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Our topics today

Our topics today

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Our topics today

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  1. Our topics today Uterine prolapse Amenorrhea Dysfunctional uterine bleeding PCOS Infertility Peri-menopause period syndrome Zhao aimin MD.Ph.D SSMU

  2. Uterine prolapse

  3. Definition The uterus gradually descends in the axis of the vagina taking the vaginal wall with it. It may present clinically at any level, but is usually classified as one of three degrees.

  4. Degrees of uterine prolapse • First degree:cervix still inside vagina

  5. Degrees of uterine prolapse • Second degree:the cervix appears outside the vulva. The cervical lips may become congested and ulcerated

  6. Degrees of uterine prolapse • Third degree:complete prolapse.In the picture the uterus is retroflexed,and the outline of bladder can be seen.This is sometimes called complete procidentia.

  7. Causes • The stretching of muscle and fibrous tissue • Increased intra-abdominal pressure

  8. In recent years,the incidence of prolapse is greatly reduced .The more liberal use of caesarean section and the elimination of labours are probably the two most important factors.

  9. Symptoms • Something coming down • Backache • Increased frequency of micturition • A ‘bearing down’ sensation • Stress incontinence • Coital problems • Difficulty in voiding urine

  10. Treatment Pessary treatment Indications Patient prefers a pessary. Pelvic surgery risks Prolapse amenable to pessary The patient is not fit for surgery Patient wishes to delay operation

  11. Surgery • Anterior colporrhaphy (and repair of cystocele) • Posterior colpoperineorrhaphy (including repair of rectocele) • Manchester repair • Vaginal hysterectomy

  12. Dysfunctional Uterine Bleeding (DUB)

  13. Definition an abnormal uterine bleeding without an obvious organic abnormality (neoplasma, pregnancy, inflammation, trauma, blood dyscrasia,hormone adminstration,at el) unnormal releasing of sex hormones

  14. Anovulatory functional bleeding ovulatory functional bleeding DUB occur in before the menopause(50%) after menarche(20%) in reproductive times(30%).

  15. Anovulatory functional bleeding

  16. Etiology of DUB: 1. disorders of hypothalamus---pituitary ---ovary axis • immature of feedback regulation in young women • ovarian function failure in climacteric women 2.other Factors: • the effects of sex hormones • nervous • circumstance • PCOS,TSH↑,PRL↑ • excessive physical exercise

  17. Pathology Change in the endometrium • simple hyperplasia(Cystic hyperplasia , benign) • complex hyperplasia(Adenomatous hyperplasia ,precursor of carcinoma) • atypital hyperplasia(10%-25%→ carcinoma) • proliferative phase of endometrium (no secretive change ) • atrophic endometrium

  18. Mechanisms Anovulation ---- • have developing folliculi • no mature follicle • no corpus luteum • only have estrogen, but no progestin • breakthrough bleeding, spoting

  19. Clinical presentation • oligomenorrhea. • polymenorrhea • hypermenorrhea • hypomenorrhea • irregular intervals and duration

  20. Diagnosis 1.History • history of age of menarche, • initial regularity of cycle, • cycle length, amount, duration of flow, • parity, contraceptive pill • abortion, ectopic pregnancy, • endometriosis, • pelvic inflammatory disease

  21. hemorrhagic diseases, • endocrinopathies, • traumas, • nutritional status To decide :the dysfunctional bleeding or anatomic abnormality

  22. 2.physical examination pelvic vaginal examination (PV) 3.laboratory diagnosis • bleed count, coagulation studies, • endocrine studies • curettage

  23. Treatment medicine treatment 1.to arrest theacute bleeding • progesterone--- secretive change, • high doses of estrogen---rapid hemostasis 2.maintenance therapy ( restoration of normal menstruation, artificial cyclical therapy ) • cyclic estrogen-progestin therapy • cyclic low dose oral contraceptive for 3 month ( for adolescent) • continue cyclic low dose oral contraceptive,( no fertility demands) 3. induce ovulation Clomiphene, HMG, FSH,GnRH)

  24. Curettage for adults rarely use for teenagers unless bleeding is very severe) aims 1.arrest an acute severe bleeding quickly and effectively 2.to prevent chronic recurrence of DUB 3.diagnosis

  25. Hysterectomy: • for older patient, • never been done in adolescent

  26. Ovulatory functional bleeding A significant percentage of patient is women of childbearing age. 1.Luteal phase defect Pathology : • corpus luteum is short-lived • luteal phase is short • inadequate secretion ofprogesterone

  27. Clinical presentation • polymenorrhea- • premenstrual staining diagnosis • basal body temperature (BBT)—-bi-directional • endometrium biopsy specimen taken just before menses reveal to bad for secretive phase

  28. treatment • HCG (5000-10000U 14th day) • progestin(15th day X 10 days) • ovulation induction (Clomiphone, HMG, FSH, mature follicle --- good corpus luteum)

  29. 2.Irregular shedding of endometrium pathology • persistent corpus luteum • estrogen and progesterone maintain to effect the endometrium

  30. Clinical presentation: • delayed onset of menses with hypermenorrhea • Regular cycles with hypermenorrhea Diagnosis: endometrium biopsy specimen taken on 5th days after the onset of bleeding, reveal a mixture of persistent secretive glands with the proliferative glands

  31. Treatment • progestin ( 5 days before next menstruation, feedback) • ovulation induction

  32. Amenorrhea It is symptom, not a disease have many causes.

  33. Definition Primaryamenorrhea • lack of menarche by age of 16 years • No secondary sexual signs by age of 14 years Secondaryamenorrhea the cessation of menstruation for at least 6 months (or 3 cycles) in women who has her menarche.

  34. Etiology Physiologic causes: • childhood • pregnancy • lactation • menopause Pathologic causes: 1.uterus or lower reproductive tract • endometrial destruction (Asherman’s syndrome) • cervical stenosis • congenital dysgenesis (imperforate hymen, no uterus)

  35. 2.Ovary • ovarian tumor, • premature ovarian failure • resistant ovary syndrome • polycystic ovarian syndrome • gonadal dysgenesis ( 75% chromosome abnormality, Turner’s syndrome,45,XO)

  36. 3.central nervous system hypothalamus – pituitary • tumors or other organic lesions • amenorrhea- galactorrhea syndromes(PRL↑) • empty sella syndrome • Sheehan Syndrome • hypogonadotropic hypogonadism • pituitary insufficiency

  37. 4. psychogenic • psychosis • emotional shock • pseudocyesis(假孕) 5.systemic • chronic disease • nutritional disorders • hepatic and renal dysfunction

  38. 6. other endocrine cause • adrenal hyperplasia, tumors ,or insufficiency • hyperthyroidism or hypothyroidism • diabetes mellitus • steroidal contraception 7. congenital anatomic • developmental anomalies