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DISORDER OF THE MENSTRUAL |
Menstrual disorders are:
a) Early puberty
b) Delayed puberty
c) bleeding during puberty
d) genetic abnormalities cycle
e) Dysmenorrhea.
The woman's body begins to mature at puberty. The body in this period is between childhood and mature genetic age. During this period, a woman can find abnormalities such as early or late puberty, bleeding, menstrual disorders and dysmenorrhea.
A) Early puberty
It is a condition in which the menstrual cycle and every other symptoms accompany it appear earlier in childhood, ie before the age of nine. In some cases this may be due to genetics and there is no organic cause. However, in other cases, this phenomenon may be due to reasons associated with the adrenal gland, the hypothalamus, pituitary gland in the brain or female ganades.
As far as the adrenal gland there is a possibility of benign or malignant tumors, adrenal hyperplasia, assisting in creating this phenomenon. Furthermore, there is masculinisation of the female patient. Also inflammation, brain lesions or tumors in the hypothalamus, particularly kraniofaryngiomata, and so on, could be responsible for early onset of puberty. For female gonads, ovarian tumors such as papillomas, dysgoniomata, and so on, or even the polycystic ovary could justify early puberty.
Clinical features in the case of early puberty, have shorter legs, more long torso, above normal circumference of the head and increased libido from an early age. It is sensible for the doctor to try to keep very good track record, with the help from the parents, asking the right laboratory and imaging tests to have a complete picture of the situation in order to differentiate the idiosyncratic form of early puberty from other medical reasons.
Psychological support at this stage is very important because the patient is still a child and maybe the treatment needed could be for a long period of time and the family and patient should be fully informed, involved and help the development of therapy to get the best results as soon as possible.
B) DELAYED PUBERTY
The delay of puberty is another phenomenon where in the Caucasian race is related to the delay of the first menstrual after the age of 15. The reasons as in the previous case of early puberty, may be the hypothalamus, pituitary, ovaries and even strokes. Also in some cases a main reason could be anatomical abnormalities of the uterus. As it is evident we have to exclude pathological causes in order to reach the conclusion of idiosyncratic delayed puberty, which needs specialized imaging and blood tests.
Brain tumors, the hypothalamus and pituitary, as well as the pituitary deficiency could be a cause of the phenomenon. Furhtemore, mental shock could be its cause. TYRNER syndrom has to do with ovarian agenesis may be a cause of this phenomenon and a karyotypos always in these cases is important. In the syndrome TYRNER case we have is amenorrhea. The thymus also plays an important role in cases of delayed puberty and anatomical lesions of the uterus or vagina, such as a untouched hymen along with aimatokolpo and aimatomitra, meaning the blood collecting in the uterus and vagina could be one of the causes of late menstrual, hormonal and not of delayed puberty, because the problem in the case referred to, is purely mechanical.
During the period of puberty can also have menstrual disorders and is very common, such as prolonged bleeding, the cycle usually during puberty and this is unsettled due to a relative immaturity of the endocrine system of women. In this case, however, the diagnosis should be based on complete laboratory investigation to rule out possible anomalies, tumors and so on. Treatment consists of oral contraceptive use for some time so that after several months to stop and see if the cycle continues to be unstable or starts to stabilize. In cases of intense anemia iron and folic acid should be given, and of course the patient to be under laboratory testing at least bimonthly in order to be properly addressed.
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