1. MENSTRUAL IRREGULARITIES

2. dysmenorrhoea

4. DYSMENORRHOEA DEFENITION
Painful menstruation
Cases of painful menstruation of sufficient magnitude so as to incapacitate day to day activities

5. TYPES PRIMARY There is no identifiable pelvic pathology SECONDARY
Pain occur due to a pelvic pathology

6. primary DYSMENORRHOEA

7. INCIDENCE OF PRIMARY DYSMENORRHOEA
5- 10%

8. CAUSES OF PRIMARY DYSMENORRHOEA
DYSRYTHYMIC UTERINE CONTRACTION UTERINE HYPOXIA AND ISCHEMIA PAIN

9. CAUSES OF PRIMARY DYSMENORRHOEA
Adolescents
Related to ovulatory cycle
Psychosomatic factors
Tension and anxiety
Lower pain threshold
Abnormal anatomic and functional aspects of uterus
Stenosis at the internal os
In appropriate law of polarity
Uterine myometrial hyperactivity
Imbalance in the autonomic and nervous control
Role of vasopressin
Role of prostaglandin

10. CLINICAL FEATURE OF PRIMARY DYSMENORRHOEA
Begins few hours before or just with the onset of menstruation
Last for few hours may extend to 24 hrs but rarely 48hrs
Spasmodic and confined to lower abdomen and may radiate to back and medial aspect of thigh
Nausea
Vomiting
Fatigue
Diarrhoea
Head ache
Vasomotor changes – pallor,cold,sweat and fainting

11. TREATMENT OF PRIMARY DYSMENORRHOEA
Improve general health
Psychotherapy
Explanation and assurance
Mild analgesic and anti spasmodic
SEVERE CASES
Prostaglandin synthetase inhibitors
Mefanamic acid mg
Flufenamic acid mg hrly
Propionic acid derivative
Ibuprofen 400mg hrly
Oral contraceptive pills

12. SURGICAL Rx OF PRIMARY DYSMENORRHOEA
Dilatation of cervical canal
Bilateral block of the pelvic plexus (Para cervical block with alcohol)
Pre sacral neurectomy

13. SECONDARY DYSMENORRHOEA

14. DEFENITION
Pain occur in the presence of a pelvic pathology

15. CAUSES OF SECONDARYDYSMENORRHOEA
Premenstrual pelvic congestion or increased vascularity Increased tension in the pelvic tissue Pain

16. CAUSES OF SECONDARYDYSMENORRHOEA
Chronic pelvic infection
Pelvic endometriosis
Adenomyosis
Uterine fibroid
Endometrial polyp
IUCD in utero

17. CLINICAL FEATURES Pain is dull
Situated in the back and front without any radiation
Appears 3-5 days prior to the period
Relieves with the start of bleeding

18. TREATMENT MEMBRANEOUS DYSMENORRHOEA Shedding of big endometrial casts
Deficiency of tryptic ferment
Rx ---same as primary dysmenorrhoea
OVARIAN DYSMENORRHOEA
Appears 2-3 days before menstruation
Dull
Distributed to one or both quadrant
MITTELSCHMERZ’S SYNDROME
Appears in the mid menstrual period
Situated in the hypogastrium or to either iliac fossa
Nausea and vomiting is absent
Last more than 12hrs
Vaginal bleeding or excessive vaginal discharge
Rx --- Assurance and analgesics

19. Premenstrual syndrome

20. DEFINITION
Premenstrual syndrome is a psycho neuro endocrine disorder of unknown etiology often noticed just prior to menstruation

21. CAUSES LINKED TO THE LEUTEAL PHASE
Alteration in the level of estrogen and progesterone
Decreased synthesis of serotonin
Withdrawal of endorphins
Psychological and psychosocial factors

22. CLINICAL FEATURES Abdominal bloating Breast tenderness
Swelling of the extremities
Weight gain
Irritability
Depression
Insomnia
Dyspareunia
Anxiety
Head ache
Loss of concentration

23. TREATMENT GENERAL Assurance Avoidance of salt, caffeine and alcohol
Pyridoxine 100mg,BD
Diuretic – Frusemide 20mg
Alprazolam 0.25mg (anxiety and depression)
Fluoxetine
HORMONES
Oral contraceptive pills(Suppress ovulation)
Progestogen 10mg (from 5th day of cycle for 20days)
Bromocriptine 2.5mg(relieves breast discomfort)
SUPPRESSION OF OVARIAN CYCLE
Danazol mg (produce amenorrhoea)
GnRH analouges (Gonadal steroids are suppressed)

24. Menorrhagia / HYPERMENORRHOEA

25. DEFINITION
Menorrhagia is defined as cyclic bleeding at normal intervals
Bleeding is either excessive in amount or duration or both

26. CAUSES ORGANIC Fibroid uterus Adenomyosis Pelvic endometriosis
IUCD in utero
Chronic tubo-ovarian mass
Tubercular endometritis
Retroverted uterus
SYSTEMIC
Liver dysfunction
CCF
Severe hypertension
ENDOCRINAL
Hypothyroidism
Hyperthyroidism
HEMATOLOGICAL DISORDERS
ITP
Leukemia
Von willebrand’s disease
FUNCTIONAL
Hypothalamo – pituitary ,ovarian – endometrial axis

27. DIAGNOSIS
Long duration of flow
Passage of big clots
Pallor
Low Hb

28. TREATMENT
Appropriate to the cause for menorrhagia

29. EPIMENORRHOEA/ POLYMENORRHOEA

30. DEFINITION
It is defined as cyclic bleeding where the cycle is reduced to an arbitary limit of 21 days or less and remains constant at that frequency
If the frequent cycle is associated with excessive and prolonged bleeding, it is called epimenorrhagia

31. CAUSES Hyper stimulation of the ovary by the pituitary hormone
Adolescence
Preceding menopause
Following delivery and abortion
PID(Ovarian hyperemia)
Ovarian endometriosis (Ovarian hyperemia)

32. TREATMENT
Hormonal Therapy

33. metrorrhagia

34. DEFINITION
Metrorrhagia is defined as irregular acyclic bleeding from the uterus
Bleeding from any part of the genital tract is included under metrorrhagia
Contact bleeding or inter menstrual bleeding is also included

35. CAUSES CA cervix Polyp Infection Cervical endometriosis
Ovular bleeding
IUCD
Decubitus ulcer

36. TREATMENT Malignancy should be excluded
Treatment to the underlying pathology

37. MENOMETRORRHAGIA

38. DEFINITION
When the bleeding is so irregular and excessive that the menses cannot be identified at all

39. CAUSES OF ACYCLIC BLEEDING
CAUSES OF CONTACT BLEEDING
CA Cervix
Mucous polyp of cervix
Ectopy of cervix
Infection
Cervical endometriosis
CAUSES OF INTERMENSTRUAL BLEEDING
Urethral caruncle
Ovular bleeding
IUCD in utero
Decubitus ulcer

40. TREATMENT Malignancy should be excluded
Treatment to the underlying pathology

41. oligomenorrhoea

42. DEFINITION
Menstrual bleeding occuring more than 35 days apart and which remains constant at that frequency is called oligomenorrhoea

43. CAUSES Age Obesity Stress and exercise PCOD Hyperprolactenaemia
Hyperthyroidism
Androgen producing tumour
Tubercular endometritis

44. hypomenorrhoea

45. DEFINITION
When the menstrual period is unduly scanty and last for less than 2 days,it is called hypomenorrhoea
CAUSES
Uterine synachia
Endometrial tuberculosis
OCP
Thyroid dysfunction
Premenopausal period
Malnutrition

46. amenorrhoea

47. DEFINITION
Absence of menstruation

48. TYPES PRIMARY Delay of menarche past 17 years of age SECONDARY
Menses ceases sometimes after menarche

49. CAUSES FOR PRIMARY AMENORRHOEA
Anatomical defects in the structure of uterus and vagina
Imperforate hymen
Little or no development of secondary sex characteristics
Genetic defects
Intracranial lesions
Pituitary failure

50. CAUSES FOR SECONDARY AMENORRHOEA
Organic brain disease
Ovarian neoplasm
Polycystic ovary
Nutritional
Psychological disturbances
Oral contraceptives

51. TREATMENT
Treatment of underlying pathology

52. NURSING MANAGEMENT Medical evaluation Physical examination
Vaginal smear
Estrogen level
TFT
CBC
Urinalysis
Blood glucose level