STUDY - Technical - New Dacian's Medicine
Oligomenorrhea
(Classical / Allopathic Medicine)
In
most women, menstrual bleeding occurs every 28 days, plus
or minus 4 days. Although some variation is normal,
menstrual bleeding at intervals of greater than 36 days
may indicate oligomenorrhea - abnormally infrequent
menstrual bleeding characterized by three to six menstrual
cycles per year. When menstrual bleeding does occur, it's
usually profuse, prolonged (up to 10 days), and laden with
clots and tissue. Occasionally, scant bleeding or spotting
occurs between these heavy menses.
Oligomenorrhea
may develop suddenly, or it may follow a period of gradually
lengthening cycles. Although oligomenorrhea may alternate
with normal menstrual bleeding, it can progress to secondary
amenorrhea.
HISTORY:
Ask the patient when the menarche occurred and whether she has ever experienced normal menstrual cycles.
Ask the patient to describe the pattern of bleeding as well as how many days the bleeding lasts and how frequently it occurs.
Ask the patient if she has been having symptoms of ovulatory bleeding or mild, cramping abdominal pain 14 days before she bleeds. Ask her if the bleeding is accompanied by premenstrual signs and symptoms, such as breast tenderness, irritability, bloating, weight gain, nausea, diarrhea, or cramping pain.
Check for a history of infertility. Does the patient have children or is she trying to conceive?
Ask the patient about her method of birth control.
Review the patient's medical history for gynecologic disorders such as ovarian cysts. If the patient is breastfeeding, has she experienced problems with milk production? If she hasn't been breastfeeding recently, has she noticed milk leaking from her breasts?
Ask the patient about recent weight gain or loss. Is the patient less than 80% of her ideal weight? If so, does she claim that she's overweight? Ask her whether she's exercising more vigorously than usual.
Screen the patient for a metabolic disorder by asking about excessive thirst, frequent urination, and fatigue. Ask the patient if she has been jittery or had palpitations. Also, ask about headaches, dizziness, and impaired peripheral vision.
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs. Also, ask the patient about alcohol intake.
Ask the patient when the menarche occurred and whether she has ever experienced normal menstrual cycles.
Ask the patient to describe the pattern of bleeding as well as how many days the bleeding lasts and how frequently it occurs.
Ask the patient if she has been having symptoms of ovulatory bleeding or mild, cramping abdominal pain 14 days before she bleeds. Ask her if the bleeding is accompanied by premenstrual signs and symptoms, such as breast tenderness, irritability, bloating, weight gain, nausea, diarrhea, or cramping pain.
Check for a history of infertility. Does the patient have children or is she trying to conceive?
Ask the patient about her method of birth control.
Review the patient's medical history for gynecologic disorders such as ovarian cysts. If the patient is breastfeeding, has she experienced problems with milk production? If she hasn't been breastfeeding recently, has she noticed milk leaking from her breasts?
Ask the patient about recent weight gain or loss. Is the patient less than 80% of her ideal weight? If so, does she claim that she's overweight? Ask her whether she's exercising more vigorously than usual.
Screen the patient for a metabolic disorder by asking about excessive thirst, frequent urination, and fatigue. Ask the patient if she has been jittery or had palpitations. Also, ask about headaches, dizziness, and impaired peripheral vision.
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs. Also, ask the patient about alcohol intake.
PHYSICAL
ASSESSMENT:
Take the patient's vital signs, and weigh her.
Check for increased facial hair growth, sparse body hair, male distribution of fat and muscle, acne, and clitoral enlargement.
Note if the skin is abnormally dry or moist, and check hair texture.
Be alert for signs of psychological or physical stress.
Take the patient's vital signs, and weigh her.
Check for increased facial hair growth, sparse body hair, male distribution of fat and muscle, acne, and clitoral enlargement.
Note if the skin is abnormally dry or moist, and check hair texture.
Be alert for signs of psychological or physical stress.
SPECIAL
CONSIDERATIONS:
Oligomenorrhea is common in infertile, early postmenarchal, and perimenopausal women because it's associated with anovulation. Usually, anovulation reflects abnormalities of the hormones that govern normal endometrial function.
Oligomenorrhea may result from an ovarian, hypothalamic, pituitary, or other metabolic disorder, or it may stem from the effects of certain drugs. It may also result from emotional or physical stress, such as sudden weight change, debilitating illness, or rigorous physical training. Oligomenorrhea in the perimenopausal woman usually indicates the impending onset of menopause.
Oligomenorrhea is common in infertile, early postmenarchal, and perimenopausal women because it's associated with anovulation. Usually, anovulation reflects abnormalities of the hormones that govern normal endometrial function.
Oligomenorrhea may result from an ovarian, hypothalamic, pituitary, or other metabolic disorder, or it may stem from the effects of certain drugs. It may also result from emotional or physical stress, such as sudden weight change, debilitating illness, or rigorous physical training. Oligomenorrhea in the perimenopausal woman usually indicates the impending onset of menopause.
PEDIATRIC
POINTERS:
Teenage girls may experience oligomenorrhea associated with immature hormonal function.
Prolonged oligomenorrhea or the development of amenorrhea may signal congenital adrenal hyperplasia or Turner's syndrome.
Teenage girls may experience oligomenorrhea associated with immature hormonal function.
Prolonged oligomenorrhea or the development of amenorrhea may signal congenital adrenal hyperplasia or Turner's syndrome.
PATIENT
COUNSELING:
Ask the patient to record her basal body temperature daily to determine if she's having ovulatory cycles. Remind the patient that she may become pregnant even though she isn't menstruating normally. Discuss contraceptive measures as appropriate.
Ask the patient to record her basal body temperature daily to determine if she's having ovulatory cycles. Remind the patient that she may become pregnant even though she isn't menstruating normally. Discuss contraceptive measures as appropriate.
Bibliography:
1. Rapid Assessment, A
Flowchart Guide to Evaluating Signs & Symptoms, Lippincott
Williams & Wilkins, 2004.
2. Professional Guide to
Signs and symptoms, Edition V, Lippincott
Williams & Wilkins, 2007.
3. Guide to common symptoms,
Edition V, McGraw - Hill, 2002.