- 1. OBESTRICTIC PROBLEM Patch16-Group4 ezpaseva
2. AMENORRHEA
- DEFINTION Absence of menstruation
- There are 3types1-1ry and 2ry
- 3-physiology and pathology
3. oligomenorrhea
- Is infrequent or light menstruation
- Menstrual duration : greater than 35day
- Common at extremes age of reproductive life (ovulation often
does not occur)
oligomenorrhea 4.
- 1. emotional or physiological stress
- 3. increase level oestrogen
5. DYSMENORRHEA
- 45%-95% ofwomen in reproductive age
6.
- Duration of menstrual flow of>5days
- Younger than normal age of menarche
- Pelvic inflammatory disease
- ( rarely ) cervical stenosis
7.
- C/F: crampy supra pubic pain
- TREATMENT: Medical treatment NSAIDs
8. MENORRHAGIA
- Blood loss of greater than 80ml/period
- 1-idiopathic: No organic pathology ( DUB )
9.
- 1. DUB; unclear but disordered endometrial prostaglandin
production has been implicated in the aetiology
2 . secondary;fibroid 10.
- OTHER PHYSIOLOGYVonWillebrands disease
11.
- ~ suggest an organic cause
- ~ Initial investigation {full blood count}
12.
13. ABNORMAL PUBERTY Puberty and pubertal changes may occur
earlies than normal menstruation + secondary sexual characters
become early in life8-9years or even3-4years of age Puberty and
pubertal changes has not developed on16-17 years old DEFINITION
Precocious puberty Delayed puberty Subjective 14. 1. Idiopathic 2.
Intracranial lesion 3. Adrenal gland ,ovarian and Thyroid problem
4. Drugs Either constitutional or pathological The pathological
causes: 1- chromosomal abnormalities 2- Hypothalamic ,pitutary,
Thyroid,Adrenal gland, Ovarian and Uterine causes CAUSES PRE
puberty D puberty Subjectives 15. The Idiopathic treated by:- 1-
proestrogens 2- Danazol 3- Cyproteroneac- etate 4- LHRHanalogues
----- TREATMENT PRE puberty D puberty Subjectives 16. Sex Hormones
& Function
- Progesterone & Estrogen .
17. GnRH 18. FSH & LH 19. Progesterone & Estrogen
- Estrogens: 3types estradiol (it is the main estrogen produced
by the ovary) ,estriol and esterone.
- It is a dominant hormone at follicular phase of menstrual
cycle.
- Two cell Theory for estradiol production:
- -1 LH (low level) stimulate Theca cells
20.
- 2- FSH (high level) stimulate granulosa
cellsandrogensestrogens
- Action:1-secondary sex characteristics of female.
- 2-proliferation of endometrim during proliferative phase.
- 3-increase uterine blood flow .
- 4-development of breast duct.
- Progesterone:mainly synthesized in the corpus lutumand so it is
the dominant hormone in the luteal phase of menstrual cycle.
- Action : 1-resposible for glandular secretory activity during
secretory phase. .
21. Progesterone & Estrogen
- Estrogens: 3types estradiol (it is the main estrogen produced
by the ovary) ,estriol and esterone.
- It is a dominant hormone at follicular phase of menstrual
cycle.
- Two cell Theory for estradiol production:
- -1LH (low level) stimulate Theca cells
22.
- 2-deciduatization of endometrium in the late lutealphase.
- 3-devlopment of breast alveoli.
23. Menstrual cycle
- -Menstruation: means a periodic discharge of sanguineous fluid
and a sloughing of uterine lining.
- -Parameters: frequency - length and amount of the menstrual
flow.
- A- average of menstrual cycle is frequently quoted to be 28 +
2days.
- B- average of menstrual 5days.
- C- average of frequency of blood flow is 60 ml.
24.
- -Mechanism of uterine bleeding.
- -Homeostasis in menstrual endometrium.
25. Androgen Excess
- -Sources of androgen: 1-endocrine gland.
- -androgen excess mains: Abnormalsecretion of adrenal and
ovarian androgen.
- -causes: 1-ovarian tumor.
26.
- -Symptom:1- general appearance :obesity; muscular male
body.
- 3- menstrual irregulatory.
- -Lab finding: testosterone ,17hydroxy progesterone, DHEA,
dexamethazone, LH,FSH, lipid.
27. 2-Anti androgen. 3-corticosteroids. 4-promocriptin.
5-Insulin sensitive drugs. 6-surigcal . 7-diet. Treatment: 1- oral
contraceptive. 28. Pre menstrual Syndromes PMS or PMTS
- Etiology: hormonal, social, genetic, vitamin deficiency,
others.
- C/f :nervous,GIT,mastalgia,Fluid retention.
29. Delay or absent Puberty
- When the menarche has failed to occur at age of 17years
old.
- Failure of menstruation due to pan hypopitutrism is associated
with dwarf +endocrine abnormality patient with XO chromosomal
pattern and gonadal dysgensis =dwarf.
- In some patient puberty delayed even the gonads are present
+other endocrine function are normal =primary amenorrhea.
30. Precocious & Delayed puberty
- It is early but normal pattern of puberty due to an early of
gonadotrpin secretion form pituitary it is most frequent endocrine
symptom of hypothalmic disease.
- Abnormal exposure to estrogen lead early development of
secondary sexual characteristics without gametogensis .
- Classification of causes precocious puberty:
- A- true precocious puberty:
31.
- Cerebral e.g.: disorder involve posterior hypothalamus
- developmental abnormalities.
- B- precocious pseudo puberty:
- -Adernal:1- congenital virilizing adrenal hyperplasia .
- 2- esterogen secreting tuomers.
- -gonadal: granulosa cell tumors of the ovary.
- pineal tumor may associated with precocious puberty but
- associated when there is secondary damage to
32. Hyper prolactinemia
- -prolactin contain 199 a.a secreted by endometrium and
placenta.
- 1causes milk secretion from the breast after estrogen and
progesterone priming.
- Has role in preventing ovulation in lactating mother.
- 3 Inhibit the effect gonadotropins by an action at level of
ovary.
- -normal plasma prolactin conc is approximately 5ng/ml in men
and 8ng/ml in women.
33.
- Hyper prolactinemia: in up to 70% of patient with chromophobe
adenomas of anterior pituitary have elevated plasma prolactin
levels, in some . instances, the elevation may be due to damage of
pituitary stalk but in some cases the tumor cells are actually
secreting the hormone .
- Hyper prolactinemia may cause glactorrhea, conversely most
women with glactorrhea have normal prolactin levels.
- Observation that 15-20% of women with secondary amenorrhea have
elevated prolactin (by blocking action of gonadotropinsin ovaries)
when the level decrease the normal menstrual cycle and fertility
return.
34. -Hypogondism produce by prolactinomasis
associatedwithosteoporosis due to estrogen deficiency. Treatment :
Bromocriptine or other dopamine agonist - surgical. -Radio therapy.
35.
36.