Transcript الشريحة 1

Menstrual disturbances
Cramps:
• -Many girls experience abdominal cramps during
the first few days of their periods. They're
caused by prostaglandin, a chemical in the body
that makes the smooth muscle in the uterus
contract. These involuntary contractions can be
either dull or sharp and intense.
• -The good news is that cramps usually only last
a few days. But call your daughter's doctor if she
has severe cramps that keep her home from
school or from doing stuff with her friends.
• -It can take 2 to 3 years from a girl's first
period for her body to develop a regular
cycle. During that time, the body is
essentially adjusting to the influx of
hormones unleashed by puberty. And
what's "regular" varies from person to
person. The typical cycle of an adult
female is 28 days, although some are as
short as 21 days and others are as long as
45.
• -Changing hormone levels might make a girl's
period last a short time during one month (just a
few days) and a long time the next (up to a
week). She may skip months, get two periods
almost right after each other, or alternate
between heavy and light bleeding from one
month to another.
• -But any girl who's sexually active and skips a
period should see a doctor to make sure she's
not pregnant.
• And if your daughter's period still hasn't settled
into a relatively predictable pattern after 3 years,
or if she has four or five regular periods and then
skips her period or becomes irregular, make an
appointment with her doctor to check for
possible problems. Also let your daughter's
doctor know if her cycle is less than 21 days or
more than 45 days, or if she doesn't get a period
for 3 months at any time after first beginning to
menstruate.
Delayed Menarche
• -Girls go through puberty at different rates.
Some reach menarche (the medical term
for the first period or the beginning of
menstruation) as early as 9 or 10 years old
and others don't have their first periods
until they're well into their teen years. So, if
your daughter is a "late bloomer," it doesn't
necessarily mean there's something wrong
with her.
• -When girls get their periods actually
depends a lot on genetics. Girls often start
menstruating at approximately the same
age their mothers or grandmothers did.
Also, certain ethnic groups, on average,
go through puberty earlier than others. For
instance, African-American girls, on
average, start puberty and get their
periods before Caucasian girls do.
• -Although most period problems are
harmless, a few conditions can be more
serious and require medical attention:
Amenorrhea (the Absence of
Periods)
• Girls who haven't started their periods by the
time they're 16 years old or 3 years after they've
shown the first signs of puberty have primary
amenorrhea, which is usually caused by a
genetic abnormality, a hormone imbalance, or a
structural problem. Hormones are also often
responsible for secondary amenorrhea, which is
when a girl who had normal periods suddenly
stops menstruating for more than 6 months or
three of her usual cycles.
• -Since pregnancy is the most common
cause of secondary amenorrhea, it should
always be ruled out when a girl skips
periods. In addition to hormone
imbalances, other things that can cause
both primary and secondary amenorrhea
include:
• stress
• significant weight loss or gain
• anorexia (amenorrhea can be a sign that a girl is
losing too much weight and may have anorexia)
• stopping birth control pills
• thyroid conditions
• ovarian cysts
• other conditions that can affect hormone levels
• Something that can also cause primary and
secondary amenorrhea is excessive
exercising (often distance running ) combined
with a poor diet, which usually results in
inappropriate weight loss or failure to gain
weight during growth. But this doesn't include
the usual gym class or school sports team, even
those that practice often. To exercise so much
that she delays her period, a girl would have to
train vigorously for several hours a day, most
days of the week, and not get enough calories,
vitamins, and minerals.
Menorrhagia:
• (Extremely Heavy, Prolonged Periods)
• -It's normal for a girl's period to be heavier on
some days than others. But signs of
menorrhagia (excessively heavy or long periods)
can include soaking through at least one
sanitary(pad) an hour for several hours in a row
or periods that last longer than 7 days. Girls with
menorrhagia sometimes stay home from school
or social functions because they're worried they
won't be able to control the bleeding in public.
• -The most frequent cause of menorrhagia is an
imbalance between the levels of estrogen and
progesterone in the body, which allows the
endometrium (the lining of the uterus) to keep
building up. When the endometrium is finally
shed during menstruation, the resulting bleeding
is particularly heavy.
• -Because many adolescents have slight
hormone imbalances during puberty,
menorrhagia isn't uncommon in teens. But in
some cases, heavy menstrual bleeding can be
caused by problems such as:
• fibroids (benign growths) or polyps in the
uterus
• thyroid conditions
• clotting disorders
• inflammation or infection in the vagina or
cervix
• -If your daughter has heavy periods, or
periods that last longer than 7 days, talk to
her doctor
Dysmenorrhea (Painful Periods)
• -There are two types of dysmenorrhea,
which is severely painful menstruation that
can interfere with a girl's ability to attend
school, study, or sleep:
Primary dysmenorrheal:
•
- is very common in teens and is not
caused by a disease or other condition.
Instead, the culprit is prostaglandin, the
same chemical behind cramps. Large
amounts of prostaglandin can lead to
nausea, vomiting, headaches,
backaches, diarrhea, and severe
cramps. Fortunately, these symptoms
usually last for only a day or two.
Secondary dysmenorrhea :
•
-is pain caused by some physical
condition like polyps or fibroids in the
uterus, endometriosis, pelvic, or
adenomyosis (uterine tissue growing into
the muscular wall of the uterus).
Treating Menstrual Problems;
• -To determine whether a problem requires
treatment, The doctor may do a pelvic
exam, a Pap smear, blood tests (to check
hormone levels), or urine tests. If there
might be a structural problem or some sort
of growth, an ultrasound or CT scan may
be performed. Together, these tests can
help the doctor determine how a condition
should be handled.
• -Growths such as polyps or fibroids can often be
removed and endometriosis can often be treated
with medications or surgery. If a hormone
imbalance is to blame, the doctor will likely
suggest hormone therapy with birth control pills
or other hormone-containing medications.
• for menstrual pain with no underlying medical
cause, anti-inflammatory medicines are the most
effective treatment. Conditions like clotting
disorders or thyroid problems may require
treatment with medications as well.
When to Call the Doctor?
• If the period hasn't started at the expected
time for example if she's 15 or her period
hasn't become regular after 3 years of
menstruating. The most likely cause is a
hormone imbalance (which may need
treatment), but this also might point to
another medical problem. The midwife
need to take good history for the following
conditions
• If the woman stops getting the period or it
becomes irregular after it has been regular. If the
cycle is less than 21 days or more than 45 days,
or if a period for 3 months stopped at any time
after first beginning to menstruate.
• If the woman has heavy or long periods,
significant blood loss can cause iron-deficiency
anemia. Also, heavy bleeding could be a sign of
a growth in the uterus, a thyroid condition, an
infection, or a blood clotting problem.
• is very painful periods. Having cramps for
a couple of days is normal, but if the
woman isn't able to participate in her
normal activities, let the doctor know. She
might have a medical problem, such as
endometriosis, causing the pain.
Things help during the PMS
• -When the woman experiencing a
particularly bad PMS or cramps, you can
help make her to feel more comfortable by
suggest that she:
• eat a balanced diet with lots of fresh fruit and vegetables
• reduce her intake of salt (which can cause water
retention) and caffeine (which can make her jumpy and
anxious)
• include foods with calcium, which may reduce the
severity of her PMS symptoms
• try over-the-counter pain relievers like acetaminophen or
ibuprofen for cramps, headaches, or back pain
• take a brisk walk or bike ride to relieve stress and aches
• soak in a warm bath or put a hot water bottle on her
abdomen, which may help her relax