AMENORRHEA

Definition — This is the symptom of Absence of menstruation

Causes

Physiological Pathological
1) During pregnancy, Lactation 1. Disorders of menstrual
outflow
Before puberty, tract or uterus
After menopause. 2. Disorders of ovary
3. Disorders of ant pituitary
4. Disorders of central Nervous system
5. Environmental stress.

Primary Amenorrhea Secondary Amenorrhea

I. Primary Amenorrhea - Causes as below

1. Congenital obstructive Lesion at Lower genital tract-
cryptomenorrhoea -
due to Imperforate hymen or Transverse septum above hymen
2. Congenital Agenesis of uterovaginal canal or uterus

a) Rokitansky - Kuster - Hauses syndrome - Vagina is

Absent
uterus Absent Karyotype is 46xx.
 b) Uterus agenesis = Rudimentary or absent of uterus
3. Faulty Gonadal development =
a) Turners syndrome (45x0)
b) Gonadal Interrex eg. Hermaphrodites (ovary and
testes) Present
c) Other Gonadal abnormalities - PCOD

4. Congenital adrenogenotal syndrome (Female pseudoherma

phrodition)
5. Fancies - juvenile Diabetes mellitus.
6. Hypothyroidism.
7. Pituitary cause — pituitary dwarfism.
8. Hypothalamic cause - GnRH deficiency.
9. Psychogenic.
10. Neutrogena systemic disease - pulmonary TB., Anemia
11. Nutrition - par Nutrition
12.Drug - Anabolic steroid., androgens.

11. Secondary Amenorrhea - Cessation of menses for Three or more

1. Obstructive lesion at Lover genital tract, e.g. Fibrotic stenosis of ex.,

Vaginal stenosis.
2. Uterine Cause = Endometrial TB. Hysterectomy Radiation, Puerperal or
postorbital sepsis.
3. Ovarian Causes e.g. 1) Premature Ovarian Failure 2) prematuse
menopause
 bil ophorectory ovaron inadiation Ovarian TB., Ovarian Neoclassic,
PCOD.
1. Adrenogenital syndrome
2. Pancreas - DM - Amenorrhea
3. Thyroid
4. Ant. Pituitary cause.
4. Psychogenic (Hypothalamic) Amenorrhea eg. Psychosis,
Anorexianervosa,
mental disease
5. Neutrogena Amenorrhea - Injury or disease of midbrain, Base skull
fracture
5. Systemic causes - Infectious ds.
6. Defective Nutrition
7. Drugs.

Clinical feature — Disease Occurs at puberty till 3rd Decode Absence of menses,
Hirsuitism, Obesity, Oligomenrrhoes Dysfunctional
menarrhgia

Aetiopathogenesis - l.Ovaroan Enlargement

2. Hypothalamus - pituitary dysfunction
3. Adrenal Compact.

Diagnosis - In woman 14-30 year.

Clinical Examination shows Normal weight or obesity
Hirsutism on face and involution.
Bill firm Enlarged ovaries.
Ingestion for Amenonchoea
1) History clinical Examination

Primary Amenonchoea
1.,History
2.( linieal Evaluation — Htight, weight, sec«tt{iftry character
3.Laboratry test - IBC, WBC; K^ A

4. Endocrine Evaluation - sr, FSH, LH, TSH, Prolactin testosterone sr.T3 &
T4
5.SpeciaI test - Sonography (pelvis), Karyotyping
6.Progestogen Challenge test.

Secondary Amenonchoea - Same as in primary Amenonchoea Rx

of Amenonchoea

1. Primary Health care — Improvement

• Agenesis = Hymenotomy
• Vaginal artesian - by Recon - Struction
• Drug Amenonchoea - by stopping drug
• PCOD - Hormonal Therapy
• HRT
 Case No. 1

Preliminary Data
Name : Miss. Sajana Vaidya
Age : 23 yrs
Sex : Female
Religion : Hindu
Address : Nagapur, Ahmednagar
Occupation : BA Student

Chief Complaints :
 Pain complaints of suppressed menses since 3 months.
ODP :
 Menses are suppressed with dull heavy sensation in occiput.
 Patient bores the head into pillow and screams out.
 Oedema of labia relieved by cold water.
 Face swollen , red , waxy and pale region
 < Heat in any form, touch , pressure
 > open air,uncovering, cold bathing

Past History : No history of any major illness.

Family History : No history of any major illness in family.

Past Treatment : Allopathic

Physical General :
Appetite : Decreased
Aversion : N/P
Desire : milk
Tongue : Fiery red, swollen
Bowel : Constipation
Urine : Burning during mictration
Perspiration : Medium
Sleep : sound
Thermally : Hot
Mental Generals :
 Apathy different
 Cant concentrate mind when attempting to read or study.

Systemic Examination :

RS B.P. : 120/90 mm of HG
CVS NAD P.R. : 76/ min
CNS R.R. : 19/min
Physical Examination :
Built - Thin
Nutrition - Good
Lymphnode - N/P
Oedema - present
Pollar
NAD
Cynosis

Provisonal Diagnosis : Amenorrhoea

Differential Diagnosis :
1. Cervical Polyp
 2. Fibroid Uterus
3. Amenorrhoea
Investigation :
HB - 10.9 gm %
WBC - 12000/ mm3
Final Diagnosis : Amenorrhoea
Prescription :
For , Miss. Sanjana Vaidya
Age 23 Yrs
Apis met 200/1 dose
+
Placebo 1 dram
4 glb x B.D. x 7 days
Follow Up :
Date Symptom Treatment
Previous complaints
Placebo 1 dram
03/06/2010 decreased.
4glb x BD x 7 days

No any complaints.
Placebo 1 dram
11/0/2010 Patient feels better and
4glb x BD x 5days
general level
16/06/2010 Patient get cured

Result : Case is cured

Case No. 2

Preliminary Data
Name : Miss. Kavita Chitre
Age : 22 yrs
Sex : Female
Religion : Hindu
Address : Nagapur, Ahmednagar
Occupation : BA Student

Chief Complaints :
 Pain complaints of absent of menses since 3 months.
ODP :
 Patient complaints of severe pain up back pain lattends back and hip
 Sensation as if uterus were squeezed.
 Dizziness, drowsiness, dullness and trembling.
 General depression from heat and sun.
 Sneezing fullness of root of nose.
 < dump wheather, before thuderstorm, emotion, bad nease.
 > profuse urination , open air

Past History : No history of any major illness.

Family History : No history of any major illness in family.
Past Treatment : Allopathic

Physical General :
Appetite : Decreased
Aversion : N/P
Desire : N/P
Tongue : Numb, thick, coated
Bowel : Regular
Urine : Normal
Perspiration : scanty
Thirst : Thirstless
Thermally : Chilly

Systemic Examination :

RS B.P. : 130/70 mm of HG
CVS NAD P.R. : 76/ min
CNS R.R. : 19/min
Physical Examination :
Built - Thin
Nutrition - Average
Lymphnode - N/P
Oedema
Pollar NAD
Cynosis

Provisonal Diagnosis : Amenorrhoea

Differential Diagnosis :
1. Cervical Polyp
2. Fibroid Uterus
3. Amenorrhoea
Investigation :
HB - 11 gm %

Final Diagnosis : Amenorrhoea

Prescription :
For , Miss. Kavita Chitre
Age 22 Yrs
Gelsenium 200/1 dose
+
Placebo 1 dram
4 glb x B.D. x 7 days
Follow Up :
Date Symptom Treatment
Previous complaints Placebo 1 dram
12/06/2010
decreased. 4glb x BD x 7 days
. Patient feels better but Placebo 1 dram
20/06/2010
general level 4glb x BD x 5days
. Patient feels better but
27/6/2010
some symptom present

Result : Case is improved