menstruation prepared by:mayy naser and manar ghnemat to : dr ikhlas jarar
TRANSCRIPT
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Menstruation
Prepared by:mayy Naser and manar ghnematTo : Dr ikhlas jarar
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Introduction
Menstruation:• Is a physiological discharge of
blood ,endometrial cellular debris , and mucus through the vaginal of non pregnant woman and is result of monthly cycling of female reproductive hormone.
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• Eumenorrhea denotes normal, regular menstruation that lasts for a few days (usually 3 to 5 days, but anywhere from 2 to 7 days is considered normal). The average blood loss during menstruation is 35 milliliters with 10–80 ml considered normal
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PHYSIOLOGY OF MENSTRUAL CYCLE
The normal menstrual cycle is divided into:1.The ovarian cycle.(1)The follicular phase (day 1 to 13(2) Ovulatory phase (day13 to15) (3) The luteal phase (day 15 to 28).2. The uterine cycle.
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Menstrual abnormalities
• 1. Dysmenorrhea• 2.Amenorrhea• 3.Intermenstrual pain• 4. PMS (premenstrual syndrome)• 5. Menorrhagia
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dysmenorrhea
• 1. dysmenorrhea: is painful menstruation .• Types: • primary dysmenorrhea : associated with
menstruation in the absence of pelvic disease.
• Increase the level of prostaglandins in the menstrual fluids.
• Secondary dysmenorrhea :associated with pelvic disorder.
• Causes: PID, ovarian cysts ,endometriosis.
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Symptoms of dysmenorrhea
• Abdominal cramping: usually begins at onset of menstrual flow a few hours before onset
• Nausea• Vomiting • Diarrhea • Headache• dizziness
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Treatment
• 1. Analgesics for the relief of cramping with premenstrual syndrome and use for mild to moderate pain.
• Acetyl salicylic acid.• NSAIDS: inh. Synthesis of PG because
PG are responsible for cramping of dysmenorrgea.
• Ipoprofen 200mg every 4-6 hr .• Naproxen 200 mg every 8-12 hr.
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• 2.Diuretics:by FDA , used in eliminating water during premenstrual and menstrual periods.
• 5 days before menses , diuretics help relieve bloating , excess water , cramps , and tension.
• 1-ammonium choride:3g per day in 3 divided doses.(large doses cause GI symptoms
• 2-caffeine:promotes diuresis by inh. Tubular reabsorption of sodium & chloride.
• 3-pamabrom: 50 mg four times daily(not exceed 200 mg per day)
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Amenorrhea
• Is the absence of menstruation • Primary or secondary amenorrhea requires
physician evaluation
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Intermenstrual pain and bleeding
• Occur at mid cycle and may last for hours to days.
• Pain associated with ovulation .• Therapy consists of nonprescription
analgesics.• Patients with pain lasting longer than
2 days should be referred to a physician.
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Premenstrual Syndrome(PMS)
• Symptoms : mood swings , fatigue , appetite change , bloating , breast tenderness , irritability , depression (begin 1-7 days before the onset of menses.
• Nonpharmacological therapy:• Dietary modification , regular exercise ,
reduction of stress factor , avoiding caffeine , fruits and vegetable consuming and avoid salty food.
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Pharmacological treatment
• Diuretic• Benzodiazepines , (MAO-I) , (TCA) , selective
serotonin reuptake inhibitor .• Fluoxetine : is FDA approved and used for
premenstrual dysphoric disorder.• Calcium supplements : to reduce emotional
and physical symptoms of PMS.
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Menorrhagia
• Excessive menstrual blood loss• Low hematocrit , low hemoglobin , low
serum iron may occur ( lead to anemia)• Treatment is usually estrogen – progestin
combination (oral contraceptive)
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Toxic Shock Syndrome
• Can categorized by menstruation or non menstruation.
• Affect woman less than 30 years , women 15-19 at high risk.
• Occurs in women \men contagious• Mainly staphlococcus Aureus infection .• Related to use of tampons. And contraceptive use• S&S : flue like , fever , diarrhea , vomiting ,abrupt
onset ( 8-12 hr)
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VAGINAL PRODUCTS
• A. Vulvovaginal candidiasis• 1. General considerations
• a. Occurrence:.Approximately 75% of all women will experience vulvovaginal candidiasis (yeast infection)
• b. Cause.Candida albicansis responsible for up to 92% of infections.
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• c. Predisposing factors: .Antibiotics, oral contraceptives • containing high-dose estrogen,pregnancy, diabetes,and
immunosuppression in-crease the risk for infection.
• d. Symptoms.Can include a thick, white, ‘‘cottage cheese–like,’’; vaginal burning; and pruritus.
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Patient assesment
• (1)First episode of symptoms• (2)Pregnant• (3)Younger than 12 years of age• (4)Systemic symptoms such as fever• (5)History of recurrent vaginal yeast infections• (6)Discharge with a fishy odor (indicates bacterial
vaginosis, most often caused by• anaerobic bacteria
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. Pharmacological treatment
• include • intravaginal creams, suppositories, and ointments.• d.External vaginal creams can be used in combination with
intravaginal products to treat• vulvar symptoms of pruritus.
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Otc products
• Mycelex-T (clotrimazole), • Monistat 3 and Monistat7 (miconazole),• Femstat 3 (butocona-zole),• and Monistat 1 and Vagistat 1 (tioconazole).
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. Nonpharmacological
• (1)Dry vaginal area well after bathing with a towel.• (2)Avoid tight or damp clothing.• (3)Wear cotton underwear.• (4)Use unscented soap to avoid irritation.• (5)Avoid douching.