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In simple words puberty is the ag, , , , , , , , , , , , , , which various physical changes occure in |, the body through which a kid's body |, matures into an adult body v e |, of sexual reproduction, Puberty in a fe hen |, secondary sexual characteristics start t, develop in her and reproductive organs |, become functionally active. In females, normally age of puberty is between 11-15 | >, years. During puberty various biological, morphological and psychological changes | 7, occure in the female which make her, sexually mature. ,, Changes take place in females at, puberty — o, > Breast development - Under the | ~, influence of hormone oestrogen, | ~, 000, , , , , , PUBERTY, , , , Deve, , uterus, fallopian, , , , Fat deposition in th, breasts., Increase, Widenir, , Appearance of acne, , , , , , , , , , aaaaaaaddddddddddieaenuny

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—-_- ~, , , , , , , , MENSTRUAL CYCLE AND MENSTRUAL, DISORDERS, , , , , , > — Review of menstruation, > Menstrual disorders, % Premenstrual sy, , Dysmenorrhoea, , , , Cryptomenorthoea, , , , Menorrhagia, , Menstruation, Menstruation is the discharge of, blood and mucosal tissue from the inner, lining of the uterus occurr, females through the vagina aft, 30 days throughout the reproductive a, (13-45 years), Usually its duration is, days., , First menstruation in, known as menarche. It, age of 11-15 years. The, menarche is earlier in the developed, counteris., , Whereas later in the developing, counteris, , Menstruation ceases temporarily, during pregnancy and period of lactation, After menopause it ceases permanently, Cessation of menstruation spontaneously at, the age of 45-55 years is known as, menopause., , Following two hormones play an, important role in the process of, menstruation, g regularly in, , , , every 26, , , , , female is, , , , ns between the, , verage age of, , , , , , Dysfunctional Uterine Bleeding (DUB), , (a) Follicle Stimulating Hormone (FS, It is secreted by anterior pituitan, , in the maturati, , , , gland. It is hel, , of ovarian follicles secretion, , , , , , hormone, oestr, , (b) Luteinizi: Hormone Tt is als, , , , secreted by anterior pituitary gland, and it is helpful in the developmen, of corpus luteum, , | Stages of Menstrual Cycle —, , There are four stages of Menstru, , , , Cycle, 1. Proliferative phase, 2. Secretory phase, 3. Premenstrual phase, 4. Menstrual phase, , For detail refer chapter-2 of secti, , Menstrual disorders, In this chapter, following menstrut!, disorders are being described1 Premenstrual syndrome, 2. Dysmenorrheoa, 3. Cryptomenorrhoea, , , , , , , , , , fter men, Causes, Exact, ssi, > Increase, the hutea, > Decreass, , luteal ph, >» Pyridox’, > Psychol, Clinical feats, > Headacl, Abdomi, Breast |, Back ac, Insomn, Irritabit, Lack o}, , > Anxiet, >, >, , , , Nausea, Dizzin, Faintin, Swelli, Dyspa, Treatment

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na, , , , , , , , , , , , , , , , , , , , , , , , , , , eae, Chapter 4: Menstrual Cycle and Menstrual Disorders 2 _, 4 Dysfunctional Uterine Bleeding | * Reassure the woman and provide i, (DUB) emotional support ~, 1, Premenstrual syndrome > Encourage family memb }, > It is also known a with her all time atleast a -t ;, tension them, oo, % It is a psychosomatic disorder which | * Administer supplementary Vi ., occurred 7-10 days prior to B6 (Pyridoxine)., menstruation > Alprazolam 0.2, > During this, certain behavioural, luteal phase red c, physical and emotional features are anxiety and depressive feature, found in a woman > Antidepressant drug may alsc, > It is found in about 90% of prescribed such a, menstruating women. Although more | * Administer bromocriptine to relieve, common in middle aged women breast problems. D, > The symptoms of premenstrual | > Oral contraceptive pills are given tc, syndrome resolve _ spontaneously suppress ovulation, for 3-6 month /, after menses. > For suppressing ovarian cycle, Causes - following drug are given ;, Exact causes are unknown. Some of Goserelin (GnRH analogues), possible causes are as follows - Donazol i, > Alteration in oestrogen progesterone | > General measures such as you, ratio during luteal phase exercise, Pranayama, _ relaxation, > — Increased carbohydrate intolerance in techniques etc are also effective, the luteal phase. 2. Dysmenorrhoea, > — Decreased serotonin synthesis during Painful menstruation is known as, Juteal phase. dysmenorrhoea., > Pyridoxine deficiency Types — It is of two types ¥ — Psychologal factors. (A) Primary dysmenorthoea, Clinical features — (B) Secondary dysmenorrhoea ., » Headache (A) Primary dysmenorrhoea, > — Abdominal cramps It occurs without any identifiable, > — Breast pain pathology. In other words we can say it is, > Back ache, generalized body pain not associated with any other disease ‘, > Insomnia Causes — §, > — Irritabitly Although in case of primary s, > — Lack of concentration dysmenortheoa, exact cause is unknown, > = Anxiety However some of possible causes/related, > Nausea factors may be, > Dizziness > — Septate or bicornuate uterus %, > Fainting attacks > — Uterine hypoplasia, > — Swelling of the extremities > — Cervical stenosis ., > — Dyspareunia etc > Increased secretion of vasopressin a, , during menstruation, , , , Treatment ~

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Tnereased synthesis of prostagiand, , , , , , , , , , , , Semencisgicsl factors wuch 8S) 7, anxiety, tension etc | (, , Clinical features ~ c, , DS Pain in lower abdomen back 01 Clinic, thighs [t usually starts few wis} * I, hefore the menstruation oF W h the |, acting of menstrual bleeding The |, Severity of pain may range from the |, mild to severe >, , } Other associated symptoms are, pauses, vomiting. _—_dizzines, festlessness, fatigue, headache, | Treat, diarrhoea, pain in lower back etc. |, , Treatment - |, , % Reassure the woman and provide |, emotional support | >, , $ Administer mild analgesics or |, antispasmodics during menses |, , } In severe cases, following drugs are |, prescribed, , (a) Prostaglandin synthetase inhibitors, , such as, , (b), , ,, , % — Mefanamic acid, , , , Ibuprofen, Oral contraceptive pills, , ment — It depends upon, , , , Surgical t, presence of related factors such as in, case of cervical stenosis, dilatation of, the cervical cans, In case of elderly patient, hysterectomy may be done if other, , measures remain fail, , , , is done, , , , (B) Secondary dysmenorrhoea, When dysmenorrhoea occurs due to any, , Known pelvic pathology such as, , any, , disorder in the woman's reproductive, oragns or infection. it is known as, secondary dysmenortl, , ‘Causes —, , ¥, , Endometriosis, Adenomyosis, Pelvic inflammatory disease, , , , periodic s!, , bleed, | come, , | di, | durin;, , ment, , , , , , , , out through the vagina., , this condition menstruatic, , but is not visible, , Causes ~, , | Usual, its m, , Clini, , , , , , , , lly any obstruction in the p is, ain cause. Its causes are, , Imperforate hymen (It is the, commonest cause), , Vaginal or cervical atresia, , Transverse vaginal septum, , Cervical stenosis after cervical, amputation or canisation, , Secondary vaginal atresia alter, , -omplicated vaginal delivery, ical features Menstrual blood does not come, , Cyolie lower abdominal pain, , , , , , 4. Dysfunction, > Iris abbreviat, » Ab e, , delivery and, > It is foun, , oductive, Possible causes ids, , , , , , > — Uterine poly, » — Adenomyosi, >» Blood clottis, > Problems wi, Clinical features, Abnormal

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“So, , Je and Menstrual Di, , Chapter 4: Menstrual Cyc, , Signs , > Haematocolpos, menstrual blood in the vagina, , > — Enlarged uterus, , , Haematometra, blood in the uterine cavity, , > Bulging hymen, , Management , 7 Furst of, , of, , Retension, , Accumulation, , all patient's diagnosis is, based upon clinical, , s and, , confirmed, various, , , , manifestatic, examination, , >» Management of, , mainly depend upon its cau, , example, , If cause is imperforate hymen then, , simple cruciate incision of the hymen, , cryptomerrheoa, use for, , is made., > In case of cervical stenosis, cervical, , dilatation is done., , y In case of, reconstructive surgery is done, , > — Reassure the woman and her family, members, and provide emotional, support, , 4. Dysfunctional Uterine Bleeding, , > — Itis abbreviated as DUB., , > Abnormal uterine bleeding which is, not associated with any genital tract, abnormalities and general or, endocrinologial disorders., , > — This condition is more common after, delivery and abortion, , > It is found in about 10-15% of, , reproductive aged women., , vaginal atresia,, , ,, , > — Uterine polyps, , > — Adenomyosis, , ¥ Blood clotting disorders, Problems with ovulation etc., , Clinical features , , , , , , > Abnormal vaginal bleeding is the, , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , History takir, Biman. mina, Blood examinati, Haemoglobin level, @ Bleeding Time, @ Clotting Time, @ Prothrombin Tir, m Platlet count, mB Thyroid profile, Ultrasonograph, Diagnostic uterine curettay, => Diagnostic hysteroscop, Diagnostic laparoscoy, => Hysterography, Management > Reassure the woman and provide, emotional support to reduce, , , , anxiety and fear, > Encourage the, adequate bed rest during bleed, > If the woman is suffering, anaemia then provide iron ther, and encourage her to take iron ric, foods. Transfuse mate, blood as per need., Pharmacological management, Following drugs are used (A) Hormones, > Oral contraceptive pills containing, progesterone and oestrogen, Norethisterone acetate, , woman to, , , , , , , , cross, , ,, > Medoxy progesterone acetate, > — Danazol, , > GnRH analgues, , > Clomiphene citrate, , (B) Antifibrinolytic agents, , > — Tranexamic acid, , Surgical management, > — Uterine curretage