Fisiologi Haid dan

Gangguan Haid
 

Hipotalamus
Long F.B Sort F.B
     r
!ltra Sort FB
     e
     t "#o$n %eg.
     t
      i GnRH
     m
     s Sekresi Pulsasi
     n
     a
     r dalam
     t “Critical Range”
     o
     r
    u
     e
      N
Inhibin B
Hipofisis FSH & LH
E&P

Ovary

Folikulogenesis
Steroidogenesis
&
oogenesis
 E & P
Ovulasi
Menstruasi Tunggal
 

GnRH Progesterone
1!"#HP
FISIOLOGI OVULASI / MENST
$g%m&

'*
GONADOTROPIN
+

LH Progesterone
, LH
SH
( FSH
FSH
- Estradiol


LH
/

0
Estradiol
1

' Estradiol '()OH Progesterone

'()OH Progesterone

ESTROGEN Progesterone

& #'(
2 4 6 8 10 12 14 16 18 20 22 24 26 28
PROGESTERON

ENDOMETRIUM E r/P
 

FISIOLOGI OVULASI/MENSTRUASI
PE&)R)H*$ +*R,$G*$
PLASMINOGEN
Plasminogen
Aktivator ⊕
PLASMIN

Plasminogen
-G"
⊕ Aktivator inhibitor

Metalloroteinase
'eluarga  $aminin% !ibronetin%
!amil"
Metalloroteinase ⊕ 'olagen beri(atan )g
• • #ollagenases
'olagenases Mole(ul a)esi
*integrins+
• • Gelatinases
Gelatinases
• • Stromel"sins
Stromel"sins
-G" -,.P
⊕  
Peluruhan
DEGRADASI
MATRIKS Endometrial
Leon Speroff and Frits marc A. Clinical Gynecologic Endocrinology and Infertility. Ed. VII TH. Lippincott Williams 
Wil!nis "#iladelp#ia $%&&'( p ) **+ , *--
 

P2 P2 P2

MMP MMP
MMP MMP MMP

L L
L L MMP L

MMP L
MMP MMP MMP P2 MMP
P2 MMP
L L L L
L L
 

FISIOLOGI MENSTRUASI
Perdara/an d menstruasi normal
i/entikan ole/ 

 A. Kolaps jaringan yang terjadi serentak

B. Vasokonstriksi memanjang
C. Stasis pembuluh darah
Keseimbangan antara :

"ibrinol-tik . Proteolitik Koaglasi

! En/-me 0roteol-ti1 ! T"

 
!
*Plasminogen(  !
!
PAI#$
PGE% *&aso2ilator( PG"%α $&asokonst'(
! PGI% *Platelet Inhibitor( ! T)#A% *Platelet +Aggregator(
  ET,   ET,

D. Pemulihan yg dipengaruhi E

E & P ,ith)ra,al blee)ing a)alah er)arahan "ang aling stabil

Not by uterine contraction
 

MENSTRUASI NORMAL

ITE/VAL $SI0L1S( %- 2 +' Hari

31/ASI +24 Hari

ALI/ $V5L16E( +& , 7& ml

0)( O3 S
1,
'/ '/

O3
1/
'* '/

O3
0
1' '/
 

P.U.D P.U.A

FISIOLOGI MENSTRUASI
 

Perdarahan Uterus Abnorma

Menoragia Metroragia

! #'ulasi ⊕ ! #'ulasi ⊕ %

! Siklus Reguler ! Siklus ,regular
! urasi an3ang ! urasi an3ang
! Perdara/an an5ak ! Perdara/an an5ak
 

,nter'al urasi
*normalitas *lir
Hari7 Hari7

#ligomenore  9:

Pol5menore ; 24

.enoragi  Regler

.etroragi Iregler

Leon Speroff and Frits marc A. Clinical Gynecologic Endocrinology and Infertility. Ed. VII TH. Lippincott Williams &
Wilnis !"iladelp"ia #$%%' p ( )* + *$
 

.E$#R*G,*
! #'ulasi ⊕
! Siklus Reguler

Sistemik Iatrogenik Patologi Pelvis 3ne40laine2

Gangg8an • IU#Ds   !ibroi)s * ./ 0 1/2+ Hormonal
"em9e!8an 3ara#   3 Inhibisi Hemostasis 4
Hipotiroid
• 'ontrasesi
Hormonal
$o(al
  3 $uas Permu(aan ↑↑ 'eti)a(seimbangan
Etc. • Et-   3 Angiogenesis antara 

•  En)ometriosis
*A)enomiosis+ !ibrinoliti( 5
Proteoliti( 'oagulasi
• Poli En)ometrial
• En:yme proteolytic • TF
  $"lasminogen( • "AI,*
• P-I-D
• "GE% • "GF%α 
$Vasodilator( $Vasoconst.(
• "GI% • TH,A% $"latelet
$"latelet In#i9itor( ,Aggregator(
• Etc • Etc
 

Diagnosis Menoragia
4linis
! Siklus Reguler
! Perdara/an an5ak
! #'ulasi ⊕

Tidak ada gangguan 4eseim5angan

Hormon steroid seks

4oagulasi
Fi5rinolitik 6
Proteolitik

 Asam Traneksamat
 

E 5 P 6ith)ra,al Blee)ing
Pen"embuhan
Abnormalitas Stasis Distimulasi
'olas 7aringan 8aso(onstri(si oleh Estrogen
$ama  Pembuluh
Seara Serenta(
Darah

Menoragia 
Ti)a(
*O9ulasi ⊕ + ⊕ ⊕ Seimbang   ⊕

AINS
 Asam Traneksamat
 

.E$#R*G,*

! #'ulasi ⊕
! Siklus Reguler

! urasi &ama ⊕  %
! Perdara/an <an5ak

Une:laine)
*'eti)a(seimbangan antara 'oagulasi 3 !ibrinolisis+

Treatment
Non Hormonal Hormonal

• AIS • I1C3s "

• Antifi9rinoliti! • "50

• 6emper9ai!i fragilitas !apiler • "rogestogen 5ral

• Sim8lator Hemostasis Endogen •  Lain%

,
)
3ana:ol
  , Gestrinone
  , Gn/Ha
 

P.U.A

Menoragia Metroragia

! #'ulasi ⊕ ! #'ulasi ⊕ %

! Siklus Reguler ! Siklus ,reguler
! urasi &ama ! urasi &ama
! Perdara/an <an5ak
! Perdara/an <an5ak
 

.etroragia

BU'AN PUD PUD Hormonal

• Patologi Tra(tus
Rero)u(si E5P P E

• Gangguan
'oagulasi Darah
6-B BTB 6-B BTB 6-B
  *ITP% $eu(emia+

• Obat3obatan De;- !ase

  *Obat Tra)isional+ $uteal $o, Dose o; • DMPA BTB
#ombine) • Imlant
O-#-
Ano9ulasi
Polimenore Unuose) E-
*E Berlebihan+
 

E 5 P 6ith)ra,al Blee)ing
Pen"embuhan
Abnormalitas Stasis Distimulasi
'olas 7aringan 8aso(onstri(si
Pembuluh oleh Estrogen
Seara Serenta( $ama 
Darah
Menoragia Ti)a(
*O9ulasi ⊕ +   ⊕ ⊕ Seimbang   ⊕
P-U-D
*Ano9ulasi <
Unuose) E+
  ⊕
 

P)
ES-R#GE$ <ER&E<,H*$7

E ↑↑
*UNOPPOSED+

En)ometrium
Proli;erati;
*Hierlasia+

Rauh
 

Progesterone
1!"#HP ,S,#&#G, .E$S-R)*S,
$g%m&

'*

, LH Progesterone
LH
LH LH
( SH
FSH FSH
FSH
- FSH
Estradiol


/
LH
0

' Estradiol

Estradiol '()OH Progesterone '()OH Progesterone

'()OH
'()OH Progesterone
Progesterone
Progesterone
Progesterone
Progesterone
2 4 6 8 10 12 14 16 18 20 22 24 26 28

O9ul-
 

P)
)$)PP#SE ES-R#GE$
ES-R#GE$ <ER&E<,H7

INTER&AL IREG3LER

D3RASI MEMAN5ANG

6ERAT
ALIR
*3M3MN7A(
 

P)
)$)PP#SE E
E  <ER&E<,H 7

PER*R*H*$
<*$=*> 

! En2ometrim Ra0h *)i0er0lasia(

# Le0asn-a 5aringan Ikat
  # Pemblh Darah 6an-ak

! Pele0asan En2ometrim : 8okal ti2ak serentak

  *Ti2ak a2a Kola0s 5aringan(
 

)<
)$#PP#SE E
E?CESS,@E E  7

)o9 to
Diagnose

<5 EAclusion
 

)<
)$)PP#SE E
E?CESS,@E E  7

-/ere is no

! Pregnan1- *Abortion e1to0i1 0regnan1-(

! Me2i1ation *in1l2e2 tra2itional me2'(
! Disor2ers o8 bloo2 1oaglation
! Re0ro21tive tra1t 0atholog- *tmor in8e1tion et1'(
! Trama

! )istor- * Age Parit- ,-1le et1'(

! Ph-si1al E4am' *In1l2e2 6MI et1'(
! Laborator- e4am' *Pregn' test )emostati1 8n1t' et1'(
! Others *6EM T&S SIS ; )-st' D4'(
 

<E.
 Age = >/ "ears
 Age ? >/ "- ,ith
ris( o; malignan"
 Hea9" blee)ing &
inter9al ? .@ )a"s
 !ailure o; me)iinal
treatment
 

-@S

 ,hea0 non invasive

 Get more in8ormation :
  # Thi1kness o8 en2ometrim
  # Others 0athologi1al 1on2ition
  *m-oma 1-st ov' Et1'(
 

H( (

! Premeno0ase D36
! 6EM : No Abnormalit-
! "ailre o8 Me2i1inal Treatment
 

Anti;ibrinol"tis

E 5 P 6ith)ra,al Blee)ing
Estrogen
Abnormalit" Prolonge) In)ue)
Simultaneous o; 8asular
8asoonstrit Healing
Tissue #ollase Stasis
ion
Menorrhagia
*O9ulation +   ⊕ ⊕ imbalane   ⊕
D-U-B
*Ano9ulation <
Unuose) E+
  ⊕

Anti;ibrinol"tis
Hormonal Treatment
 

STEP TREATMENT GOAL

7
Stop
Medi8inal
&
•  3Me)ial #urettage
Progestogen
• E 5 P ,ith)ra,al blee)ing → 
Tissue ollase
Bleeding 47E   3 Estrogen & rogestogen

•  NSAIDs or Anti !ibrinol"ti

*Trane:ami Ai)+
• #oagulation
Surgi8al • #urettage • Tissue #ollase
II Medi8inal • #ombine) O-# • Regular "le
Reurrene
Pre9ention
&
47E
• !amil" lanning
• DMPA • En)omet- gro,th suression
• !amil" lanning
• #"li Progestogen Thera" • Regular "le
• #lomihenitrate • O9ulation *In;ertilit" ases+
Surgi8al •En)ometrial Ablation • #oml- En)om- A)hesion
•H"steretom"
 

DUBTr
eat
ment
Be (are to

nderlying Diseases !
" #besity$
" PC#s$
" %nsulin &esistan'e

Delayed Clini'al %mpa't !

 A. )alignan'y !
* Breast + ,- 
  * Endometrial + /- 
B. 0%DD)
C. CVD
D. Et'
 

HO9 LO:2 THE STEP 77

T%E;TME:T OF #!B

Teenager • O# ./ "ears o; ol)

 "les
• #"li P- Regular "les
Serm
O9ula3 Preg
In;ertilit" ## Ho, $ong 4 nant
Rero3 tion
Tube% <
)uti9e
Peritoneal !ator
Age
Multiara O# #ontraetion

• $o, Dose ne, Gen- #O#s

Peri • DMPA Reg- #"les < Meno
menoause • GnRHa  *?  Months+ Amenorrhea  ause
 

*()(<
Menorrhagia Metrorrhagia  

•  ⊕ O9ulation ∀   ⊕ ; 

• Regular #"le #"le • Be 9are <

Irreg8lar

• Prolonge) Duration • "rolonged;5normalities

!nderlying 38ration

• E:essi9e !lo, • E<essi=e >leeding

Imbalane Hormonal Non DUB DUB

o; oagulation
;ators Ano9ulation unoose) E
#onser9ati9e Ati9e
7 77

Stoe) Blee)ing Reurrent Pre9ention

• #onser9ati9e
surg-
En)ometrial
SAI3s C.5.C • C8rettage
ablation
Antifi9rinolytics • 6edicinal Teenage /eprod8cti=e Perimen
". contino8s
$Trane<amic Acid(
• P
age oause •  H"steretom"
Ra)ial surg-
5t#ers • P- #"li
5t#ers • E5P • #-O-# In;ertilit" C#ild not
• E E5P 3esired • P- #ontinous
• C.C • DMPA
&
• Gonadotropin • #-O-#
Trane:ami Ai) • DMPA • #-O-#
• 5t#ers
• Others 2n%Ha Surgial