A Simple Guide to Amenorrhea

A Simple Guide to Amenorrhea
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What is Amenorrhea?
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Amenorrhea is a symptom defined as absence of menstruation.

What are the types of Amenorrhea?
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1.Primary Amenorrhea
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is defined as the absence of onset of menstruation (menarche) in a girl who has reached the age of 18 years.

2.Secondary Amenorrhea
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is defined as the absence of menstruation for a peroid of at least 6 months in a girl who has previously experienced normal menstruation and is not pregnant.

What are the causes of Amenorrhea?
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1.Physiological(hormonal):
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pregnancy hormones - pregnancy is the still the most common cause of secondary amenorrhea.
Growth hormone deficiency
Abnormal production of testosterone

2.Genetic Causes:
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abnormal formation of genital tract causing cryptomenorrhea -obstruction to the flow of menstrual blood such as imperforate hymen
Chromosonal abnormalities:
Turner syndrome
Ovarian agenesis

3.Uterine Pathology:
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adhesions from previous operation
endometriosis
tuberculosis infection
radiation

4.Ovarian:
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Agenesis(no ovaries)
Abnormal ovaries(again congenital)
Polycystic Ovaries
Granulosa-thca tumours of ovaries
radiation of ovaries

5.Pituitary:
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Pituitary tumours
Hypopituitarism
Hypothalamic abnormalities

6.Psychological:
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Depression
Anorexia nervosa,
starvation

7.Systemic Diseases:
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Hypothyoidism
Cushing syndrome

8.Medical causes:
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Chemotherapy
oral cotraceptive
corticosteroids
hypotensive drugs

How to establish a diagnosis of Amenorrhea
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History:
1.Primary Amenorrhea
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Genetic disorders:
failure to develop female sex characteristics
anatomic abnormalities due to chromosonal defects such as Turner syndrome
hirsutism-excessive male hormones

2.Secondary Amenorrhea
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Metabolic disorders:
symptoms of hypothyroidism
symptoms of polycystic ovarian syndrome
Obesity

Pyschologic disorders:
depression
anorexia nervosa

Pelvic examination:
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vulval and vaginal examination for cryptomenorrhea,
bimanual palpation for ovarian masses like polystic ovaries
abnormal uterus or ovaries

Investigations:
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Pregnancy test

blood for follicle stimulating hormones, luteinising hormones, prolactin

Progesterone withdrawal bleeding test
Luteinizing hormone releasing tests

Serum testesterone and androsterones

Transvaginal ultrasound to check on the uterus and ovaries
X-ray Skull, Brain CAT or MRI scans to exclude pituitary tumours

What is the Treatment of Amenorrhea?
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Medications:
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Specific treatment for amenorrhea depends on:

1.age,
2.overall health,
3.cause of the condition (primary or secondary)
4.the preference of the patient

Treatment for amenorrhea may include:
1.Pregnancy - no treatment if the patient wish to continue with pregnancy. Usually a referral to an obstetrician may be necessary

2.hormonal replacement(oestrogen and progesterone supplements ) in genetic cases and androgen producing tumours.

3.Cyproterone acetate is an anti-androgen which counters the effects of male hormones. It is usually given with a small dose of oestrogen.

4.Hyperprolactinaemia -treatment with bromocriptine which acts by stimulating the prolactin Inhibiting factor in the hypothalamus.

5.Polycystic ovary Disease -clomiphene and gonadatrophins may be given to improve menstruation and help fertility

6.Adrenal dysfunction due to deficiency of the enzyme 21-hydroxylase (androgegenital syndrome) results in excess ACTH and excessive production of androgens-treatment is with corticosteroids such as prednisolone

Other Treatments:
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1.Treatment of underlying systemic disease like thyroxine for hypothyroidism,

2.dietary changes to include increased caloric and fat intake especially in cases of low fat due to self induced dieting, anorexia nervosa

3.Pyschiatric treatment for women with depression, anorexia nervosa, or genetic dysfunction.

4.Healthy lifestyle for those who are obese

A Simple Guide to Dysmenorrhea

A Simple Guide to Dysmenorrhea
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What is Dysmenorrhea?
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Dysmenorrhea is a symptom, not an illness.
It means painful menstruation.

What are the types of Dysmenorrhea?
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Dysmenorrhea may be classified into:

1.Primary or Spasmodic Dysmenorrhea

2.Secondary Dysmenorrhea due to causes like

Endometriosis or

Pelvic Inflammatory Disease

What are the Causes of Dysmenorrhea?
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The cause of primary Dysmenorrhea is still not known.

There are a few theories:
1.during menstruation, contraction of the uterine muscles occurs in spasms trying to push the menstrual flow through a narrow cervical opening

2.Prostagladins output occurs at time of menstruation producing muscles spasms

3.Menstrual clots occludes the uterine opening and requires more contractions of the uterine muscles to push it through

4.Stress may constrict the opening of the uterus and hence greater contraction of the uterine muscles is required to force out the menstrual flow.

What are the Symptoms of Dysmenorrhea?
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Primary Dysmenorrhea:
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1.typically occurs on the first day of menses and becomes less after the 2nd day.

2.lower abdominal cramp radiating down to thighs and back

Secondary Dysmenorrhea:
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1. Starts about 1 week before menses and reach maximum on first day before reducing intensity for rest of menses peroid

2.dull aching pain in lower abdomen with radiation to the back

Symptoms may be associated with
1.vomiting,

2.urinary frequency,

3.headache,

4.painful breasts,

5.abdominal distension,

6.depression and

7.irritabilty.

What is the Treatment for Dysmenorrhea?
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Primary Dysmenorrhea:
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1.simple analgesics like paracetamol

2.Non-steroidal anti-infammatory drugs like Ponstan, Synflex

3.Antispasmodics

4.Tranquilliser or antidepressant

5.Muscle relaxant

6.female hormones

Secondary Dysmenorrhea:
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1.Identify and treat the underlying cause(eg. antibiotics for PID)

2.Endometriosis may require a course of female hormones or surgery for control

3.Dilatation of the endocervical canal may help

What is the prognosis of Dysmenorrhea?
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Primary Dysmenorrhea may end with first pregnancy due to widening of uterine opening.

Secondary Dysmenorrhea prognosis depends on the treatment of causes.

A Simple Guide to Syphilis

A Simple Guide to Syphilis
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What is Syphilis?
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Syphilis is a infectious sexually transmitted disease caused by the bacterium Treponema pallidum.
It can be acute, subacute or chronic depending on the stage.

How is Syphilis spread?
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Syphilis is passed from a infected person through sexual contact with a infected sore which occur mainly on the external genitals, anus, or rectum.
The lips and the mouth may also have sores.

The bacteria can penetrate through normal mucous membrane and minor abrasions of the epithelium.
Transmission of the organism usually occurs during sexual contact.
Pregnant women with the disease can pass it to the babies they are carrying.

What are the symptoms of Syphilis?
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The signs and symptoms of syphilis may occur in four stages:

Primary
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These signs may occur from 10 to 90 days after exposure:

1.A small, firm, painless sore (chancre) appears on the body where the syphilis enter the body, usually the genitals, rectum, or lips.
A single chancre is typical, but there may be multiple sores.

2.Enlarged lymph nodes in your groin.

The chancre lasts 3 to 6 weeks, and it heals without treatment.
However, if untreated, the infection progresses to the secondary stage.

Secondary
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The signs and symptoms of secondary syphilis may begin two to 10 weeks after the chancre appears, and may include:

1.Rash marked by red or reddish-brown sores over any area of the body especially the palms and soles. The rash usually does not cause itching.

2.Fever

3.Fatigue and a vague feeling of discomfort

4.swollen lymph glands,

5.sore throat,

6.weight loss,

7.Soreness and aching

The signs and symptoms of secondary syphilis will resolve with or without treatment.
Without treatment, the infection will progress to the latent and late stages of disease.

Latent
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A period called latent syphilis in which no symptoms are present may follow the secondary stage.
Signs and symptoms may not appear until the disease may progress to the tertiary stage.

Tertiary
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Without treatment, syphilis bacteria may spread, leading to serious internal organ damage including the brain, nerves, eyes, heart, blood vessels, liver, bones,joints and finally death years after the original infection.

1.Neurological problems. These may include stroke; infection and inflammation of the membranes and fluid surrounding the brain and spinal cord (meningitis); poor muscle coordination; numbness; paralysis; deafness or visual problems; personality changes; and dementia.

2.Cardiovascular problems. These may include bulging (aneurysm) and inflammation of the aorta and of other blood vessels.
Syphilis may also cause valvular heart disease, such as aortic valve insufficiency.

Many people infected with syphilis do not have any symptoms for years, yet remain at risk for late complications if they are not treated.

What is the danger of Syphilis during pregnancy?
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The syphilis bacterium can infect the baby of a woman during her pregnancy. Depending on how long a pregnant woman has been infected, she may have a high risk of having a stillbirth or of giving birth to a baby who dies shortly after birth.
An infected baby may be born without signs or symptoms of disease.
Untreated babies may become developmentally delayed, have seizures, or die.

How do you diagnose Syphilis?
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1. dark-field microscope: examining material from a chancre using this microscope.
If syphilis bacteria are present in the sore, they will show up when observed through the microscope.

2.A blood test for syphilis antibodies is accurate, safe, and inexpensive. There will be some antibodies in the blood for months even when the disease has been successfully treated.

Because untreated syphilis in a pregnant woman can infect and possibly kill her developing baby, every pregnant woman should have a blood test for syphilis.

What is the treatment of Syphilis?
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Syphilis is easy to cure in its early stages.

Treatment with intramuscular injection of penicillin can kill the organism that causes syphilis.
If you're allergic to penicillin, other antibiotics such as erythromycin will kill the syphilis bacterium.
Treatment however will not repair damage already done.
Left untreated, the disease can lead to serious complications or death.

Persons who receive syphilis treatment must abstain from sexual contact with new partners until the syphilis sores are completely healed.
Persons with syphilis must notify their sex partners so that they also can be tested and receive treatment if necessary.

Even if you were treated for syphilis during your pregnancy, your newborn child should receive antibiotic treatment.

To make sure you're responding to the usual dosage of penicillin, the doctor likely will want you to have periodic blood tests.
Blood test may remain positive up to 18 months even after successful treatment of syphilis.

Having syphilis once does not protect a person from getting it again. Following successful treatment, people can still be susceptible to re-infection.

How do you prevent Syphilis?
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The surest way to avoid transmission of sexually transmitted diseases, including syphilis, is to 1.abstain from sexual contact

2.in a long-term mutually monogamous relationship with a partner who has been tested and is known to be uninfected.

3.Avoiding alcohol and drug use may also help prevent transmission of syphilis because these activities may lead to risky sexual behavior.

4.Correct and consistent use of latex condoms can reduce the risk of syphilis only when the infected area or site of potential exposure is protected.

5.Complications from syphilis such as neurosyphilis are rare because of better diagnosis and treatment