Documente Academic
Documente Profesional
Documente Cultură
PHYSIOLOGY AND
PATHOPHYSIOLOGY
HYPOTHALAMUS
ANTERIOR PITUITARY GLAND
OVARY
ENDOMETRIUM
But the main regulation is
intraovarian
Uterine activity
Environment
CNS
Compartemen
IV
Hypothalamus
GnRH
Anterior
pituitary
Compartemen
III
LH
FSH
Compartemen
II
Ovary
Estrogen
Comparteme
nI
Progesterone
Uterus
Menses
Ovulasi
# of cells
Endoderm of the
yolk sac
10,000
Proliferation by
mitosis
600,000
Mitosis, meiosis,
atresia
6-7,000,000
80% loss
1-2,000,000
Loss to atresia
300,000
Ovulation
400-500
Membran sel
LISOSOM
Asam fosfatase
Enzim litik
Upregulated
MMP
Penurunan
aliran darah
Vasokonstriksi
a. spiralis
Prostaglandin
Iskemia
Sekresi dan
aktivasi sitokin
Makrofag
PMN
LImfosit granulasi
Menstruasi
Triptase &
kimase
Regenerasi endometrium
Degranulasi
Sel Mast
VEGF & FGF
Definitions
Normal:
Mean interval is 28 days
+/- 7 days.
Mean duration is 4 days.
More than 7 days is
abnormal.
Abnormal Bleeding
Abnormal bleeding (DUB or dysfunctional
uterine bleeding) includes:
Too frequent periods (more often than every 26
days).
Heavy periods (with passage of large, egg-sized
clots).
Any bleeding at the wrong time, including
spotting or pink-tinged vaginal discharge
Any bleeding lasting longer than 7 days.
Extremely light periods or no periods at all
Definition
Pattern
Amenorrhea
Menorrhagia
Metrorrhagia
at
Decreased,
scanty
flow,
the
term Interval > 36-40
hypomenorrhea is used for regular timing days
with scanty amount.
Bleeding
periode
or
spotting
between
Interval
days.
<21
normal Between
periods (usually
light flow)
Definitions
Menorrhagia:
Definitions
Metrorrhagia:
Uterine bleeding occurring
at irregular but frequent
intervals.
Etiologies AUB
Organic
Systemic
Reproductive
tract disease
Iatrogenic
Dysfunctional
Ovulatory
Anovulatory
Reproductive Tract
Causes of Benign Origin
Atrophy
Leiomyoma
Polyps
Cervical lesions
Infection
DUB
Abnormal uterine bleeding
for which an organic
etiology has been excluded.
It is either ovulatory or
anovulatory in origin.
LH
FS
H
PUD
E2
Kelainan
Organik
Sistemik
Metabolik
Keganasan
Ggn kehamilan dini
Premenstrual Syndrome
Premenstrual Syndrome (PMS) is defined as the cyclic
recurrence in the luteal phase of the menstrual cycle of a
combination of distressing physical, psychological,
and/or behavioral changes of sufficient severity to result
in deterioration of interpersonal relationships and/or
interference with normal activities. Nearly 200
symptoms have been associated with this definition and
it is the clustering of these signs and symptoms that is
the hallmark of PMS.
Catamenial
Premenstrual Magnification
PMS
Concordance Rate
The concordance rate (if both twins have PMS)
was found to be significantly higher in
monozygous twins (93%) than dizygous twins
(44%) and in non-twin control women (31%).
90
85
71
70
67
60
48
Diagnostic and
Statistical Manual
of Mental
th
Disorders, 4 ed.
(DSM-IV)
Providers using
these criteria
Number of
symptoms
required
One
5 of 11 symptoms
Not required
Interference with
social or role
functioning
required
Prospective
charting of
symptoms
Not required
Prospective
daily charting of
symptoms
required for two
cycles
Patterns of PMS
Premenstrual symptoms can begin at ovulation with
gradual worsening of symptoms during the luteal phase
(pattern 1).
PMS can begin during the second week of the luteal
phase (pattern 2).
Patterns of PMS
(Continued)
Some women experience a brief, time-limited episode of
symptoms at ovulation, followed by symptom-free days
and a recurrence of premenstrual symptoms late in the
luteal phase (pattern 3).
The most severely affected women have symptoms that
at ovulation worsen across the luteal phase and remit
only after menses cease (pattern 4). These women
describe having only one week a month that is symptomfree.
Differential Diagnosis
Psychiatric disorders
Major depression
Dysthymia
Generalized anxiety
Panic disorder
Bipolar illness (mood
irritability)
Other
Medical disorders
Anemia
Autoimmune disorders
Hypothyroidism
Diabetes
Seizure disorders
Endometriosis
Chronic fatigue syndrome
Collagen vascular
disease
Differential Diagnosis
(Continued)
Premenstrual
exacerbation
Of psychiatric disorders
Of seizure disorders
Of endocrine disorders
Of cancer
Of systemic lupus
erythematosus
Of anemia
Of endometriosis
Psychosocial spectrum
Past history of sexual
abuse
Past, present, or current
domestic violence
Diagnosis of PMS
PMS
A. Does not meet DSM-IV criteria
but does meet ICD-10 criteria
for PMS
B. Symptoms occur only in the
luteal phase, peak shortly
before menses, and cease
with menstrual flow or soon
after
Treatment of PMS
Oral contraceptives
Vitamin B6
Bromocriptine
Monoamine oxidase inhibitors
Synthetic progestational agents
Spironolactone
Massage therapy
Chiropractic therapy
Calcium
MENOPAUSE
Irreguler menstruation
Gejolak panas
Osteoporosis
Tulang keropos
Ngilu-ngilu
Patah tulang
Bungkuk
Tambah pendek
NORMAL
Kulit keriput
Sukar tidur
Jantung berdebar
Pusing
Mudah pingsan
Vagina kering
Hub. Seks sakit
Lendir sedikit
Nafsu sek turun
Libido menurun
Gangguan berkemih
Inkontinensia
Ngompol
Estrogen + progestin
Plasebo
LIVER
te
Renin substra
ogen)
in
s
n
te
io
g
n
a
(=
Angiotens
in II
Renin
KIDNEY
Aldosterone
HRT
ADRENAL GLAND
Increased edema
ESTROGE
N
1.5
1.0
0.5
0
0
Estradiol (n = 225)
0
10
11
12
13
-0.5
-1.0
-1.5
Angeliq (n = 224)
The end