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Menarche/Menstruation disorder

It is 28 days cycle of women Where ovum are Produce natural transport and leave from the body.It is normal physiological process that regulated by various female sex hormone and pituitary hormone.Naturally Mastration are initiate due to puberty is from vary 11 to 15 years. If menstruation does not initiate within this time it may be called menstruation disorder. From this this disorder many of the change body physiology and parson may introduce various discomfort.

Menstrual syndrome PMS

Symptoms

Patient may complain five days before means in Each of three Prior menstrual cycle.

Breast tenderness
Abdominal bloating
Headache
Swelling of extremities
Depression
Angry outburst
Irritability and anxiety, confusion
Social withdrawal
- Symptoms relief within 4 days of means.

Causes this reasons

lack of pyridoxine that decrease dopamine and serotonin resultant disturbance balance of estrogen and progesterone.
lack of vitamin D and Calcium that decrease linoleic acid acid increase the production of PE1.

Treatment

Medication

1.Bromocriptine

1.25 mg at bedtime may increase the dose 2.5 at twice.

2.PGE inhibitors (Mefenamic acid)

250 mg three times started from 14 days before onset of action.

3.Antidepressant (fluoxetine. Sertaline. citapolam)

Two times a day

co-administration with pyridoxine, calcium and Vitamin D3.

Dysmenorrhea

Symptoms

lower abdominal pain( crumping), abdominal bloating
Abdomen feel thigh and backache.
Gastrointestinal abnormalities eg, nausea vomiting diarrhoe
Pelvic pain.

Treatment

1.. Mefenamic acid

250 mg three times or 500 mg twice daily.

2.Montelukast( less effective)

10 mg once daily.

3.vasopressin antagonist (conivaptan)

4. Oral contraceptive combination (COC)

Administration-20 microgram ethyl estradiol + 150 microgram norelgastromin.

5. progesterone only

Norethisterone (1st generation)

Dose:Three times daily for 15 days after being period for 10 mg twice per day for 10 days.
Side effect- breakthrough bleeding.

I preferred to use third generation eg. Gestodene or Norgestimate.

Co- administered- Vitamin B1 100 mg per day. omega 3 fatty acid and magnesium hydroxide.

Other treatment- antibiotic may help to prevent transmitted disease by intercourse.

I suggest that 250 mg Mefenamic acid three times or 500 mg twice started from 14 days before onset of action. If fail the treatment or symptoms or pain not relife then apply no 4 or 5 ……

Menorrhagia

Excessive vaginal bleeding period more than 80 ml.

Treatment

1.Tranexamic acid

Dose adjustment

First 3 days of period 1g three times per day.
It should be changed if no effect after three periods.
Periods calculate 21 days period cycle.

Side effect

It may increase the Risk of thrombosis disease.

2. Progestogen (norethisterone)

Dose adjustment

Three times daily for 15 days after being period for 10 mg twice per day for 10 days.

3.Danazol are prohibited for this treatment

4.GnRh analogue are Less as treatment not more than 6 month. It is responsible for reduced radicular bone density.

Andrometriosis

It is the condition in which endometrial tissue is found outside the uterus. It may be found outside of reproductive tract, gastrointestinal tract and even the lungs.

Symptoms

Form dysmenorrhoea- pelvic pain .
When endometrial deposite urinary tract- hematuria, dysuria, uterine obstruction.
When endometrial deposit in gastrointestinal tract- Dyschezia, cyclical tenesmus, rectal bleeding event obstruction.

Treatment

Better to remove by laparoscopy.

Medication

Gnrh analogue
Low dose oral contraceptive combination ( COC)
Progestogens ( It helpful to reduce andrometriosis)
Levonorgestrel
- Co-administration- Omega 3 fatty acid, Vitamin D3, E and Calcium.