Fisiologi Haid

Views:
 
Category: Education
     
 

Presentation Description

No description available.

Comments

By: widiahitayani (37 month(s) ago)

boleh download dong

By: eddie_dr (38 month(s) ago)

izin download

By: aldila.noorfitriana (38 month(s) ago)

izin download :)

By: lathief (38 month(s) ago)

sip 2

By: abcdddd123 (38 month(s) ago)

izin download dok.

See all

Presentation Transcript

Fisiologi Haid : 

Fisiologi Haid dr. Reza Tigor Manurung, SpOG

Menstruasi/haid : 

Menstruasi/haid Peristiwa keluarnya cairan darah dari vagina perempuan berupa luruhnya lapisan dinding dalam rahim yang banyak mengandung pembuluh darah Siklik Panjang siklus: jarak antara mulainya haid yang lalu dan mulainya haid berikutnya

Slide 3: 

Haid normal  Akibat penurunan kadar progesteron/ovulasi Siklik: 25 – 31 hari sekali Lama: 3 – 6 hari Banyaknya: 30 – 60 cc (ganti pembalut 2 – 5 pembalut/hari)  sulit dinilai Variasi tinggi Ovulasi  pertengahan siklus

Haid Normal : 

Haid Normal Siklus haid dipengaruhi oleh berbagai hormon: GnRH LH, FSH Estrogen Progesteron

HYPOTHALAMIC- PITUITARY- OVARIAN AXIS : 

HYPOTHALAMIC- PITUITARY- OVARIAN AXIS

HYPOTHALAMIC ROLE IN THE MENSTRUAL CYCLE : 

HYPOTHALAMIC ROLE IN THE MENSTRUAL CYCLE The hypothalamus secretes GnRH in a pulsatile fashion GnRH activity is first evident at puberty Follicular phase GnRH pulses occur hourly Luteal phase GnRH pulses occur every 90 minutes Loss of pulsatility down regulation of pituitary receptors   secretion of gonadotropins Release of GnRH is modulated by –ve feedback by: steroids gonadotropins Release of GnRH is modulated by external neural signals

Slide 10: 

GnRH (gonadotropin releasing hormone) dihasilkan oleh hipotalamus, memicu hipofisis anterior mengeluarkan hormon FSH (follicle-stimulating hormone) dan LH (leuteinizing hormone)

Slide 11: 

FSH memicu pematangan folikel di ovarium  sintesis estrogen meningkat Estrogen  proliferasi endometrium Estrogen  hipofisis mengeluarkan LH

Slide 13: 

LH yang meningkat  Ovulasi  Korpus luteum  Progesteron Progesteron  endometrium sekretorik Progesteron  menghambat sekresi LH dan FSH hipofisis Bila tidak terjadi kehamilan  korpus luteum akan mengalami degenerasi  korpus rubrum, progesteron akan turun Akibatnya estrogen dan progesteron akan turun  menstruasi

PHASES OF THE MENSTRUAL CYCLE : 

PHASES OF THE MENSTRUAL CYCLE Ovulation divides the MC into two phases: 1-FOLLICULAR PHASE -Begins with menses on day 1 of the menstrual cycle & ends with ovulation ▲RECRUITMENT FSH  maturation of a cohort of ovarian follicles “recruitment”  only one reaches maturity

FOLLICULAR PHASE : 

FOLLICULAR PHASE MATURATION OF THE FOLLICLE (FOLLICULOGENESIS) ♥ FSH  primordial follicle (oocyte arrested in the diplotene stage of the 1st meiotic division surrounded by a single layer of granulosa cells)   1ry follicle (oocyte surrounded by a single layer of granulosa cells basement membrane & thica cells)   2ry follicle or preantral follicle (oocyte surrounded by zona pellucida , several layers of granulosa cells & thica cells)

FOLLICULOGENESIS (2) : 

FOLLICULOGENESIS (2)  tertiary or antral follicle 2ry follicle accumulate fluid in a cavity “antrum” oocyte is in eccentric position surrounded by granulosa cells “cumulous oophorus”

FOLLICULOGENESIS (2) : 

FOLLICULOGENESIS (2) SELECTION Selection of the dominant follicle occurs day 5-7 It depends on - the intrinsic capacity of the follicle to synthesize estrogen -high est/and ratio in the follicular fluid Ss the follicle mature   estrogen  FSH “-ve feed back on the pituitary”  the follicle with the highest No. of FSH receptors will continue to thrive The other follicles “that were recruited” will become atretic

Slide 20: 

FSH ACTIONS -recruitement -mitogenic effect   No. of granulosa cells  FSH receptor -stimulates aromatase activity  conversion of androgens  estrogens “estrone & estradiol” -  LH receptors ESTROGEN Acts synergistically with FSH to - induce LH receptors - induce FSH receptors in granulosa & thica cells LH  theca cells  uptake of cholesterol & LDL  androstenedione & testosterone

TWO CELL THEORY : 

TWO CELL THEORY

FOLLICULOGENESIS (3) : 

FOLLICULOGENESIS (3) OTHER FACTORS THAT PLAY A ROLE IN FOLLICULOGENISIS -INHIBIN Local peptide in the follicular fluid -ve feed back on pituitary FSH secreation Locally enhances LH-induced androstenedione production -ACTIVIN Found in follicular fluid Stimulates FSH induced estrogen production  gonadotropin receptors androgen No real stimulation of FSH secretion in vivo (bound to protein in serum)

PREOVULATORY PERIOD : 

PREOVULATORY PERIOD NEGATIVE FEEDBACK ON THE PIUITARY - estradiol & inhibin -ve feed back on pituitary   FSH -This mechanism operating since childhood POSITIVE FEEDBACK ON THE PITUITARY   estradiol (reaching a threshold concentration)   +ve feed back on the pituitary (facilitated by low levels of progestrone)   LH surge  secretion of progestrone Operates after puberty +ve feed back on pituitary   FSH

PREOVULATORY PERIOD : 

PREOVULATORY PERIOD LH SURGE Lasts for 48 hrs Ovulation occurs after 36 hrs Accompanied by rapid fall in estradiol level Triggers the resumption of meiosis Affects follicular wall  follicular rupture Granulosa cells  lutenization  progestrone synthesis

OVULATION : 

OVULATION The dominant follicle protrudes from the ovarian cortex Gentle release of the oocyte surrounded by the cumulus granulosa cells Mechanism of follicular rupture 1- Follicular pressure Changes in composition of the antral fluid   colloid osmotic pressure 2-Enzymatic rupture of the follicular wall LH & FSH  granulosa cells  production of plasminogen activator   plasmin   fibrinolytic activity  breake down of F. wall LH   prostglandin E   plasminogen activator   PG F2α   lysosomes under follicular wall

LUTEAL PHASE : 

LUTEAL PHASE LASTS 14 days FORMATION OF THE CORPUS LUTEUM After ovulation the point of rupture in the follicular wall seals Vascular capillaries cross the basement membrane & grow into the granulosa cells  availability of LDL-cholestrole LH  LDL binding to receptors  3α OH steroid dehydrogenase activity  progestrone Granulosa cells luteal cells corpus luteum  progesterone

LUTEAL PHASE : 

LUTEAL PHASE Marked  in progestrone secretion Progestrone actions: -suppress follicular maturation on the ipsilateral ovary -thermogenic activity  basal body temp -endometrial maturation Progestrone peak 8 days after ovulation (D22 MC) Corpus luteum is sustained by LH It looses its sensitivity to gonadotropins  luteolysis  estrogen & progestrone level  desquamation of the endometrium “menses”

LUTEAL PHASE : 

LUTEAL PHASE estrogen & progestrone   FSH &LH The new cycle stars with the beginning of menses If prgnancy occurs  hCG secreation  maintain the corpus luteum

HORMONAL PROFILES DURING THE MENSTRUAL CYCLE : 

HORMONAL PROFILES DURING THE MENSTRUAL CYCLE

ENDOMETRIAL CHANGES DURING THE MENSTRUAL CYCLE : 

ENDOMETRIAL CHANGES DURING THE MENSTRUAL CYCLE 1-Basal layer of the endometrium -Adjacent to the miometrium -Unresponsive to hormonal stimulation -Remains intact throughout the menstrual cycle 2-Functional layer of the endomietrium Composed of two layers: -zona compacta  superficial -Spongiosum layer

ENDOMETRIAL CHANGES DURING THE MENSTRUAL CYCLE : 

ENDOMETRIAL CHANGES DURING THE MENSTRUAL CYCLE 1-Follicular /proliferative phase Estrogen  mitotic activity in the glands & stroma   enometrial thickness from 2 to 8 mm (from basalis to opposed basalis layer) 2-Luteal /secretory phase Progestrone - Mitotic activity is severely restricted -Endometrial glands produce then secrete glycogen rich vacules -Stromal edema -Stromal cells enlargement -Spiral arterioles develop, lengthen & coil

MENSTRUATION : 

MENSTRUATION Periodic desquamation of the endometrium The external hallmark of the menstrual cycle Just before menses the endometrium is infiltrated with leucocytes Prostaglandins are maximal in the endometrium just before menses Prostaglandins  constriction of the spiral arterioles ischemia & desquamation Followed by arteriolar relaxation, bleeding & tissue breakdown

Slide 42: 

Dismenore Menarkhe Rata-rata: 12 tahun, range 10 – 16 tahun Menopause Mastodinia Mittleschmerz Premenstrual syndrome

Haid tidak Normal : 

Haid tidak normal, dan perdarahan yang menyerupai haid dapat dikelompokkan menjadi: Gangguan irama (normal 21-35 hari): Polimenore: haid dengan interval < 21 hari Oligomenore: haid dengan interval > 35 hari Amenore: tidak terjadi haid Perdarahan haid tidak teratur, dimana interval datangnya haid tidak menentu. Haid tidak Normal

Slide 44: 

2. Jumlah perdarahan tidak normal (normal 2-5 kali ganti pembalut/hari): Hipermenore: ganti pembalut > 6x perhari Hipomenore: ganti pembalut < 2x/hari 3. Gangguan dalam lama perdarahan (normal 2-5 hari): Menoragi: lama perdarahan > 6 hari dan jumlahnya banyak (> 80 cc) pada interval yang teratur Brakimenore: lama perdarahan < 2 hari 4. Perdarahan bercak (spotting) prahaid, pertengahan siklus, pasca haid

Slide 45: 

Metroragi: Gangguan haid dengan perdarahan menyerupai siklus haid yang terjadi di luar siklus haid normal. Menometrohagia: Gangguan haid dengan perdarahan yang banyak dan lama yang terjadi di luar siklus haid normal/tidak teratur

Perdarahan Uterus Abnormal : 

Perdarahan Uterus Abnormal Penyebab: Organik: Non-organik: Perdarahan Uterus Disfungsional (PUD)

Slide 47: 

Penyebab Organik: Kelainan Jinak Rahim: mioma, polip serviks Keganasan: kanker mulut rahim, kanker rahim Komplikasi dari kehamilan: kehamilan anggur, keguguran Infeksi: servisitis, endometritis Gangguan sistemik: penyakit darah, ggn hormon tiroid, stress Obat-obatan/iatrogenik: IUD, KB hormonal Trauma: laserasi

Slide 48: 

Penyebab Non-organik Perdarahan yang terjadi semata-mata hanya karena gangguan fungsional mekanisme kerja hipotalamus-hipofisis-ovatium-endometrium Bukan disebabkan oleh kelainan organik alat reproduksi Disebut juga sebagai Perdarahan Uterus Disfungsional (PUD) Merupakan penyebab perdarahan abnormal yang paling sering Terjadi pada usia perimenars, usia reproduksi, dan usia perimenopause