fisiologi haid dan gangguan haid

8/16/2019 Fisiologi Haid Dan Gangguan Haid

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Fisiologi Haid danGangguan Haid


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FSH

LH

Estradiol

Progesterone

'()OH Progesterone

EstradiolFSH

LH

E r/PE r/P

FISIOLOGI OVULASI / MENSTGnRH

GONADOTROPIN

ESTROGEN

&

PROGESTERON

ENDOMETRIUM

2 4 6 8 10 12 14 16 18 20 22 24 26 28

Estradiol

SHLH

Progesterone

'()OH Progesterone

Progesterone1!"#HP

$g%m&

'*

+

,

(

-

/

0

1

'

#'(


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FISIOLOGI OVULASI/MENSTRUASI

PE&)R)H*$ +*R,$G*$PLASMINOGEN

-G"

Plasminogen

Aktivator

-G" -,.P

DEGRADASI

MATRIKS

PLASMIN

Metalloroteinase

!amil"• #ollagenases• Gelatinases• Stromel"sins

$aminin% !ibronetin%

'olagen beri(atan )g

Mole(ul a)esi

*integrins+

⊕

⊕

⊕

⊕

Plasminogen

Aktivator inhibitor

Leon Speroff and Frits marc A. Clinical Gynecologic Endocrinology and Infertility. Ed. VII TH. Lippincott Williams

Wil!nis "#iladelp#ia $%&&'( p ) **+ , *--

'eluarga

Metalloroteinase• 'olagenases• Gelatinases• Stromel"sins

Peluruhan

Endometrial


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L

L

L

L

LL L

LL

L

L

L

MMP

MMP

MMPMMP

MMPMMP MMP

MMP

MMP

MMP

MMP

MMP

P2 P2P2

P2 P2


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FISIOLOGI MENSTRUASI

Perdara/an d menstruasi normali/entikan ole/

Keseimbangan antara :

Koaglasi

! T"! PAI#$! PG"%α $&asokonst'(! T)#A% *Platelet +Aggregator(

ET,

"ibrinol-tik . Proteolitik

! En/-me 0roteol-ti1

*Plasminogen(! PGE% *&aso2ilator(! PGI% *Platelet Inhibitor(

ET,

A. Kolaps jaringan yang terjadi serentak

B. Vasokonstriksi memanjang

C. Stasis pembuluh darah

D. Pemulihan yg dipengaruhi E

Not by uterine contractionE & P ,ith)ra,al blee)ing a)alah er)arahan "ang aling stabil


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MENSTRUASI NORMAL

ITE/VAL $SI0L1S( %- 2 +' Hari

31/ASI + 2 4 Hari

ALI/ $V5L16E( +& , 7& ml

'/'/

O3O30 )0 ) ((

'/'/

SS

'*'* '/'/

1,1,

O3O3

11//

O3O3

11'''/'/

00


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P.U.A

FISIOLOGI MENSTRUASI

P.U.D


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Perdarahan Uterus Abnorma

Menoragia Metroragia

!#'ulasi ⊕!Siklus Reguler

!urasi an3ang

!Perdara/an an5ak

!#'ulasi ⊕ %!Siklus ,regular

!urasi an3ang

!Perdara/an an5ak


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Diagnosis Menoragia

4linis

Tidak ada gangguan

Hormon steroid seks

4eseim5angan

!Siklus Reguler!Perdara/an an5ak!#'ulasi ⊕

4oagulasiFi5rinolitik 6

Proteolitik

Asam Traneksamat


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Abnormalitas

E 5 P 6ith)ra,al Blee)ing

Pen"embuhanDistimulasi

oleh Estrogen'olas 7aringan

Seara Serenta(

8aso(onstri(si$ama

Stasis

PembuluhDarah

Menoragia

*O9ulasi ⊕+⊕ ⊕

Ti)a(Seimbang ⊕

Asam Traneksamat

AINS


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.E$#R*G,*

! #'ulasi ⊕

!Siklus Reguler

! urasi &ama ⊕ %! Perdara/an


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P.U.A

Menoragia Metroragia

!#'ulasi ⊕

! Siklus Reguler

! urasi &ama! Perdara/an


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.etroragia

BU'AN PUD PUD Hormonal

• Patologi Tra(tusRero)u(si

• Gangguan'oagulasi Darah

*ITP% $eu(emia+

• Obat3obatan *Obat Tra)isional+

E 5 P

6-B

De;- !ase

$uteal

Polimenore

BTB 6-B BTB 6-B

$o, Dose o;

#ombine)

O-#-

P E

Ano9ulasiUnuose) E-

*E Berlebihan+

BTB• DMPA• Imlant


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Abnormalitas

E 5 P 6ith)ra,al Blee)ing

Pen"embuhanDistimulasi

oleh Estrogen'olas 7aringan

Seara Serenta(

8aso(onstri(si$ama

Stasis

PembuluhDarah

Menoragia

*O9ulasi⊕

+ ⊕ ⊕

Ti)a(Seimbang

⊕

P-U-D

*Ano9ulasi <Unuose) E+

⊕


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P)ES-R#GE$


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FSH

LH

Progesterone

'()OH Progesterone

FSH

LH

Estradiol

Progesterone

'()OH Progesterone

EstradiolFSH

LH

2 4 6 8 10 12 14 16 18 20 22 24 26 28

Estradiol

SH

LHProgesterone

'()OH Progesterone

Progesterone1!"#HP$g%m&

'*

+

,

(

-

/

0

1

'

,S,#G, .E$S-R)*S,

FSH

LH

Progesterone

'()OH Progesterone

O9ul-


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P))$)PP#SE ES-R#GE$

ES-R#GE$


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P))$)PP#SE E

E


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)<)$#PP#SE E

E?CESS,@E E 7

)o9 to

Diagnose


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)<)$)PP#SE E

E?CESS,@E E 7

-/ere is no

! Pregnan1- *Abortion e1to0i1 0regnan1-(! Me2i1ation *in1l2e2 tra2itional me2'(! Disor2ers o8 bloo2 1oaglation! Re0ro21tive tra1t 0atholog- *tmor in8e1tion et1'(! Trama

! )istor- * Age Parit- ,-1le et1'(! Ph-si1al E4am' *In1l2e2 6MI et1'(! Laborator- e4am' *Pregn' test )emostati1 8n1t' et1'(! Others *6EM T&S SIS ; )-st' D4'(


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< E .

Age = >/ "ears

Age ? >/ "- ,ith

ris( o; malignan"

Hea9" blee)ing &

inter9al ? .@ )a"s

!ailure o; me)iinal

treatment


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H( (

! Premeno0ase D36

! 6EM : No Abnormalit-

! "ailre o8 Me2i1inal Treatment


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STEP TREATMENT GOAL

7

StopBleeding

Medi8inal

&47E •

Me)ial #urettage

3 Progestogen 3 Estrogen & rogestogen •

E 5 P ,ith)ra,al blee)ing →

Tissue ollase

• NSAIDs or Anti !ibrinol"ti *Trane:ami Ai)+

• #oagulation

Surgi8al • #urettage • Tissue #ollaseII

ReurrenePre9ention

Medi8inal&

47E• #ombine) O-# • Regular "le• !amil" lanning• DMPA • En)omet- gro,th suression

• !amil" lanning• #"li Progestogen Thera" • Regular "le

•#lomihenitrate

•O9ulation *In;ertilit" ases+

Surgi8al •En)ometrial Ablation•H"steretom"

• #oml- En)om- A)hesion


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DUB Treatment

nderlying Diseases !

" #besity$

" PC#s$

" %nsulin &esistan'e

Be (are to

Delayed Clini'al %mpa't !

A. )alignan'y !

* Breast + ,-

* Endometrial + /- B. 0%DD)

C. CVD

D. Et'


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HO9 LO:2 THE STEP 77

T%E;TME:T OF #!B

Teenager

Rero3)uti9e

Age

• O#• #"li P-

"les

In;ertilit" ## Ho, $ong 4

./ "ears o; ol)Regular "les

Multiara O#

Peri

menoause

• $o, Dose ne, Gen- #O#s• DMPA• GnRHa

Meno

ause

Serm

Tube% <

Peritoneal !ator

Preg

nantO9ula3

tion

*? Months+

#ontraetion

Reg- #"les <

Amenorrhea


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