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American Journal of Public Health Research
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The Implementation of a Tele-Homecare System with Service Oriented Architecture and HL7 Message Transmission Standard
Ching-Sung Wang

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The Influence of Ethanol on Pyruvate Kinases Activity in Vivo, in Vitro, in Silico
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American Journal of Medical Sciences and Medicine
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Clinical and Histological Features in Wegener Granulomatosis
Li Cavoli Gioacchino, Passantino Rita, Bono Luisa, Tortorici Calogera, Ferrantelli Angelo, Giammarresi Carlo, Rotolo Ugo

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The Curse of Lymphatic Filariasis: Would the Continual Use of Diethylcarbamazine Eliminate this Scourge in Papua New Guinea?
Anne Lanham, Lillian Mwanri

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First Menstruation 2 Years after Her Last Delivery in Granmultiparous Sudanese Woman a Case Report

Wisal Omer Mohamed Nabag

Associate professor of obstetrics & Gynecology, Alziem ALazhari University, Sudan

Abstract: Introduction: Amenorrhea is the medical term for the absence of menstrual periods, either on a permanent or temporary basis Pregnancy is an obvious cause of amenorrhea and is the most common reason for secondary amenorrhea. Patient and Method: The patient was referred to Khartoum North Teaching Hospital, Khartoum state Sudan from remote area in North Sudan in May 2012. The patient was admitted, treated and discharged in a good condition. Results: 35 years patient married before her menarche had seven normal vaginal deliveries, at home running on her eight pregnancy referred as a case of deep vein thrombosis. She was treated and delivered vaginally term baby, six weeks latter IUCD was inserted as suitable method for her. The patient was lactating her baby for two years as usual then experience vaginal bleeding as abnormal and was proofed to be her normal menstrual. Discussion: Most girls begin menstruating between ages 9 and 18, with an average around 12 years old. The patient was get married at 12 years of age before her first menstruation and delivered her first child when she was 15 years old. She lactated her babies proper and had lactation amenorrhea. The lactation amenorrhea method has been shown to be 98% effective in typical use. IUCD was inserted after 2 years she regained her normal menstruation as a first time. Conclusion: Lactation amenorrhea is an effective method of contraceptive if it was fulfill certain criteria, known as "ecological breastfeeding” and of particular use in developing nations where contraceptives are not widely available or affordable.

Keywords: primary amenorrhea, lactation amenorrhea, granmultiparous, Intra Uterine Contraceptive Devise (IUCD)

Received August 15, 2013; Revised November 13, 2013; Accepted November 17, 2013

Citation: Wisal Omer Mohamed Nabag, First Menstruation 2 Years after Her Last Delivery in Granmultiparous Sudanese Woman a Case Report. American Journal of Medical Sciences and Medicine, 1 (5). 98-100. January 2013. doi:10.12691/ajmsm-1-5-5

1. Introduction

Amenorrhea is the medical term for the absence of menstrual periods, either on a permanent or temporary basis. Amenorrhea can be classified as primary or secondary. In primary amenorrhea, menstrual periods have never begun (by age 16), whereas secondary amenorrhea is defined as the absence of menstrual periods for three consecutive cycles or a time period of more than six months in a woman who was previously menstruating [1]. The menstrual cycle can be influenced by many internal factors such as transient changes in hormonal levels, stress, and illness, as well as external or environmental factors. Missing one menstrual period is rarely a sign of a serious problem or an underlying medical condition, but amenorrhea of longer duration may signal the presence of a disease or chronic condition. The normal menstrual cycle occurs because of changing levels of hormones made and secreted by the ovaries. The ovaries respond to hormonal signals from the pituitary gland located at the base of the brain, which is, in turn, controlled by hormones produced in the hypothalamus of the brain. Disorders that affect any component of this regulatory cycle can lead to amenorrhea. However, a common cause of amenorrhea in young females sometimes overlooked or misunderstood by the individual and others, is an undiagnosed pregnancy. Amenorrhea in pregnancy is a normal physiological function. Occasionally, the same underlying problem can cause or contribute to either primary or secondary amenorrhea. Primary amenorrhea is typically the result of a genetic or anatomic condition in young females that never develop menstrual periods (by age 16) and is not pregnant. Many genetic conditions that are characterized by amenorrhea are conditions in which some or all of the normal internal female organs either fail to form normally during fetal development or fail to function properly. Pregnancy is an obvious cause of amenorrhea and is the most common reason for secondary amenorrhea. Further causes are varied and may include conditions that affect the ovaries, uterus, hypothalamus, or pituitary gland [2].

Birth control for postpartum mothers who are breastfeeding can be complicated. Many women want to avoid hormonal contraceptives because they can interfere with lactation in some women. Nonpermanent birth control options are then limited to the copper IUD, condoms, the diaphragm, and natural methods such as natural family planning or the lactation amenorrhea method. Lactation amenorrhea is probably the least understood methods of birth control for postpartum breastfeeding women. While breastfeeding in and of itself is not a reliable form of birth control, lactation amenorrhea does provide a reliable contraceptive effect in women who adhere to certain rules. Lactation means to make breast milk, and amenorrhea means to not be having a monthly period. This method can only be used by women who are breastfeeding and have not yet had a period since giving birth. It sounds simple enough, but there is more to it than just lactation amenorrhea. In order for the lactation amenorrhea method to be effective, ALL of these criteria must be met: The baby must be less than six months old, the baby must nurse at least every six hours during the night and at least every four hours during the day, and the mother must not have had a postpartum period. If any one of these criteria is not met, then the method is no longer effective [3].

2. Patient and Method

The patient was referred to Khartoum North Teaching Hospital, Khartoum state Sudan from remote area in North Sudan in May 2012. The patient was admitted, treated and discharged in a good condition.

3. Results

35 years `Sudanese woman, married when she was 12 years (before menarche) and she delivered 7 babies vaginally without complications her babies were a live and well. she was referred in her eights pregnancy as a case of Deep venous thrombosis in her first trimester due to severe hypermesis gravid arum which was not hydrated in a hot weather in north Sudan..the woman was treated and delivered at term vaginally and 6 weeks after Intra uterine contraceptive devise (IUCD) was inserted as a suitable method of family planning after counseling because the patient had no idea or experience about family planning methods, usually she had lactation amenorrhea for 2 years following her all deliveries and she got pregnancy before she regained her menstruation. IUCD was followed after insertion, 2yeas later the patient weaned her child was reported complain of vaginal bleeding as abnormal for her she had no abdominal pain and no post coital bleeding. On general examination the patient looks well not pale, abdominal examination no area of tenderness and there was no masses, Speculum examination revealed that the IUCD threat was there in place, normal cervix and vagina. Certain investigation were requested to ruled out pregnancy either intra or extra uterine. complete blood count was normal, serum human Gonadotrophin was negative vaginal Ultrasound revealed normal size empty uterus IUCD in place normal pelvic organ and no adenxial masses. The patient was reassured and the vaginal bleeding was stopped in 7 days and regained after one month and then monthly as normal menstruation.

4. Discussion

The patient was get married at 12 years of age before her first menstruation which was so early, but was usual in our setup in Sudan especially in its remote areas. Most girls begin menstruating between ages 9 and 18, with an average around 12 years old. Primary amenorrhea typically occurs when a girl is older than 15 if she has undergone other normal changes that occur during puberty [1], the patient was delivered her first child when she was 15 years old. Then she had lactation amenorrhea for almost 2 years when she was get pregnancy for the second time, the same scenario was repeated itself 6 times until her eights pregnancy which was complicated with DVT. The lactation amenorrhea method has been shown to be 98% effective in typical use. This is as effective as oral contraceptives and more effective than condoms. Women should keep in mind, however, that the first postpartum ovulation can occur at any time and may not be preceded by a "warning" period. It is therefore advisable to use a backup method of birth control if the 2% possibility of pregnancy is not acceptable. The lactation amenorrhea method is of particular use in developing nations where contraceptives are not widely available or affordable. It is also beneficial to mothers in developed countries who wish to use the lactation amenorrhea method as a temporary hormone-free birth control until the milk supply is well established and the breastfeeding relationship is going well. Lactation amenorrhea can also be the primary method of birth control until an infant has begun, supplementing with solid foods. To make the lactation amenorrhea method the most effective, practicing what is known as "ecological breastfeeding" is advised. This involves breastfeeding the baby as often and for as long as the baby likes, even at night. No supplemental bottles are to be given, and no pacifiers are to be used. This is because the more the baby sucks at the breast the more ovulation-suppressing hormones are released into the mother's body [2], its the case in our patient because she is housewife, and she had no problem just to lactate her baby in addition to that In Sudan, especially in rural and low developing population, lack of enough accurate information, traditional and religious believes, false rumors, financial considerations and lack of strategic planning, are the major contributing factors preventing uses of contraceptives methods [4]. IUCD was suitable method for her condition because she was 35 years with DVT. 2 years after her delivery as usual for her to had lactation amenorrhea after that she started to menstruate but it abnormal for her to have vaginal bleeding usually she got pregnancy so the investigations rule pregnancy and she menstruate normally.

5. Conclusion

Lactation amenorrhea is an effective method of contraceptive if it was fulfill certain criteria, known as "ecological breastfeeding” and of particular use in developing nations where contraceptives are not widely available or affordable.

References

[1]   | Lobo RA. Primary and secondary amenorrhea and precocious puberty: etiology, diagnostic evaluation, management. In: Lentz GM, Lobo RA, Gershenson DM, Katz VL, eds. Comprehensive Gynecology. 6th ed. Philadelphia, PA: Mosby Elsevier; 2012:chap 38.
[2]   | Bulun SE. The physiology and pathology of the female reproductive axis. In: Melmed S, Polonsky KS, Larsen PR, Kronenberg HM, eds. Williams Textbook of Endocrinology. 12th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 17.
[3]   | Styne DM, Grumbach MM. Puberty, ontogeny, neuroendocrinology, physiology, and disorders. In: Melmed S, Polonsky KS, Larsen PR, Kronenberg HM, eds. Williams Textbook of Endocrinology, 12th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 25.
[4]   | Abdel Aziem A Ali*, et al. Use of family planning methods in Kassala, Eastern Sudan2011 http://www.biomedcentral.com/1756-0500/4/43#B14.