Amenorrhea

• Amenorrhea is the absence of menstruation in a woman.

• It normally occurs in:– The period before puberty– Pregnancy and breastfeeding– After menopause

Amenorrhoea itself is divided into two, namely:

1.Primary Amenorrhoea– is the absence of menstruation in women aged 18 years

and over, never getting menstruation.

– occurs in 0.1 - 2.5% of women of reproductive age.

– usually caused by hormonal disorders or growth problems can also be caused by low GnRH, stress, anorexia, weight loss is extreme, thyroid disorders, strenuous exercise, birth control pills and ovarian cysts.

2.Secondary Amenorrhoea– is the absence of menstruation after menarche or

ever having periods but stopped successively for 3 months (in the case of oligomenorrhea), or 6 cycles after getting the menstrual cycle regular for 6 months or more.

– not on women who are not pregnant, breastfeeding or menopause

– the incidence rate ranged between 1-5%

Causes of Amenorrhea

A.Reproductive Tract Disorders1.Agglutination labia (labia lips clotting)2.Congenital abnormalities of the vagina

• imperforate hymen (hymen does not have holes)• septa vagina (vaginal has a barrier in between)

3.Syndrome Mayer-Rokitansky-Kuster-Hauser. • Women who have normal ovaries but does not have

a uterus and a vagina or have both but little or shrink.

4.Testicular feminization syndrome.• Occur in patients with chromosome 46, XY

karyotype, and have X-linked dominant• Causing disruption of the hormone testosterone• These patients have testes with normal function

without the female reproductive organs (ovaries, uterus).

• Physically vary from woman without armpit and pubic hair growth until the appearance like a man but infertile.

B.Ovarian Disorders1.Gonadal dysgenesis

• Gonadal dysgenesis is not the presence of the egg by the ovaries are replaced by scar tissue.

2.Ovari premature failure• This is a failure of ovarian function before age 40 years.

The cause is expected to damage the egg due to infection or autoimmune process

3.Ovarian tumors• Ovarian tumors may interfere with normal egg cells

C.CNS disorders1.Pituitary disorders.

• Pituitary tumor or inflammation can lead to amenorrhea.

• Hyperprolactinemia (prolactin hormone excess) due to tumor, drug, or other abnormalities may lead to disruption of the hormone gonadotropin.

2.Hypothalamic disorders.• Polycystic ovary syndrome, thyroid dysfunction,

and Cushing's syndrome is a disorder that causes disruption of the hypothalamus.

Treatment of Amenorrhea Handling amenorrhea depends on the cause. Treatment can include birth control pills, use of certain medications,

or surgery. Surgery is only done if the cause is a tumor or abnormality in the

structure of the reproductive organs.

Prevention Amenorrhea• Amenorrhea caused by lifestyles can be treated with lifestyle

changes.• Do not forget to rest after hard work. Do not exercise excessive or

appetite. Do not get affected by bulimia or anorexia.• Control stress in a healthy way. Take note also experienced

menstrual cycle.• Note if there are abnormalities in menstruation.

Dysmenorrhea

• Dysmenorrhea is a term used to describe pain when a woman enters a particular menstrual cycle.

Type of DysmenorrheaBased on the presence or absence of

gynecological disorders.a.Primary dysmenorrhea

dysmenorrhea happens without gynaecologic problems.

easily occurs on women who are emotionally unstable.arise since menarcheoccurs between the ages of 15-25 years and later will

be lost at the age of late 20s or early 30s.The pain usually occurs several hours before and after

the menstrual periodsometimes accompanied by nausea, vomiting,

diarrhea, headache, lower back pain, fatigue and so on.

b.Secondary dysmenorrheais pain associated with gynecological disorders,

both anatomical and pathological processes and pelvis.

usually happens some time after menarche.Can also be started after the age of 25 years.The pain started 1-2 weeks before menstruation

and continued until a few days after menstruation.encountered gynecological disorders such as

endometritis, adenomyosis, ovarian cysts, uterine fibroids, pelvic inflammation and others.

• Based on the intensity of pain.a.Mild dysmenorrhea

dysmenorrhea with pain that lasts a while so we need a short break to relieve pain, without the use of drugs.

b.Moderate dysmenorrheadysmenorrhea requiring the drug to relieve pain without

the need to leave the daily activities.

c. Severe dysmenorrheawhich is dysmenorrhea who need a break for so long with

the result leaving day-to-day activities during the day even more.

Causes of Dysmenorrhea

Primary dysmenorrhea

• Causes of menstrual pain is not be found exactly despite much research was done to find the cause. Etiology of primary dysmenorrhea are:– Psychological factors

• It usually occurs in adolescents with emotional instability– Endocrine factors

• In general, it is related with intestinal contractions were not good.

• It is very closely related to hormonal influences.• Increased production of prostaglandins will cause

uncoordinated contractions of the uterus, causing pain.

Secondary dysmenorrhea

• In secondary dysmenorrhea, etiology that may occur are:– Constitutional factors

• anemia, the use of IUD, bump that causes bleeding, tumors or fibroids.

– Congenital uterine anomalies• the inverted uterus, inflammation of the mucous membrane of the

uterus.– Endometriosis

Treatment of Dysmenorrhea

• Primary Dysmenorrhea– Adequate rest– Exercise regularly – Warm compresses diarea around the belly– Drink lots of water, avoid excessive salt intake and

caffeine to prevent swelling and fluid retention.– Eat foods rich in iron, calcium, vitamin B complex such as

milk, green vegetables.– Elevate hip position exceeds the shoulder when sleeping

on your back to help relieve dysmenorrhea.

• Secondary dysmenorrhoea – depends on the underlying cause