders
- Physical examination- Laboratory diagnostic
- USG- Laparoscopy- X-Ray- CT Scan- Colposcopy- MRI
Therapy : - Depend on etiology- Induction of menstruation
AMENORHEA
Definition
1. Do not reach menarche, without secondary sexual development until 13 years old
2. Until 15 years old with secondary sexual development, but not reach menarche
3. absence of periods for a length of time equivalent to a total of at least three of the previous cycle intervals or 6 months of amenorrhea
Classification (classical)
Primary amenorhea : Not have reach menarche at all
Secondary amenorhea : Had a menstruation before than stop.a. Physiologically : Puerpuerium
Breast feedingDuring pregnancyMenopause
b. Pathologically : Other causes.Amenorhea could be followed by
galactorhea andhirsutism.
Causes of AmenorrheaDisorders of sexual differentiation
Distal genital tract obstructionGonadal dysgenesisAmbiguity of external genitalia
Other peripheral causesPregnancyGestational trophoblastic disease
Aseherman’s syndrome
Causes of Amenorrhea
Chronic anovulation or ovarian failureDue to CNS-hypothalamic-pituitary dysfunctionDue to inappropriate feedback (PCOS)Due to thyroid and adrenal disordesPersumtive ovarian failure
DISMENORHEA
DefinitionPain that feel just before or on
menstruation
Classification : Primary
dismenorhea/functional/idhiopatic : pain that have no pathological causes
Secondary dismenorheaCaused by factor that could be found
Etiology :Prostaglandin theory F2-a
Prostaglandin elevated the end of menstrual cycles caused contraction of uterus ischemia pain.
Secondary dismenorheaCould be caused by :- Pelvic infection- Endometriosis- Myoma- IUD- Endometrial polyp
Treatment : SymptomaticEndocrinologyOperativePsychology
Symptomatic treatment : - Analgesic- Sedative- Antispasmodic- Diuretic- Light exercises- Bed rust- Oral contraceptive- Tocolytic- Panasacral neurectomy
DISFUNGTIONAL UTERINE BLEEDING
Definition
Is an abnormal bleeding from uterus that came only by hormonal disturbance without organic abnormalities.
Happen in teenagers, reproductive period and premenopause period.
Clasification :1. DUB in anovulation cycles
Corpus luteum do not developed, level of estrogen is high, progesteron level is low.
2. DUB in ovulation cycles- midcycles bleeding- Bleeding cause by disturbance in
endometrial release- Spotting premenstruation and
postmenstruation.
3. DUB in persistent follicles- often found in reproductive line- Endometrial hyperplasia : -Simplex
- Cystic- Atypical
How to reach diagnosis
1. Anamnesis, gynecological examination2. Anovulation diagnosis
Basal temperature : monophasicProgestin level : lowGonadotropin level : LH lowHyperfunction of adrenal : high
testosteronHypothyroid : high TSHEndometrial Biopsy : atrophy,
proliferateMittelschmeric : absentMenstrual cycles : irregular.
Treatment Hormonal therapy combination estrogen and progesteron
OTHER DISTURBANCE
I. Pseudoamenorhea / Kriptomenorhea
Definition
There is menstruation, but the blood could not expelled became blockade on cervix, vagina, hymen.
Classification- Congenital- Acquisita : a. Infection (GO,
diphtheria)b. Abnormal deliveryc. Senility
Diagnosis : Molimina menstrualia Hematokolpos Hematometra
Hematosalphing
Treatment :Incision/excision of blockade hymen
II. Menstrual Praecock
DefinitionBleeding in below 10 years child, accompanied by secondary sexual development.
Classification :a. Puberty praecock Gonadotropin is formed, could get pregnant Idiopathic Central puberty praecock Albright syndrome Neoplasm that produce gonadotropin
b. Pseudopuberty pracock
There is no gonadotropin, and no ovulation :
Granulosa cell tumors/techa cell tumor Disturbance on suprarenal glands Gonad therapy
IV. Polymenorhea
Short period, less than 21 days.
A. If the cycles is short, but regular :
- short of proliferation phase
- short of secretion phase
- both of them
B. Cycles that previously normal but become, shorter
Happen in :- Climacterium- Puberty- TBC
Therapy :Estrogen on combination betweenEstrogen and progesterone
Oligomenorhea
Menstruation rare, long cycles more that 2 months
Caused by :- Prolonged follicular phase- Prolonged luteal phase- Both of themAlways think about pregnancy.
Menorhagia
Expelled blood in large amount in regular menstrual cycles
Caused by :
Hypoplasia uteri Asthenia During or after diseases Myoma Hypertension Decompensatio cordis Infection Hemophilia
MetrorhagiaIrregular bleeding do not associated with menstrual cycles.
I. Caused by pregnancy- Abortion- Ectopic pregnancy
II. Not caused by pregnancyUsually hormonal or organic.