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MENSTRUAL ASSOCIATED SYMPTOM, นางสาว ศศิวิมล ดวงคิด ชั้นปีที่2 เลขที่78…
MENSTRUAL
ASSOCIATED
SYMPTOM
MENSTRUAL CYCLE
•Interval: 21-35 days
•Duration: 2-7 days
•Blood loss: 10-80 ml
•2 segments
-Ovarian cycle: follicular phase, ovulation, luteal phase
-Uterine cycle: menstruation, proliferative phase, secretory phase
DYSMENORRHEA
•Definition: painful menstruation
•Ovulation cycle
•Classification
-
Primary
dysmenorrhea: absence of
pelvic pathology, ovulation cycle
-
Secondary
dysmenorrhea: results from
identifiable organic diseases,
most common 🡪 endometriosis
History taking
•Timing: onset, duration
•Severity: disruption in life-style
•Previous gynecologic history: PID, surgery
Physical examination
Vaginal exam:
not essential in young female without sexual intercourse experience
Investigation
CBC, ESR
Cultures: STD
US
Laparoscopy : gold standard for endometriosis
HSG: intrauterine scarring, fibroid
Hysteroscopy
DYSFUNCTIONAL
UTERINE BLEEDING
➡
Abnormal uterine bleeding (AUB)
TERMINOLOGY
Midcycle spotting/ intermenstrual bleeding
Postmenopausal bleeding
Estrogen withdrawal bleeding >>หยุดยาคุม ocp
Estrogen breakthrough bleeding >>Anovulation DUB
Progesterone withdrawal bleeding >>Normal menstruation
Progesterone breakthrough bleeding>>การใช้ progesterone only นานๆ
➡
DYSFUNCTIONAL UTERINE BLEEDING (DUB)
exclude other disease
Classification
Anovulatory DUB
Ovulatory DUB
Treatment
•Advise
•Symptomatic treatment
•Stop bleeding
•Progestin
•Oral contraception
•estrogen
•Decrease recurrent bleeding
•Cyclic progestin
•Oral contraception
•Treat cause
PREMENSTRUAL
SYNDROME
Definition:
physical and emotional symptoms that occur in 1-2 weeksbefore menstrual period and resolve around the start of bleeding
RISK
-Age: 30-40 yr
-Genetics
=Personality and stress
=Socioeconomic problem
PATHOPHYSIOLOGY
•Unknown
•abnormal serotonin production
•beta-endorphin change in luteal phase
•decrease GABA function
TREATMENT
✔•Supporting
✔•Medication
-SSRI
-Anxiolytic
✔•Ovarian suppression
-OCP
-GnRH agonist
✔•Surgery
-oophorectomy
DISORDER RELATED TO MENSTRUAL CYCLE
•Dysmenorrhea
•Amenorrhea
•Dysfunctional uterine bleeding
•Premenstrual syndrome
Primary dysmenorrhea
PATHOGENESIS
Prostaglandin (PG F2α):
uterine smooth muscle contraction
uterine ischemia
terminal nerve sensitization
TREATMENT
General support
Medication NSAIDS Hormone: OCP Levonorgestrel IUD GnRH agonist Danasol
Surgery
Presacral neurectomy
LUNA (laparoscopic uterine nerve ablation)
Secondary dysmenorrhea
Cervical stenosis
Endometriosis
IUD insertion
PID
Adenomyosis
Myoma uteri
Congenital anomalies
Ovarian tumor
Pelvic congestion syndrome
CAUSE & TREATMENT
Cervical stenosis🡪 cervical dilatation
Endometriosis🡪 ablation
IUD insertion🡪 off
PID🡪 antibiotic
Adenomyosis🡪 surgery
Myoma uteri🡪surgery
Congenital anomalies🡪correction
Ovarian tumor🡪surgery
Pelvic congestion syndrome🡪medication
นางสาว ศศิวิมล ดวงคิด ชั้นปีที่2
เลขที่78 รหัสนักศึกษา62120301078