MENSTRUAL DISORDERS

The absence of the menstrual periods

TYPES ARE FOLLOWING: PRIMARY AND SECONDARY

PRIMARY: if menstrual periods bleeding has never occured in the absence of hormonal treatment .

SECONDARY: periods cease for 3-6 months , or may be more depends on the conditions .

  • Primary amenorrhea is a rare disorder that occurs in less than 1% of the female population .

  • Both the age at menarche and the prevalence of secondary amenorrhea vary significantly .


Primary Amenorrhea :

  • The absence of menses by the of 16 has been used traditionally to defined primary

  • Other factors are as growth , secondary sexual characteristic ,the presence of pelvic pain and the secular trend towards an earlier age of menarche .

  • Age 13 in the absence of secondary sexual characteristic or if height is less than the third percentile ,age of 12-13 in the presence of the breast development and cyclic pain or within 2 years of breast development if menarche , defined by the first menstrual periods has not occured .

Secondary Amenorrhea :

  • ANOVULATION and irregular cycles are the relatively common for up to 2 years after menarche and for 1-2 years before the final menstrual periods .

  • Intermenstrual interval normally between the 35 or may be more .

  • Pregnancy is the most common cause of amenorrhea, and should be excluded early in any evaluation of menstrual irregularity .

  • Three or more months of secondary amenorrhea should prompt an evaluation as should a history of intermenstrual intervals more than 35 or less than 21 days or bleeding that persists for more than 7 days .

Diagnosis:

  • Interrelationship between critical components of the reproductive tract :

  • The hypothalamus

  • The pituitary

  • Ovaries

  • Uterus and outflow tract

  • The disorders of menstrual function can be thoughts of in 2 main categories : disorders of the uterus and outflow tract and disorders of ovulation .

  • The feedback loop involving the ovarian steroids estradiol and progesterone and the gonadotropin- releasing hormone ,pituitary ---follicle stimulating hormone and luteinzing hormone .


Disorders of Ovulation

HYPOGONADOTROPIC HYPOGONADISM : The low level of the estrogen or low level of the LH and FSH are seen or fthe functional abnormalities that interference with the hypothalamic GnRH secretion or the normal pituitary responsive to GnRH.

  • These disorders may be present with primary or secondary amenorrhea .

  • Association with other features of the suggestive of hypothalamic or pituitary dysfunction

  • Eating disorders and chronic disease must be specially excluded .

  • Patient having headache ,signs of the other hypothalamic dysfunction or hyperlactinemia .

Treatment of hypo- and hypergonadotropic causes of Amenorrhea.

Its associated with chronically low levels of the estrogen or the ovarian insufficiency .

The development of secondary sexual characteristic requires gradual of estradiol replacement with eventual addition of progestin. And the patients with hypogonadotropic hypogonodism ,ovarian failure can consider with ooctye donation which has a high rate of success .

IF ANY GIRL NOT GETTING MENSTRUAL PERIODS ON TIME AT AGE OF 13 OR 14 PLEASE VISIT TO GYNECOLOGIST FOR THE FURTHER PHYSICAL OR MEDICAL CONFIRMATION .

For more detail look wiki: MENSTRUAL DISORDERS