Transcript Slide 1

MENSTURAL IRREGULARITIES
AMENORRHOEA
Amenorrhea
indicates the
absence of the menstruation.
OLIGOMENORRHOEA
Oligomenorrhoea
denotes the infrequent,
irregularly timed episodes of bleeding usually
occurring at the intervals of more than 35
days.
POLYMENNORHOEA
Denotes the infrequent, irregularly timed
episodes of bleeding usually occurring at
the intervals of 21 days.
Menorrhagia
Denotes the regularly timed episodes of
bleeding, that are excessive in amount (>
80 ml) and / or duration of flow ( > 5
days).
METRORRHAGIA
It refers to irregularly timed episodes
of bleeding super imposed on the
normal cyclical bleeding.
MENOMETRORRHAGIA
Denotes
the
excessive,
prolonged
bleeding that occurs at irregularly timed
and frequent intervals.
HYPOMENORRHOEA
Refers to the regularly timed but
scanty episodes of bleeding.
PROSTAGLANDINS SYNTHETASE
INHIBITORS
1.Fenamate Group : Mefannamic acid 250-500 mg
8’th hourly or flufenamic acid 100-200 mg 8’th
hourly.
2.Propionic acid derivations : 1 buprofen 400 mg 8
hourly or naproxen 250 mg 6’th hourly.
3.Indomethicin: 25 mg 8’th hourly.
Prostaglandins synthetase inhibitors (PSI)
1. By inhibition of cycle oxygenase enzyme reduces
the prostaglandins synthesis.
2. Got Direct analgesic effects.
3. Intrauterine pressure is been reduced.
DYDROGESTERONE
1.Does not inhibit the ovulation
2. But probably interferes with the ovarian steroid
ogenesis.
3.Given from the 5 days of cycle for 20 days.
4.Continued for the 3 to 6 cycles.
5.Above fails means then laparoscopy is indicated to
find out the pelvic pathology to account for pain.
SURGERY
1. Dilatation of the cervical canal.
2. Bilateral block of pelvis plexus.
3. Pre sacral neurectomy (laproscopic).
Treatment
1. Medroxy progestrone 10 mg orally twice daily.
2. 17- alpha hydroxy progestrone 1 g weekly by
injectioon for 6 months to 1 yr is prescribed.
3. Six monthly uterine aspiration.
4. Progesterone therapy avoids the risk of malignancy
reduces the need for the hysterectomy.
5. Hysterectomy will be required if the progesterone
fails.
Hormone therapy
1.Active progestational steroids such as norethynoderl,
nor ethisterone, medroxy progestrone or lynestretiol are
used and is safer than the estrogen.
2.Intial dose of 10-30 mg a day, to arrest the bleeding in
24-28 hrs, after which 5 mg a day for 20 days is given.
3.A 2’nd course of 5 mg daily is given from 20 days, after
which the withdrawl mensturation should occur, it can
be continued for a period of 6 months.
Duphaston
1. Does not suppress the ovulation
2. Has no adverse effect on lipoproteins.
3. Useful in the women who desires for the pregnancy.
4. Medroxy progestrone (MDPA) 10 mg is usually
given and is free of adverse effects.
Danazol
1.
Has
progestegonic
action
on
the
endometrium.
2. 200 mg for 4-6 months.
3.Menorrhagia may return after the stoppage of
the drug.