Disorders of the menstruation (Amenorrheoa (Risk factors (Family history.…
Disorders of the menstruation
This is absence of menstruation. it is a symptom of a variety of disorders.
Primary amenorrheoa refers to delayed menarche, where a girl of 16 has not began to show signs of secondary developmental characteristics such as development of breasts.
Secondary amenorrheoa refers to cessation of menstruation for one for one or more cycles when this has been established.
Treatment is determined by the etiology of the amenorrhea and the desires of the patient. Ideally, treatment should be directed at correcting the underlying pathology.
the causes may include pregnancy, menopause, endometriosis, hysterectomy, oophorectomy, chemotherapy, tension, emotional upset, eating disorders as well as some contraceptives.
The main symptom is a lack of menstruation.
milky nipple discharge
additional facial hair
Treatment for primary amenorrhea may start with watchful waiting, depending on the person's age and the result of the ovary function test. If there is a family history of late menstruation, periods may start in time.If there are genetic or physical problems that involve the reproductive organs, surgery may be necessary. This will not guarantee
Lifestyle factors: If the person has been exercising excessively, a change of exercise plan or diet may help to stabilize the monthly cycle.
Stress: If emotional or mental stress is a problem, counseling may help.
Some health conditions can cause weight loss. A doctor may test for these and offer treatment as appropriate.
Underactive thyroid: If menstruation stops because of an underactive thyroid, the doctor may prescribe treatment with thyroxine, a thyroid hormone.
Premature ovary failure: Hormone replacement therapy (HRT) may cause menstruation to return.
The hypothalamus is in the center of the brain and controls reproduction. It produces gonadotropin-releasing hormone (GnRH). GnRH signals the production of other hormones needed for the egg to mature and for ovulation
Family history. If other women in your family have experienced amenorrhea, you may have inherited a predisposition for the problem.
Eating disorders. If you have an eating disorder, such as anorexia or bulimia, you are at higher risk of developing amenorrhea.
Athletic training. Rigorous athletic training can increase your risk of amenorrhea.
tests can measure the levels of testosterone, estrogen, and other hormones in your blood.
Your doctor may also use imaging tests to diagnose secondary amenorrhea. MRI, CT scans, and ultrasound
the causes are unknown but are associated with uterine contractions and vasospasms. Dysmenorrheoa are classified as primary when the cause is not known and there is no obvios pelvic or gynaecological pathology. secondary is classified when there is pelvic and/ reproductive system pathology.
The patient should be helped to relax. apply heat to the lower abdomen and exercises have found to be helpful. Ibuprofen 200-400 mg 3 times a daily may be prescribed in the first 2-3 days of menstruation. for management of secondary dysmenorrheoa, the underlying cause must be identified and treated
Hyperactivity of the myometrium with accompanying uterine ischemia is considered to be of central importance in the causation of pain. Prostaglandins seem to be involved to a large extent in the development of the myometrial hyperactivity.
This is a colicky abnormal pain that starts with menstrual flow and lasts for up to 3 days.
Cramping in the lower abdomen.
Pain in the lower abdomen.
Low back pain.
Pain radiating down the legs.
Early age at menarche (< 12 years)
Heavy or prolonged menstrual flow.
Positive family history.
Physical examination and pelvic examination
This is characterised by headache, lower back pain, fullness of breasts, mood swings and fatigue. these are reported to occur a few days before menstruation.
It is important to establish stressors in the patients life and adress these. the patient should be reassured and offered some positive coping mwchanism. reassure patient to ally anxiety: refer to psychologist if it is severe
Premenstrual syndrome (PMS) disorder are triggered by hormonal events ensuing after ovulation.
There are no unique physical findings or lab tests to positively diagnose premenstrual syndrome. Your doctor may attribute a particular symptom to PMS if it's part of your predictable premenstrual pattern.
Antidepressants. Selective serotonin reuptake inhibitors (SSRIs)
Nonsteroidal anti-inflammatory drugs (NSAIDs)
Tension or anxiety
Mood swings and irritability or anger
Appetite changes and food cravings
Trouble falling asleep (insomnia)
Cyclic changes in hormones. Signs and symptoms of premenstrual syndrome change with hormonal fluctuations and disappear with pregnancy and menopause
Chemical changes in the brain. Fluctuations of serotonin, a brain chemical (neurotransmitter) Insufficient amounts of serotonin may contribute to premenstrual depression, as well as to fatigue, food cravings and sleep problem
Depression. Some women with severe premenstrual syndrome have undiagnosed depression, though depression alone does not cause all of the symptoms
Depression and Anxiety.
This is a gradual process that females reach at the end of their reproductive life. may occur in early age 40 in some women.it sis characterised by permanent cessation of menstruation. it is associated with declining ovarian function
it is accompanied by hot flushes, mood swings and increase in weight. following this period, there is a gradual atrophy of breast tissue and genitals, decrease in vaginal secretions, dyspareunia, thinning hair, loss of bone density, and vascular changes
address psychosocial issues that may be associated with menopause. the women might be at risk of developing cancers, especially breast, uterus, ovaries. the nurse must be sensitive to individual feelings and provide the necessary support and advice on nutrition and exercise.periodic medical assessment should be given.
hormone replacement therapy (HRT) is very important as it eliminates persistent hot flushes thus promoting comfort, as well as decreasing bone loss and decreasing the risk if colon cancer
Essential Health Education
patient must be advised on a correct diet, advised on drinking adequate amount of water. nurse should give instructions on correct way to breast examinations and report any findings.also give advise about regular exercise. mammograms should be done annually
The menopausal ovary no longer produces estradiol (E2) or inhibin. Therefore, FSH and LH are no longer inhibited by estrogen's negative feedback mechanism. Fluctuations and deficiencies in estrogen levels cause many of the menopausal signs and symptoms.
Natural decline of reproductive hormones.
Chemotherapy and radiation therapy
Primary ovarian insufficiency.
blood tests to check FSH levels and TSH
Gabapentin (Neurontin, Gralise, others)
Clonidine (Catapres, Kapvay, others)
Medications to prevent or treat osteoporosis.
High blood pressure
High LDL (low density lipoproteins) or "bad" cholesterol
Low HDL (high density lipoproteins) or "good" cholesterol
Family history of heart disease