AMENORRHEA

DEFINITION

Refers to the absence or abnormal cessation of menstrual periods in women of reproductive age

DIFFERENTIAL DIAGNOSIS

TYPE

Primary - The absence of menstrual periods by the age of 16, despite normal growth and secondary sexual characteristic

Secondary - The cessation of menstrual periods in a women who has previously had regularly menstrual cycles

ETIOLOGY

  • Excessive excercise
  • Weight changes
  • Structure problems
  • Stress
  • Hormonal imbalance
  • Certain medication
  • Pregnancy
  • Chronic illness condition

PATHOPHYSIOLOGY

  1. Hypothalamic dysfunction - stress,
  • Low body weight
  • Excessive exercise
  1. Hypothalamic-pituitary axis dysfunction - GnRH Suppression
  • Reduced FSH and LH
  1. Ovarian dysfunction
  • Anovulation (PCOS)
  • Hormonal imbalance
  1. Impaired ovarian hormone production
  • Decreased estrogen and progesterone
  • Disrupted follicular and secretory
  • Phases of the menstrual cycle
  1. Uterine response
  • Lack of hormonal stimulating for uterine lining
  • Absence of menstrual bleeding
  1. Feedback mechanism
  • Disruption in communication across hypothalamus, pituitary, ovaries and uterus

CLINICAL MANIFESTATION

Headaches or vision changes

Excess facial hair or body

changes in breast tissue

Pelvic pain

Absence of menstrual periods

Weight changes

Hot flashes

Nipples leaking milk

Acne

Vaginal dryness

INVESTIGATION

  1. History taking & Physical examination
  1. Blood test
  • Full blood count (FBC)
  • Hormonal assay
  1. Imaging
  • Pelvic ultrasound
  • CT Scan
  • MRI
  1. Other
  • Thyroid test
  • Pregnancy test

Thyroid disorder

Premature ovarian failure

Pregnancy

Hyperprolactinemia

Polycystic ovary syndromes (PCOS)

Structural uterine abnormalities

Turner syndrome

Functional hypothalamic amenorrhea

Medication-induced amenorrhea

Androgen-producing tumors

Cushing's syndrome

MANAGEMENT

MEDICATION
Symptomatic

  • Tab paracetamol 1g TDS
  • Tab ibuprofen 250-500mg
    • Depo-provera IM 150mg every 3 month
    • Crinone 1.125g intravag OD

PROCEDURE

  • clomiphene citrate (CC) therapy
  • Estrogen therapy

NURSING CARE

  1. Rest in bed according supine, recumbent, semi fowler or fowler position
    1. Taking and monitoring vital sign such as blood pressure, pulse rate, respiration rate, temperature and pain score for show progress toward recovery
    2. Insert and monitoring intravenous normal saline drip to avoid electrolyte imbalance
    3. Administration medication according to prescription such as right patient, right medication, right dosage, right route, right time, right documentation, right refuse
    4. Taking blood specimen and labelling sample for investigation purpose
    5. Record tracking and saving documentation for support diagnosis and as proof of activities
    6. Encourage increased intake if the patient has a low body weight
    7. Counsel and educate patient

HEALTH EDUCATION

  1. Attending follow up treatment according to the time and date given by doctor
  2. Take the medication with correct dosage and timing according to doctor prescription 2 time per day (BD), 3 time per day (TDS), 4 time per day (QID), immediately (STAT) when necessary (PRN)
  3. Consume a balance diet based on the food pyramid such as intake of high protein food, carbohydrate food, vegetables and fruits
  4. Encourage drinking 8 glasses of boiled water a day to prevent dehydration in body
  5. Avoid drinking alcohol and smoking cigarettes because it can affect health
  6. Practice a healthy and active lifestyle by doing light exercise such as jogging, walking, yoga and so on for speedy recovery capability
  7. Count the menstrual cycle
  8. Family planning

COMPLICATION

  • Infertility and problems with pregnancy
  • Psychological stress
  • Osteoporosis and cardiovascular disease
  • Pelvic pain

PROGNOSIS

  • Cure if early treatment
  • Not cure if not treat and can lead to other disease