GANGGUAN MENSTRUASI DAN

FARMAKOTERAPINYA

Department of Pharmacology and Clinical Pharmacy

Faculty of Pharmacy Universitas Padjadjaran
2017
References
 Basic
Science
The woman’s body is built in a
different way from that of the
male; it is less muscular and has
a slighter skeleton to support the
muscles.

In the abdomen, the non pelvic

organs are similar and subject to
the same diseases.
Uterus
A hollow,muscle-walled organ in the pelvis, communicating with Fallopian tubes
and, through cervix, the vagina.
Pre-pregnancy : 7x5x3 cm3, 40g
Full term : 30x25x20 cm3, 1000g

Anatomy/Structure
Muscle in three layers with vascular anastomosis between them:
1. Outer : thin, longitudinal, merging with ligaments
2. Middle : very thick, spiral muscle fibres with blood vessels between
3. Inner : thin,oblique with condensation at each cornu and at the upper
and lower end of the cervical canal-the internal and external os

Increase in size during pregnancy due to hypertrophy of existing cells. Changes

are stimulated by estrogen and gradual stretch.
Cervix:
Barrel-shaped canal at the bottom of the uterus. Mostly connective tissue with
muscle at upper and lower end. In late pregnancy, the ground substance of
connective tissue becomes softer with a greater water content, and the cervix
becomes softer, clinically.

Ligaments:
Uterus is supported by ligaments. The
principal support of the uterus are:
1. The transverse cervical ligament
(cardinal ligament)
2. The round ligament
3. The uterosacral ligament
Ovary
(4x3x2 cm3, 10g)
The ovaries have twin functions: steroid production and gametogenesis. Each
ovary is attached to the back of the broad ligament.
Anatomy/Structure
The ovary has outer cortex and inner medulla and consists of large numbers of
primordial oocytes supported by a connective tissue stroma. It is covered by a
single layer of cubical, germinal epithelium which is missing in adult women.
Beneath is the fibrous capsule of the ovary, the tunica albuginea, a protective
layer derived from fibrous connective tissue.
The Fallopian tube
The Fallopian tube is the oviduct conveying sperm from the uterus to the
point of fertilization and ova from the ovary to the uterine cavity. Fertilization
usually takes place in the outer part of the tube.
Vagina
The vagina is a fibromuscular canal extending from the vestibule of the vulva to
the cervix around which it is attached to form the fornices.

Anatomy/Structure
The anterior vaginal wall is 10 cm long, the posterior wall 15 cm. It is capable of
great distension as in child birth, after the prolonged hormonal stimulation of
pregnancy.

The walls have:

1. An outer connective tissue layer to which the ligaments are attached
2. A muscular layer consisting of an outer longitudinal layer and an inner
circular layer
3. The stratified squamous epithelium which in adult women contains
glycogen
 Menstrual Cycle

During menstrual cycle in the follicular phase, FSH causes recruitment of many
primordial oocytes, but only one develops fully to become a mature Graafian follicle and
expels its oocyte.
The Graafian follicle continues to grow and synthesizes estradiol, progesterone, and
androgen. Estradiol stops the menstrual flow from the previous cycle, thickens the
endometrial lining, and produces thin, watery cervical mucus. FSH regulates aromatase
enzymes that induce conversion of androgens to estrogens in the follicle.
The stroma cells outside the granulosa cell layer differentiate into theca interna
(a weak androgen secretor) and theca externa (no hormone secreting function).
Before ovulation, the meiosis is
completed in the primary oocyte in
response to the LH surge. The
oocyte casts off the polar body
resulting a reduce of chromosome
in the nucleus from 46 to 23.

At ovulation, the ripe follicle ruptures

releasing the oocyte into the end of
the Fallopian tube. The follicle
collapses, a corpus luteum
develops. Its cells secrete estrogen
and progesterone. If the ovum is not
fertilized, the corpus luteum
degenerates in 10 days.
MENSTRUAL-RELATED DISORDERS
• Premenstrual syndrome
• Perimenopause
CLINICAL PRESENTATIONS
CLINICAL PRESENTATIONS
NON-PHARMACOLOGY TREATMENT
PHARMACOLOGY TREATMENT