1. Prepared by:mayy Naser and manar ghnemat To : Dr ikhlas jarar
Menstruation
Prepared by:mayy Naser and manar ghnemat
To : Dr ikhlas jarar

2. Menstruation: Introduction
Is a physiological discharge of blood ,endometrial cellular debris , and mucus through the vaginal of non pregnant woman and is result of monthly cycling of female reproductive hormone.

3. Eumenorrhea denotes normal, regular menstruation that lasts for a few days (usually 3 to 5 days, but anywhere from 2 to 7 days is considered normal). The average blood loss during menstruation is 35 milliliters with 10–80 ml considered normal

4. PHYSIOLOGY OF MENSTRUAL CYCLE
The normal menstrual cycle is divided into:
The ovarian cycle.
(1)The follicular phase (day 1 to 13
(2) Ovulatory phase (day13 to15)
(3) The luteal phase (day 15 to 28).
2. The uterine cycle.

5. Menstrual abnormalities
1. Dysmenorrhea
2.Amenorrhea
3.Intermenstrual pain
4. PMS (premenstrual syndrome)
5. Menorrhagia

6. dysmenorrhea 1. dysmenorrhea: is painful menstruation . Types:
primary dysmenorrhea : associated with menstruation in the absence of pelvic disease.
Increase the level of prostaglandins in the menstrual fluids.
Secondary dysmenorrhea :associated with pelvic disorder.
Causes: PID, ovarian cysts ,endometriosis.

7. Symptoms of dysmenorrhea
Abdominal cramping: usually begins at onset of menstrual flow a few hours before onset
Nausea
Vomiting
Diarrhea
Headache
dizziness

8. Treatment
1. Analgesics for the relief of cramping with premenstrual syndrome and use for mild to moderate pain.
Acetyl salicylic acid.
NSAIDS: inh. Synthesis of PG because PG are responsible for cramping of dysmenorrgea.
Ipoprofen 200mg every 4-6 hr .
Naproxen 200 mg every 8-12 hr.

9. 2.Diuretics:by FDA , used in eliminating water during premenstrual and menstrual periods.
5 days before menses , diuretics help relieve bloating , excess water , cramps , and tension.
1-ammonium choride:3g per day in 3 divided doses.(large doses cause GI symptoms
2-caffeine:promotes diuresis by inh. Tubular reabsorption of sodium & chloride.
3-pamabrom: 50 mg four times daily(not exceed 200 mg per day)

10. Amenorrhea Is the absence of menstruation
Primary or secondary amenorrhea requires physician evaluation

11. Intermenstrual pain and bleeding
Occur at mid cycle and may last for hours to days.
Pain associated with ovulation .
Therapy consists of nonprescription analgesics.
Patients with pain lasting longer than 2 days should be referred to a physician.

12. Premenstrual Syndrome(PMS)
Symptoms : mood swings , fatigue , appetite change , bloating , breast tenderness , irritability , depression (begin 1-7 days before the onset of menses.
Nonpharmacological therapy:
Dietary modification , regular exercise , reduction of stress factor , avoiding caffeine , fruits and vegetable consuming and avoid salty food.

13. Pharmacological treatment
Diuretic
Benzodiazepines , (MAO-I) , (TCA) , selective serotonin reuptake inhibitor .
Fluoxetine : is FDA approved and used for premenstrual dysphoric disorder.
Calcium supplements : to reduce emotional and physical symptoms of PMS.

14. Menorrhagia Excessive menstrual blood loss
Low hematocrit , low hemoglobin , low serum iron may occur ( lead to anemia)
Treatment is usually estrogen – progestin combination (oral contraceptive)

15. Toxic Shock Syndrome
Can categorized by menstruation or non menstruation.
Affect woman less than 30 years , women at high risk.
Occurs in women \men contagious
Mainly staphlococcus Aureus infection .
Related to use of tampons. And contraceptive use
S&S : flue like , fever , diarrhea , vomiting ,abrupt onset ( 8-12 hr)

16. VAGINAL PRODUCTS A. Vulvovaginal candidiasis 1. General considerations
a. Occurrence:.Approximately 75% of all women will experience vulvovaginal candidiasis (yeast infection)
b. Cause.Candida albicansis responsible for up to 92% of infections.

17. c. Predisposing factors: .Antibiotics, oral contraceptives
containing high-dose estrogen,pregnancy, diabetes,and immunosuppression in-crease the risk for infection.
d. Symptoms.Can include a thick, white, ‘‘cottage cheese–like,’’; vaginal burning; and pruritus.

18. Patient assesment (1)First episode of symptoms (2)Pregnant
(3)Younger than 12 years of age
(4)Systemic symptoms such as fever
(5)History of recurrent vaginal yeast infections
(6)Discharge with a fishy odor (indicates bacterial vaginosis, most often caused by
anaerobic bacteria

19. . Pharmacological treatment
include
intravaginal creams, suppositories, and ointments.
d.External vaginal creams can be used in combination with intravaginal products to treat
vulvar symptoms of pruritus.

20. Otc products Mycelex-T (clotrimazole),
Monistat 3 and Monistat7 (miconazole),
Femstat 3 (butocona-zole),
and Monistat 1 and Vagistat 1 (tioconazole).

21. . Nonpharmacological
(1)Dry vaginal area well after bathing with a towel.
(2)Avoid tight or damp clothing.
(3)Wear cotton underwear.
(4)Use unscented soap to avoid irritation.
(5)Avoid douching.