Dr. Areefa Al Bahri Assistance professor

1. Unit Two Menstrual disorders Dr. Areefa Al Bahri Assistance professor Nursing college- midwifery department-Islamic university of Gaza

2. Dysmenorrhea Dys= painful, menorrhea = normal menstrual flow Painful menstruation types Primary dysmenorrhea: Primary dysmenorrhea is defined as cramping pain in the lower abdomen occurring just before or during menstruation, in the absence of other diseases such as endometriosis. Prevalence rates are as high as 90 percent. Initial presentation of primary dysmenorrhea typically occurs in adolescence. Symptoms uterine cramping, occasionally headache, dizziness, vomiting and diarrhea. Spasmodic pain starts with the menstrual flow and lasts for 1 to 3 days. Prostaglandins have been implicated in primary dysmenorrhea Significantly elevated Prostaglandins have been detected in the endometrium and menstrual fluid of women with primary dysmenorrhea.

3. Secondary dysmenorrhea MANAGEMENT Mild analgesics. Prostaglandin inhibitors (NSAID). Contraceptive pills are effective for some women Regular exercises Emotional support and reassurance. • Occurs in association with pathologic changes such as • endometriosis • pelvic inflammatory disease, cervical stenosis • uterine or ovarian neoplasm. • The presence of IUD may lead to secondary dysmenorrhea

4. Premenstrual syndrome Clinical manifestations Symptoms may begin 10 days or more prior to menstrual flow onset. they diminish 1 to 2 days after menses begin. It includes transitory edema, breast swelling and abdominal distension due to increase water content tissues, behavioral problems include irritability, sleep disturbances, depression, headache and vertigo. • Is a condition related to neuroendocrine neurotransmitters function. • It differs from dysmenorrhea as has no relation to ovulation. • Causes are unclear, but it may be due to heredity or environmental factors • Management • Progesterone supplement • Diuretices. • Tranqulizers may be helpful • Low sodium diet.

5. Amenorrhea Oligomenorrhea: Is markedly diminished menstrual flow nearing amenorrhea. Monorrhagia: Is excessive bleeding during regular menses. Metrorrhagia: Is bleeding from uterus between regular menstrual periods. It is indicates often benign or malignant tumor of uterus. Polymenorrhea: Is frequent menstruation occurring in intervals of less than 3 weeks. • Primary amenorrhea. A girl 16-17 years still has not menstruated yet. • Causes include congenital obstructions, congenital absence of uterus, absence or imbalance of hormones. • Secondary amenorrhea: menstruation has begun but stops. Causes include pregnancy, lactation, hormonal imbalance, poor nutrition, ovarian lesions, stress, and use of contraceptive pills. • Post pill amenorrhea: after discontinuing oral contraception, there is usually a delay before ovulation and menstrual cycle recur. However, amenorrhea exceeding 6 months should be investigated.

6. Menopause • Is the stage of female life when there is physiologic cessation of the menses along with progressive ovarian failure. Climacteric is the transition period during which the woman's reproductive function gradually diminishes and disappears. It usually occurs between the age of 45 and 55 years • Menopause can be surgically induced • The age of onset may be influenced be nutritional, cultural, and genetic factors. • Menopause occurs when estrogen levels come so low.

7. 50% of women report symptoms of heat (hot flashes) arising on the chest and spreading to the neck and face caused be vasodilatation and last for 20-30 days • Long range physical changes may include osteoporosis. • Reproductive female system starts to atrophy. • Menopausal women may need assistance in the form of counseling to adjust successfully to this developmental stage of life. The way of dealing depends on socio-cultural factors and acceptance to menopause woman.

8. Answer the following questions What is the normal menses? • Duration • Blood loss • What its content Mention at least 5 nursing Dx