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.
Dysmenorrhoea
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.