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 Erectile Dysfunction

A Simple Guide to Erectile Dysfunction
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What is erectile dysfunction (ED)?
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Erectile dysfunction is defined by the WHO as "the consistent or recurrent inability of a man to attain and/or maintain a penile erection of the penis sufficient for sexual performance"

The WHO sponsered Consultation recommend" a minimum of three months of erectile difficulty qualified foe a diagnosis of Erectile Dysfunction."

What is the incidence of ED?
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The incidence of ED is unknown:
ED is currently underdiagnosed and undertreated.
More than 50% of all men 40-70 years old are likely to experience it.

What are the Causes of ED?
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Erectile dysfunction can be due to:
1.Medical causes
2.Lifestyle causes
3.Psychosocial causes
4.or a combination of these.

Medical causes:
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1.vascular disease-is the most common cause of ED.
atherosclerosis(hardening of the arteries)

high blood pressure

high cholesterol

heart disease

stroke

All these conditions affects the blood flowing and out of the penis.

2.diabetes-
can cause nerve damage and damage to the blood vessel to the penis resulting in two thirds patients developing ED

3.nerve disease-
such as spinal cord disease, nerve degeneration from diabetes and alcohol can reduce the sensitivity of the nerves to the penis

4.hormonal problems-
low levels of testosterone(male hormone) can cause ED

5.Surgery-
any surgery of rectum,colon or prostate cancer and radiation therapy in the genital area may damage nerves and blood vessels to the penis.

6.Trauma-
spinal cord injury and pelvic fractures damages the nerves and blood vessels to the penis.

7.Side effects of medications (e.g. certain high blood pressure medications, antidepressants,tranquillisers) may reduce the blood flow to the penis

8. Urinary infections and a disease called Peyronie's Disease(causing scar tissue in the penis) can cause ED.

Lifestyle causes:
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1.alcohol -
heavy drinking reduces the ability to have a strong erection. long term excessive drinking damage nerves and blood vessels to the penis.

2.Smoking-
The incidence of ED in smokers are hiher than in non smoker because the toxic chemicals in the cigarettes can damage nerves and blood vessels to the penis.

3.Substance abuse such as heroin etc can cause damage to the nerves and blood vessels to the penis.

4. Sedentary lifestyle-
Lack of exercise may lead to ED due to poor blood circulation

Psychosocial Causes:
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1. Performance anxiety -nervousness and worry about poor sexual performance
2. Stress due to any cause

3. Depresssion

4. Relationship Problems- marital problems and tensions may affect sexual relationship

5. fatigue.

How is the diagnosis of ED made?
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1.medical hisory especially about diabetes, hypertension, medications, alcohol adrug abuse,smoking.

2.medical examination including genitals and prostate

3. Blood tests of testosterone, cholesterol, sugar and PSA( in males above 50)

What is the treatment of ED?
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Successful treatment of erectile dysfunction includes:

1. Lifestyle modifications:
exercising

dieting

quitting smoking

reducing alcohol/drug abuse

counselling to manage anxiety/stress/marital problems

2.treatment of underlying medical conditions such as diabetes

3.change of medications

4.medication for treatment of ED.

There are now oral medications available to treat erectile dysfunction.
They belong to a group of drugs known as phosphodiesterase inhibitors
e.g. Viagra, Cialis, Levitra.

There is no instant erections when the medicine is taken but with physical and psychological stimulation erections do occur.
Most of the men who has taken the drugs have had improvements in their erectile functions regardless of the cause of the ED.

Certain patients with heart problems or a history of stroke are advised against taking medications belonging to this group.

6.Other treatments for erectile dysfunction

a.Penile Injection therapy- medication which increases the blood flow in the penis is injected into the penis to cause erection before sexual activity

b.Intrautrethral therapy -pellets of medications which increases blood flow is inserted into the urethra which is the tube from the bladder to the outside.

c.Vacuum therapy :
This procedure holds the blood in the penis using a ring at the base of the penis

d:surgery for blocked blood vessels

e.penile implants -these are inserted into the penis and inflated when there is a desire for sexual intercourse.
This surgery is offered when all other options failed.

How to cope with ED?
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Erectile dysfunction can cause a lot of stress on one’s marital relationship.

Communication and honesty with the spouse is important in ED.so that she understands the problem and that she is not the cause of the problem.

In recent years, more men are becoming aware of the treatment of erectile dysfunction and are seeking help.

A Simple Guide to Irritable Bowel Syndrome

A Simple Guide to Irritable Bowel Syndrome
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What is Irritable Bowel Syndrome?
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Irritable bowel syndrome (IBS) is a common functional disorder of the gastrointestinal system. It is characterised by abdominal pain/cramps, bloating or gas, diarrhoea and/or constipation. It is also known as spastic colon.

Who is affected by Irritable Bowel Syndrome?
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It occurs in one in five persons and usually between the ages of 20-50.
Women outnumber men by two or three to one.
It can become a chronic condition causing much discomfort and inconvenience to the patient. However, it does not progress to cancer.

What is the Cause of Irritable Bowel Syndrome?
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The exact cause of IBS is not known.

The muscles of the walls of the intestines in the normal person contract and relax in a co-ordinated rhythm known as peristalsis. This action helps to move food along the intestines during which time absorption takes place.
The nerves and muscles in the bowel appear to be extra sensitive in people with IBS. The contractions are stronger and last longer.
Food is pushed along the intestines at a faster rate, giving rise to abdominal pain, gas and diarrhoea. Sometimes, the opposite occurs. The contractions are weaker causing the passage of food to slow down and constipation results.

Other factors that have been shown to play a part are stress, diet and hormones. These are called triggers.

1.Stress
which may be psychological or physical.
Psychological stresses such as family misunderstanding; bereavement; anxiety; meeting deadlines etc.
Physical stresses such as illnesses, infections, exhaustion etc.

2.Diet
certain foods have been known to cause the onset of symptoms. They include fried or oily food; gas-forming foods e.g.broccoli, beans, cabbage; chocolates; coffee.

3.Hormonal changes
some women experience attacks during or around their menstrual periods.

What are the Symptoms of Irritable Bowel Syndrome?
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The main symptoms of IBS are:
1.Abdominal pain or cramps-usually over the left side or over the lower abdomen
2.Bloating and/or gas
3.Diarrhoea, constipation or alternating diarrhoea and constipation.
4.whitish mucus in the stool

The symptoms can range from mild to severe.
In many cases the symptoms are bearable and go off after a bowel movement.
Women with IBS often have more symptoms during their menstrual periods.

How do you make the Diagnosis of Irritable Bowel Syndrome?
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Because the cause is unknown and there is a lack of specific physical signs, diagnosis is arrived at through a process of elimination .

A colonoscopy is usually done to rule out colon cancer, diverticulosis, polyps.

What is the Treatment of Irritable Bowel Syndrome?
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There is no real cure for Irritable Bowel Syndrome.
Treatment is mainly symptomatic i.e. it is directed towards the relief of symptoms.

Mild symptoms usually go off on their own.
If symptoms are severe, the doctor may prescribe the following:

Anti-spasmodics for the abdominal pain and cramps,
Anti-flatulents to get rid of gas and relief the bloating,
Anti-diarrhoeals to stop diarrhoea,
Antidepressants, even in lower doses than are used for treating depression, can help people with IBS.
Laxatives to relief constipation.

Foods and drinks that may cause or worsen symptoms include:

fatty foods, like french fries
milk products, like cheese or ice cream
chocolate
alcohol
caffeinated drinks, like coffee
carbonated drinks, like soda

Some foods make IBS better.

Fiber may reduce the constipation associated with IBS because it makes stool soft and easier to pass.
However, some people with IBS who have more sensitive nerves may feel a bit more abdominal discomfort after adding more fiber to their diet. Fiber is found in foods such as breads, cereals, beans, fruits, and vegetables.
Too much fiber at once can cause gas, which can trigger symptoms in a person with IBS.

Eat small meals for example eating four or five small meals a day.
Large meals can cause cramping and diarrhea in people with IBS.

Stress doesn’t cause IBS, but it can make your symptoms worse.
Learning to reduce stress can help with IBS. With less stress, you may find you have less cramping and pain. You may also find it easier to manage your symptoms.
Meditation, exercise, hypnosis, and counseling may help.

What can be done to prevent Irritable Bowel Syndrome?
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Prevention is an important part in the total management of this condition.
They consist of stress management and life-style changes.
Stress management
Avoid unnecessary stress
Learn to relax
Exercise regularly

Dietary changes
Avoid oily, spicy food
Avoid gas-forming foods e.g. cabbage, broccoli, beans
Avoid coffee, chocolates, and alcohol
Avoid large meals
Take more fibre