MENSTURAL IRREGULARITIES

AMENORRHOEA Amenorrhea indicates the absence of the menstruation.

OLIGOMENORRHOEA Oligomenorrhoea denotes the infrequent, irregularly timed episodes of bleeding usually occurring at the intervals of more than 35 days.

POLYMENNORHOEA Denotes the infrequent, irregularly timed episodes of bleeding usually occurring at the intervals of 21 days.

Menorrhagia Denotes the regularly timed episodes of bleeding, that are excessive in amount (> 80 ml) and / or duration of flow ( > 5 days).

METRORRHAGIA It refers to irregularly timed episodes of bleeding super imposed on the normal cyclical bleeding.

MENOMETRORRHAGIA Denotes the excessive, prolonged bleeding that occurs at irregularly timed and frequent intervals.

HYPOMENORRHOEA Refers to the regularly timed but scanty episodes of bleeding.

PROSTAGLANDINS SYNTHETASE INHIBITORS 1.Fenamate Group : Mefannamic acid mg 8’th hourly or flufenamic acid mg 8’th hourly. 2.Propionic acid derivations : 1 buprofen 400 mg 8 hourly or naproxen 250 mg 6’th hourly. 3.Indomethicin: 25 mg 8’th hourly.

Prostaglandins synthetase inhibitors (PSI) 1. By inhibition of cycle oxygenase enzyme reduces the prostaglandins synthesis. 2. Got Direct analgesic effects. 3. Intrauterine pressure is been reduced.

DYDROGESTERONE 1.Does not inhibit the ovulation 2. But probably interferes with the ovarian steroid ogenesis. 3.Given from the 5 days of cycle for 20 days. 4.Continued for the 3 to 6 cycles. 5.Above fails means then laparoscopy is indicated to find out the pelvic pathology to account for pain.

SURGERY 1. Dilatation of the cervical canal. 2. Bilateral block of pelvis plexus. 3. Pre sacral neurectomy (laproscopic).

Treatment 1. Medroxy progestrone 10 mg orally twice daily alpha hydroxy progestrone 1 g weekly by injectioon for 6 months to 1 yr is prescribed. 3. Six monthly uterine aspiration. 4. Progesterone therapy avoids the risk of malignancy reduces the need for the hysterectomy. 5. Hysterectomy will be required if the progesterone fails.

Hormone therapy 1.Active progestational steroids such as norethynoderl, nor ethisterone, medroxy progestrone or lynestretiol are used and is safer than the estrogen. 2.Intial dose of mg a day, to arrest the bleeding in hrs, after which 5 mg a day for 20 days is given. 3.A 2’nd course of 5 mg daily is given from 20 days, after which the withdrawl mensturation should occur, it can be continued for a period of 6 months.

Duphaston 1. Does not suppress the ovulation 2. Has no adverse effect on lipoproteins. 3. Useful in the women who desires for the pregnancy. 4. Medroxy progestrone (MDPA) 10 mg is usually given and is free of adverse effects.

Danazol 1. Has progestegonic action on the endometrium mg for 4-6 months. 3.Menorrhagia may return after the stoppage of the drug.