Gynecological disorders

Transcription

1 Gynecological disorders

2 Gynecological Disorders Including: Amenorrhea, PCOS Premenopausal syndrome (PMS) Menopause related conditions Dysmenorrhea

3 CASE 1: A 33-year-old woman presented with amenorrhea and weight gain of kg, despite diet and exercise, as well as progressively worsening acne. She was diagnosed with polycystic ovary syndrome (PCOS) and treated with metformin, which she did not tolerate, and local creams for her acne were ineffective.

4 Amenorrhea Means Absence of menstruation. It is either primary (no menstruation up to 16 years) or secondary (missed menstruation for three months and more in middle aged women). Symptoms are swollen breasts, headaches, excess facial hair, acne and pelvic pain. Causes : - Pregnancy, breastfeeding or menopause. - Hormone imbalance either due to thyroid malfunction, pituitary tumor or polycystic ovary syndrome (PCOS). - Low body weight, excessive exercise or stress.

5 Polycystic ovary syndrome (PCOS) Polycystic ovary syndrome is a disorder in which ovaries develop numerous small collections of fluid called follicles and may fail to release eggs. 1- The pituitary gland produces excess luteinizing hormone (LH) and insulin which increases the production of male hormone (testosterone) by the ovary. 2- Some testosterone may be converted to estrogen causing increase in its levels in the blood without change in progesterone level causing hormonal imbalance, leading to stop ovulation and irregular menstrual cycle.

6 Diagnosis The patient suffers from: Secondary amenorrhea caused by PCOS.

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8 Herbal management 1-Chaste berrry: The most common herb in treatment of (PCOS). Contains iridoid glycosides (agnoside & aucubin) and flavonoids. Act by regulating the hormones, reduces prolactin secretion and helps to increase progesterone production. It also stabilizes mood swings and headaches, hot flashes associated with PMS or early menopause.

9 Herbal management 2-Black cohosh: Contains triterpene glycosides (actein), phytoestrogens (formononetin isoflavonone) that acts as selective estrogen receptor modulator and restore hormonal balance. It can be used as an alternative to clomiphene citrate for ovulation induction in women with polycystic ovarian syndrome.

10 Herbal management 3-Saw palmetto: can help with hirsutism and hair loss due to its anti androgenic properties. 4-Licorice: interferes with testosterone production. 5-Cinnamon: regulate menstrual cycles in women with PCOS by improving the body s ability to process glucose and insulin.

11 Formula??? Omega-3 fatty acids Improves free testosterone levels that causes increased hair growth, acne and hair loss. It also improves the quality of eggs produced from the ovaries, improving fertility. Vitex agnu castus (Chasteberry) Cinnamon bark Saw palmetto Maca root A highly-nutritious radish-like root. That contains vitamins, minerals, and amino acids. Stimulate hormone production by nourishing the pituitary and endocrine glands, causing them to more efficiently produce natural hormones.

12 CASE 2 Lucy, a 29-year old marketing manager, found her work very stressful. She faced pressure from her mother to start a family and suffered from classic PMS symptoms: mood swings with extremes of irritability, abdominal bloating and tender, swollen breasts, plus painful, heavy periods.

13 Diagnosis The patient suffers from: Premenstrual syndrome (PMS)

14 Premenstrual syndrome (PMS) Describes symptoms a woman may have a few days before her menstrual cycle, including tender breasts, bloating, cramps, mood swings, and headache. The exact cause of PMS is not clear, but it is believed that the decline in hormone levels (estrogen and progesterone) during the week before period triggers the symptoms. Changes in brain chemicals or deficiencies in certain vitamins and minerals may also play a role. Too many salty foods, alcohol, or caffeine may make symptoms worse as well.

15 Life style management 1- Regular exercise. 2- Maintain a healthy diet, with plenty of fruits, vegetables and whole grains. 3- Avoid salt, sugar, alcohol and caffeine. 4- Get an adequate amount of sleep and don t smoke. 5- Dietary supplements such as folic acid, calcium (with vitamin D), magnesium and vitamins B-6 and E may alleviate some of the symptoms of PMS. Herbal management: Black cohosh or Chaste berrry.

16 Herbal management Researchers studied the effect of chasteberry extract on women with PMS and it showed that chasteberry extract significantly improved PMS symptoms (mood changes, irritability, anger, headache, bloating and breast engorgement) compared to the placebo group. A 2012 study published in the journal, Acta Medica Iranica Another study showed that the combination of chasteberry and St. John s wort was superior to placebo for all the PMS symptoms tested but especially for anxiety and bloating. A 2009 study published in the Journal of Alternative and Complementary Medicine

17 Formula 1 Chaste tree berry Evening primrose oil Peppermint Black cohosh Angelica root (Dang qui) (Angelica sinensis). St. John's wort

18 Formula 1 Evening primrose oil: contains essential fatty acids (γ-linolenic acid) metabolize into dihomo- γ-linolenic acid, a precursor for anti-inflammatory prostaglandins that helps to alleviate breast pain. Peppermint: contains volatile oil which relieve indigestion and eliminate gases which contribute to bloating. Angelica roots: contains essential oil with ligustilide as major constituent(ligustilide, inhibit uterian contractions) St. John's wort: (Hypericum perforatum) may aid in alleviating the moodiness accompany PMS.

19 Formula 2 White willow bark Uva-ursi Valerian root Juniper berry Licorice root Black cohosh

20 Formula 2 White willow bark: contains salicin which the body converts into salicylic acid. It works by lowering the body s levels of prostaglandins thus decrease the menstrual cramps. Uva ursi: contains hydroquinone derivatives (arbutin) neutralizes acidity in the urine, increasing urine flow, therefore reduces bloating and water retention. Valerian root: contains volatile oil & iridoid glycosides (valepotiriate) increases the conc. of GABA( inhibitory neurotransmitter) by inhibiting its catabolism which promotes relaxation. It may be indicated for the relief of insomnia and nervous restlessness.

21 Formula 2 Juniper berry: contains volatile oil (limonene, α-pinene,..) acts as antiinflammatory, carminative and diuretic. Licorice root: contains saponin glycoside glycyrrhizin which has strong anti-inflammatory action. It also exhibits weak estrogen-like activity due to its phytoestrogen content (glabridin, glabrene) so reduce PMS, hot flashes and other menopausal symptoms.

22 Formula 3 Each capsule contains: Chasteberry extract (standardized to 0.6% aucubin) Dandelion leaf extract (standardized to 3% vitexin). Passion flower extract Dong quai extract (Angelica sinensis) (standardized to 0.8% ligustilide).

23 Formula 3 Dong quai (Angelica sinensis), a superior tonic for gynecological problems, contains ligustilide (major essential oil component), and soothes smooth muscle spasms in the uterus. Passion flower calms and relaxes to address the restlessness, irritability and insomnia that often accompany PMS. Dandelion leaves are diuretics, helping with water retention and bloating.

24 CASE 3 1- Linda is 53 years old with lateral headache since she was in her teens. 2- Her pain worsened during college (frequency, peak). 3- Linda was pain free during her first pregnancy. 4- Menstrual periods are now very irregular & hot flashes. 5- Blood pressure was elevated to 142 over 90. Her examination is otherwise normal.

25 Diagnosis The patient suffers from: worsening of migraine through early menopause before reaching the postmenopausal due to hormonal levels fluctuation (Menstrual magnification)

26 Migraine-Hormone Link A drop in the female hormone, estrogen, can set off migraines. That's why women who get migraines often have headaches right before their period, when estrogen levels are low. During pregnancy, estrogen levels rise, bringing many women a break from these headaches. But they often start up again after the baby is born. As you get closer to menopause, your hormone levels can swing up and down, and your periods may get more irregular. If your migraines are tied to your menstrual cycle, they may become as unpredictable as your periods.

27 Case management Life style: 1- Regular exercise, sleep pattern, meals and weight loss. 2- Stress management and relaxation program. 3- Reduce caffeine and alcohol intake and avoid tobacco. Herbal management: -Chaste tree & feverfew (or ergotamine) - (+or -)Valerian (A study published in 2010 in the journal Archives of Internal Medicine)

28 Formula 4 Chaste berry fruit extract (5% agnosides) Feverfew (whole leaf and extract) 275 mg 100mg Feverfew: Contains sesquiterpene lactones (Parthenolide). Act as COX inhibitor decrease prostaglandins so act as prophylactic for classical migraine, also for premenstrual, menstrual, and other headaches.

29 CASE 4 55-year-old woman 2-year history of worsening sleep pattern coinciding with hot flashes and nocturia. She never feels rested upon awakening and describes feeling fatigued during the day, with low energy. Her other daytime symptoms include low motivation and poor concentration, and her mood is not "great,". Gastroesophageal reflux disorder (GERD) pain as "like having a heart attack."

30 Diagnosis The patient suffers from: Menopause and insomnia

31 Insomnia It is a persistent disorder that can make it hard to fall asleep. Some causes includes: 1- Depression, Stress and anxiety. 2- Medical conditions: nocturia, GERD, Heart failure, lung disease,. 3- Hormonal fluctuation (estrogen and progesterone) and menopausal hot flashes.

32 Insomnia Her insomnia could relate to: a) Menopause only. b) Depression only. c) GERD only. d) Menopause and GERD but not depression. e) Menopause, GERD, and depression.

33 Herbal management 1- Phytoestrogenic plants: Provide powerful plant compounds called phytoestrogens that mimic the hormones effects (bind to estrogen receptors in the uterus, breast,. lessening hot flashes, vaginal dryness, headache, insomnia, depressive mood, and other hormone related symptoms). e.g. Black cohosh, Soy bean and red clover.

34 Herbal management Black cohosh: contains phytoestrogenic isoflavone the precurssor of daidzein. (formononetin) Soy bean: contains phytoestrogenic isoflavone (genistein and daidzein) Red clover: contains methylized precursors: biochanin A and formononetin. It exerted an improvement of sleep, scalp hair and skin status as well as, mood and tiredness in postmenopausal women.

35 Herbal management 2- Aphrodisiac herbal supplements: These herbs stimulate hormone production by nourishing the pituitary and endocrine glands, causing them to more efficiently produce natural hormones. e.g. MACA root ( Lepidium meyenii) a highly-nutritious radish-like root. That contains vitamins, minerals, and amino acids. It reduce mood swings and the intensity of menopause symptoms.

36 Herbal management Valerian: Contains valepotriates and valeric acid,.. It increases concentration of GABA (δ amino butyric acid,inhibitory neurotransmitter,) by inhibiting its catabolism leading to CNS depression

37 Formula 5 Each capsule contains: Black Cohosh extract 80 mg,cimicifuga racemosa (2.5% triterpene glycosides) Chasteberry extract 80 mg,vitex agnus-castus (0.6% aucubin). Licorice root extract 75 mg,glycyrrhiza glabra (12% glycyrrhizin). Wild Yam extract 75 mg, Dioscorea villosa (10% disogenin). Hops extract 25 mg, Humulus lupulus (2% resins).

38 Formula 5 Triterpene glycosides of Black cohosh in addition to phytoestrogens restore the normal hormonal balance, aucubin and other glycosides of Chaste berries act centrally to restore FSH,LH balance and affect serotonin so eases hot flushes. Licorice and Wild yam: anti-inflammatory. Resin of hops: affect GABA receptors inducing sedative, hypnotic action.

39 Formula 6 Black Cohosh Damiana Chasteberry Wild yam root Quercetin helps with depression, and mood swings, associated with menopause antioxidant with anti-inflammatory.

40 Formula??? Dong Quai(Angelica root) Soy Isoflavones Wild Yam Root Black Cohosh Indicated for climacteric symptoms as hot flashes, insomnia, mood swings.

41 Formula??? Chasteberry Wild yam Valerian (sedative,antispasmodic) Red clover Dong Quai Licorice Black cohosh Ashwagandha (anti-stress) Dandelion Actions : 1-Helps relieve symptoms of normal Perimenopause and Menopause, as hot Flashes. 2-Supports healthy hormone balance during Perimenopause and Menopause

42 CASE 5: A 14-year-old female complaining of severe painful periods for the past six months. She began menstruating 10 months ago with her first two periods occurring about 2 months apart without pain or any other symptoms. Since then, she menstruates every 28 days and also notices nausea, diarrhea and headaches during her periods. The pain has gotten so bad for 3 days each month that she often misses school.

43 Dysmenorrhea A medical term for the painful cramps that may occur immediately before or during the menstrual period. There are two types of dysmenorrhea: Primary dysmenorrhea: common menstrual cramps usually begin one to two years after a woman starts getting her period. Pain usually is felt in the lower abdomen or back. They often start shortly before or at the onset of the period and continue one to three days. They usually become less painful as a woman ages and may stop entirely after the woman has her first baby. Secondary dysmenorrhea: is pain caused by a disorder in the woman's reproductive organs.

44 Diagnosis The patient suffers from: Primary dysmenorrhea

45 Herbal management In a clinical trial, an herbal capsule (Menstrugol ) containing extract of 3 plants (saffron, anise and celery) worked for primary dysmenorrhea and had better and more proper effects than placebo, mefenamic acid. Saffron, a stigma of Crocus sativus, contains the pigment crocin. Anise or fennel fruit: contain volatile oil (mainly anethole) act as antispasmodic. They also known to be able to promote menstruation, alleviate the symptoms of female climacteric. Celery seed extract (Apium graveolens), contains v.o.,phthalids, flavonoids act as anti-inflammatory, antispasmodic

46 Formula??? Ginger Chamomile Dong Quai(Angelica root) Fennel Dysmenorrhea formula, Ginger helps with GIT symptoms. Chamomile, Fennel and Dong Quai relaxes smooth muscles of uterus Uses :primary dysmenorrhea