menstruasi tidak teratur (sk 3 endokrin)

7/25/2019 Menstruasi Tidak Teratur (Sk 3 Endokrin)

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WRAP UP SKENARIO 3

BLOK ENDOKRIN

MENSTRUASI TIDAK TERATUR

Kelompok: A-1

KETUA : Kekar Yogantoro (11001113!"

SEKRETARIS : Lak#$% R%&ka A'%an% (11001110"

AN))OTA : A*%a Ne*+,a (11001100"

A,'%an-a Y+./a Ra-/$an.a (11001100"

Ar%,%a Ra$an.an% a$%n (11000201"

Ar%#a 4an%'a/ N5 (1100110!"

A+,%a 6%n%a Ar.e,%a (1100110!"

E,7a P+#%ta Sar% (110011089"

ara/ Eran.a (110011029"

aant% D;%


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MENSTRUASI TIDAK TERATUR

Seorang ;an%ta> 0 ta/+n> $a/a#%#;% +n%7er#%ta# ar#% .atang ke o,%k,%n%k RS .engan

ke,+/an /a%. t%.ak terat+r a%t+ #e?ak @ *+,an ang ,a,+5 Set%a /a%. ,a$ana 3 $%ngg+5

D+a /ar% %n%> /a%. *anak #eka,% (! gant% e$*a,+t #e/ar%"5 Pa#%en $en.aatkan /a%. ang

erta$a #e?ak +#%a 1 ta/+n> terat+r #et%a *+,an5

Pe$er%k#aan '%#%k .%.aatkan:

Kea.aan +$+$ : ta$ak +-at

Ke#a.aran : Ko$o#$ent%#

TD : 110=80 $$4g

Na.% : 80 =$en%t

ant+ng .an ar+ : .a,a$ *ata# nor$a,

Pe$er%k#aan ,+ar g%neko,og%:

A*.o$en:

In#ek#% : er+t ta$ak $en.atar

Pa,a#% : ,e$a#> '+n.+# +ter% t%.ak tera*a .% ata# #%$'%#%

A+#k+,ta#% : *%#%ng +#+# nor$a,

6+,7a=7ag%na : ',+k#+# (C"

Pe$er%k#aan en+n?ang:

US) )%neko,og% : +ter+# *ent+k .an +k+ran nor$a,> o7ar%+$ kanan .an k%r% nor$a,5

T%.ak ta$ak $a##a a.a a.nek#a kanan .an k%r%5

La* .ara/ r+t%n : 4* 10g=.L> tro$*o#%t 3005000=+L> ,a%n,a%n nor$a,

Ber.a#arkan e$er%k#aan .% ata#> Dokter $en.+ga ke,a%nan /a%. .%#e*a*kan o,e/ket%.ak#e%$*angan /or$ona,5

Pa#%en ?+ga *%ng+ng aaka/ ke,+/an %n% karena /a%. ata+ %#t%/a./a/ #e/%ngga rag+ .a,a$

$e,ak#anakan /+k+$ I#,a$5


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KATA-KATA SULIT

,+k#+# : ke,+arna -a%ran=,e,e/an .ar% t+*+/5

A.nek#a : ?ar%ngan ang *era.a .% #ek%tar ra/%$5

I#t%/a./a/ : .ara/ ang ke,+ar *+kan ;akt+ /a%. .an ?+ga *+kan .a,a$ te$o n%'a#5

+n.+# +ter% : *ag%an ata# .ar% +ter+#5


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PERTANYAAN

15 Kenaa 4* ren.a/

5 Kenaa /a%.na *erke,an?+tan

35 Kenaa /a%.na t%.ak terat+r

5 4or$on aa ang t%.ak #e%$*ang

!5 Kenaa a.a ',+k#+# a.a 7ag%na@5 Aaka/ 'aktor +#%a $e$engar+/%

95 Aaka/ a.a e$er%k#aan ta$*a/an

JAWABAN

15 Karena *anak .ara/ ang ke,+ar5

5 Karena 'aktor /or$on ang tergangg+5

35 Karena 'aktor /or$on ang tergangg+5

5 4or$on S4 L45

!5 Karena -a%ran /a%. ang a*nor$a,5

@5 Ya'a#e $enoa+#e

T%.akkarena a.a 'aktor ,a%n (#tre##> o*at> .,,5"95 Pe$er%k#aan .a,a$ .engan 6T .an #ek+,+$ -o-or *e*ek (*%,a #+.a/ $en%ka/"5


5/52

SASARAN BELAJAR

LI 15 Me$a/a$% .an $engeta/+% tentang anato$% a,at rero.+k#% ;an%ta

LO 151 Makro#ko%#

LO 15 M%kro#ko%#

LI 5 Me$a/a$% .an $engeta/+% tentang '%#%o,og% $en#tr+a#%LO 51 S%nte#%# .an Sekre#% 4or$on

LO 5 S%k,+# 4a%.

LI 35 Me$a/a$% .an $engeta/+% tentang ke,a%nan /a%.

LO 351 De'%n%#%

LO 35 Et%o,og%

LO 353 K,a#%'%ka#%

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LO 35! Man%'e#ta#% K,%n%k

LO 35@ D%agno#%# .an D%agno#%# Ban.%ng

LO 359 Tata,ak#ana

LO 358 Ko$,%ka#%

LI 5 Me$a/a$% .an $engeta/+% tentang /a%. .an %#t%/a./a/ .a,a$ an.angan I#,a$


6/52

LI 1. Memaam! "a# me#$e%a&! %e#%a#$ a#a%om! ala% 'ep'o"&k(! )a#!%a

LO 1.1 Mak'o(kop!(

15 Uter+#

Organ $+#k+,er ang te*a,> $e$%,%k% rongga .an *era.a .% antara 7e#%ka +r%nar%a

.%#e*e,a/anter%or .an rekt+$ .%#e*e,a/ o#ter%or5 Pan?ang +ter+# 95! -$ .an ,e*ar F ! -$

.engan*erat #ek%tar @0 gra$5S+at+ organ $+#k+,ar *er*ent+k #eert% *+a/ %r> .%,a%#%

er%tone+$ (#ero#a"5 Se,a$a ke/a$%,an *er'+ng#% #e*aga% te$at %$,atan#%> reten#% .an

n+tr%#% kon#et+#5 Pa.a #aater#a,%nan .engan a.ana kontrak#% .%n.%ng +ter+# .an

e$*+kaan #er7%k# +ter+#> %#%kon#e#% .%ke,+arkan5 Ter.%r% .ar% -or+#> '+n.+#> -orn+>

%#t/$+# .an #er7%k# +ter%5Bag%an +ter+# .%ata# %#t/$+# .%#e*+t -or+# +ter% .an *ag%an

.%*a;a/ %#t/$+# .%#e*+t #er7%k5 Da,a$ kea.aan nor$a, o#%#% +ter+# a.a,a/ ante',ek#% F

ante7er#%5 Ser7%k +ter% .%*ag% $en?a.% *ag%an: ar# 7ag%na,%# .an ar# #+ra7ag%na,%# G

.%*ag%an .a,a$ #er7%k ter.aat kana,%# #er7%ka,%#5 Uter+# a.a ke/a$%,an ,an?+t5 +n.+#*er*ent+k k+*a/ .an %n#er#% t+*a #erta ,%ga$ent+$rot+n.+$ .%*ag%an ata# -or+# +ter%5

Ter,%/at a#okan 7a#k+,ar ang /%ertro'%#5

a5 Ser7%k# +ter%

Bag%an ter*a;a/ +ter+#> ter.%r% .ar% ar# 7ag%na,%# (*er*ata#an = $ene$*+# .%n.%ng

.a,a$ 7ag%na" .an ar# #+ra7ag%na,%#5 Ter.%r% .ar% 3 ko$onen +ta$a: otot o,o#> ?a,%nan

(ko,agen .an g,%ko#a$%n" .an e,a#t%n5 Bag%an ,+ar .% .a,a$ rongga 7ag%na a%t+ ort%o-er7%-%#

+ter% (.%n.%ng" .engan ,+*ang o#t%+$ +ter% etern+$ (,+ar> ara/ 7ag%na" .%,a%#% e%te,

#k+a$oko,+$nar $+ko#a #er7%k#> .an o#t%+$ +ter% %ntern+$ (.a,a$> ara/ -a7+$"5 Se*e,+$

$e,a/%rkan (n+,,%ara = r%$%gra7%.a" ,+*ang o#t%+$ etern+$ *+,at ke-%,> #ete,a/

erna/=r%;aat $e,a/%rkan (r%$%ara= $+,t%gra7%.a" *er*ent+k gar%# $e,%ntang5 Po#%#%

#er7%k# $engara/ ke ka+.a,o#ter%or> #et%ngg% #%na %#-/%a.%-a5 Ke,en?ar $+ko#a #er7%k#

$eng/a#%,kan ,en.%r geta/ #er7%k# ang $engan.+ng g,%korote%n kaa kar*o/%.rat ($+#%n"


7/52

.an ,ar+tan *er*aga% gara$> et%.a .an a%r5 Kete*a,an $+ko#a .an 7%#ko#%ta# ,en.%r

#er7%k#.%engar+/% #%k,+# /a%.5

D%n.%ng +ter+# ter.%r% .ar% t%ga ,a%#an:

a" Per%ton%+$Me,%+t% .%n.%ng ra/%$ *ag%an ,+ar5 Men+t+% *ag%an ,+ar +ter+#5

Mer+akan ene*a,an ang .%%#% ?ar%ngan %kat .an e$*+,+/ .ara/ ,%$'e

.an +rat #ara'5 Per%tone+$ $e,%+t% t+*a .an $en-aa% .%n.%ng

a*.o$en5

*" La%#an otot

S+#+nan otot ra/%$ ter.%r% .ar% t%ga ,a%#an a%t+ ,a%#an ,+ar> ,a%#an

tenga/> .an ,a%#an .a,a$5 Pa.a ,a%#an tenga/ $e$*ent+k ,a%#an te*a,

ana$an #era*+t otot ra/%$5 La%#an tenga/ .%te$*+# o,e/ e$*+,+/

.ara/ arter% .an 7ena5 Lengk+ngan #era*+t otot %n% $e$*ent+k angka

.e,aan #e/%ngga #aat ter?a.% kontrak#% e$*+,+/ .ara/ ter?e%t raat>

.engan .e$%k%an en.ara/an .aat ter/ent%5 Mak%n keara/ #er7%k#> otot

ra/%$ $ak%n *erk+rang> .an ?ar%ngan %katna *erta$*a/5 Bag%an ra/%$

ang ter,etak antara o#te+$ +ter% %ntern+$ anato$%k+$> ang $er+akan

*ata# .ar% ka7+$ +ter% .an kana,%# #er7%ka,%# .engan o#te+$ +ter%

/%#to,og%k+$ (.%$ana ter?a.% er+*a/an #e,a+t ,en.%r ka7+$ +ter%

$en?a.% #e,a+t ,en.%r #er7%k#" .%#e*+t %#t/$+#5 I#t/$+# +ter% %n% akan

$en?a.% #eg$en *a;a/ ra/%$ .an $eregang #aat er#a,%nan5

-" En.o$etr%+$

Pa.a en.o$etr%+$ ter.aat ,+*ang ke-%, ang $er+akan $+ara .ar%

ke,en?ar en.o$etr%+$5 6ar%a#% te*a,> t%%#na> .an 'a#e enge,+aran ,en.%r

en.o$etr%+$ .%tent+kan o,e/ er+*a/an /or$ona, .a,a$ #%k,+#

$en#tr+a#%5 Pa.a #aat kon#e#% en.o$etr%+$ $enga,a$% er+*a/an

$en?a.% .e#%.+a> #e/%ngga $e$+ngk%nkan ter?a.% %$,anta#%

(n%.a#%"5La%#an e%te, #er7%k# *er*ent+k #%,%n.r%#> .an *er#%'at

$enge,+arakan -a%ran #e-ara ter+#$ener+#> #e/%ngga .aat $e$*a#a/%

7ag%na5 Ke.+.+kan +ter+# .a,a$ t+,ang angg+, .%tent+kan o,e/ ton+#

otot ra/%$ #en.%r%> ton+# ,%ga$ent+$ ang $enangga> ton+# otototot

angg+,5 L%ga$ent+$ ang $enangga +ter+# a.a,a/:

5


8/52

*5 M%o$etr%+$ *er+a otot o,o# t%ga ,a%# (.ar% ,+ar ke .a,a$ ara/ #era*+t

otot,ong%t+.%na,> ana$an .an #%rk+,ar"

-5 En.o$etr%+$ ang $e,a%#% .%n.%ng -a7+$ +ter%Se,a$a ke/a$%,an> #era*+t otot

ter#e*+t t%.ak *erta$*a/ *anak na$+n $enga,a$%/%ertro'%5

En.o$etr%+$ a.a,a/ ,a%#an *erongga ang ,+nak ang $engan.+ng #e?+$,a/ ke,en?ar

.an.%,a%#% .engan H-%,%ate. -o,,+$nar e%t/e,%+$G *ent+k ke,en?ar .an #tro$a *er7ar%a#%#e#+a% .engan #%k,+# /a%.G kete*a,an a#-a $en#tr+a#% .%n% J 1 F $$ .an

$en?e,ang$en#tr+a#% J F 9 $$5

35 L%ga$enta enangga +ter+#

L%ga$ent+$ ,at+$ +ter%> ,%ga$ent+$ rot+n.+$ +ter%> ,%ga$ent+$ -ar.%na,e>

,%ga$ent+$ o7ar%%> ,%ga$ent+$ #a-ro+ter%na ro%+$> ,%ga$ent+$ %n'+n.%*+,o e,7%-+$>

,%ga$ent+$ 7e#%-o+ter%na> ,%ga$ent+$ re-to+ter%na5

5 T+*a a,o%%

D+a *+a/ #a,+ran $+#k+,er ang ter*entang .ar% #+.+t #+er%or +ter+# keara/ ,atera,

.engan an?ang $a#%ng$a#%ng #ek%tar 8 F 1 -$5 Sa,+ran %n% $eng/+*+ngan -a7+$ +ter%

.engan -a7+$ er%tonea,e5T+*a .aat .%*ag% $en?a.% *ag%an :

a5 Par# +ter%na = %nter#t%t#%a,%#

*5 Par# I#t/$%-a ( ena$ang $e,%ntang a,%ng #e$%t "

-5 Par# A$+,,ar%#

.5 Par# In'+n.%*+,ar%# '%$*r%ae

D%n.%ng T+*a a,o%% ter.%r% .ar% 3 ,a%#an :

a5 La%#an#ero#a

*5 La%#an $+#k+,ar%#

-5 La%#an $+-o#a

M+ko#a t+*a .%,a%#% #e,a%# #e, ko,+$nar ang #e*ag%an $e$%,%k% *+,+getar (#%,%a" .an

#e*ag%an ,a%n $e$%,%k% ke,en?ar5

!5 O7ar%+$

O7ar%+$ (%n.+ng te,+r" a.a,a/ #ea#ang organ *er*ent+k #eert% *+a/ a,$on. ang

*era.a .%#a$%ng +ter+# .%.ekat .%n.%ng ,atera, e,7%# .an *era.a a.a ,a%#an o#ter%or

,%ga$ent+$ ,at+$> o#tero-a+.a, t+*a 'a,o%%5O7ar%+$ *er'+ng#% .a,a$ e$*ent+kan .an

e$atangan 'o,%ke, $en?a.% o7+$ (.ar% #e, e%te,ger$%na, r%$or.%a, .% ,a%#an ter,+ar e%ta,

o7ar%+$ .% kortek#"> o7+,a#% (enge,+aran o7+$"> #%nte#%# .an #ekre#% /or$on/or$on #tero%.

(e#trogen o,e/ teka %nterna 'o,%ke,> roge#teron o,e/ kor+# ,+te+$ a#-ao7+,a#%"5 Pan?ang

k%rak%ra 5! F !50 -$ .engan ,e*ar k%rak%ra 15! F 350 -$5 Ma#%ng$a#%ng $e$%,%k%

er$+kaan $e.%a, .an ,atera,5 Ma#%ng$a#%ng o7ar%+$ $e$%,%k% te% anter%or ($e#o7ar%+$".an te% o#ter%or ang *e*a#5 L%ga$ent+$ enangga o7ar%+$ a.a,a/ :

a5 ,%ga$ent+$ #+#en#or%+$ o7ar%% ( ,%ga$ent+$ %n'+n.%*+,oe,7%-+$ "

*5 ,%ga$ent+$ O7ar%% Pror%+$5

Pe$*+,+/ .ara/ o7ar%+$ ter+ta$a *era#a, .ar%arter% o7ar%-a ang $er+akan -a*ang

aorta a*.o$%na,%# .an #e,an?+tna .%a,%rkan ke,+ar o7ar%+$ $e,a,+% 7ena o7ar%-a5 O7ar%+$

ter*+ngk+# o,e/ t+n%-a a,*+g%nea ang $%r% .engan ang .%?+$a% a.a te#t%#5 Bag%an ,+ar

o7ar%+$ .%#e*+t -orte ang $e$%,%k% ga$eet .an .%*ag%an .a,a$ .%#e*+t $e.+,a ang

$engan.+ng *anak e$*+,+/ .ara/ *e#ar #erta #ara'5


9/52

.%,a%#% o,e/ #at+ ,a%#an #e,> #e, ter#e*+t .%na$akan #e, 'o,%ke,> *%,a .%,a%#% o,e/ *e*eraa

,a%#an #e,#e, ter#e*+t .%na$akan #e, gran+,o#a5

D%*ag%an -orte ter.aat #e?+$,a/ 'o,%ke, .engan *er*aga% .era?at $at+ra#%5 Pa.a 'o,%ke,

r%$or.%a,> oo#%t .%,a%#% o,e/ #at+ ,a%#an #e, %%/ (#g+a$o+e# e%t/e,%+$"5 o,%ke, r%$er

$e$%,%k% .+a ata+ ,e*%/ ,a%#an #e, gran+,o#a k+*%# ang $eng%tar% oo#%t5 o,%ke, #ek+n.er$engan.+ng r+angr+ang *er%#% -a%ran .%antara #e, gran+,o#a5 R+anganter#e*+t #er%ng

$enga,a$% enat+an (-oa,e#en-e" $e$*+at -a7+$ #entra, ang .%#e*+t#e*aga% antr+$5

o,%ke, .gra' ata+ 'o,%,ke, 7e#%k+,er ang $at+r $e$%,%k% antr+$ ang #angat .o$%nan .an

'o,%ke, *%a#ana $enon?o, ke,+ar er$+kaan o7ar%+$5Set%a *+,an> a.a ;an%ta .e;a#a>

#at+.ar% 'o,%ke, ang $a#ak $enge,+arkan oo#%t .ar% o7ar%+$> er%#t%;a %n% .%#e*+t O7+,a#%5

O'$a# *e#!%al!a Ek(%e'#a

15 6+,7a

Ta$ak .ar% ,+ar ($+,a% .ar% $on# +*%# #a$a% te% er%ne+$"> ter.%r% .ar% $on#

+*%#> ,a*%a$aora> ,a*%a $%nora> -,%tor%#> /$en> 7e#t%*+,+$> or%'%-%+$ +ret/rae etern+$>

ke,en?arke,en?ar a.a .%n.%ng 7ag%na5

5 Mon# +*%# = $on# 7ener%#

La%#an ,e$ak .% *ag%an anter%or #$/%#%# o# +*%#5 Pa.a $a#a +*erta# .aera/ %n%

$+,a%.%t+$*+/% ra$*+t +*%#5

35 La*%a $aora

La%#an ,e$ak ,an?+tan $on# +*%# ke ara/ *a;a/ .an *e,akang> *anak

$engan.+ng,ek#+# 7ena5 4o$o,og e$*r%o,og%k .engan #krot+$ a.a r%a5 L%ga$ent+$

rot+n.+$ +ter%*erak/%r a.a *ata# ata# ,a*%a $aora5 D% *ag%an *a;a/ er%ne+$> ,a*%a

$aora $enat+(a.a -o$$%#+ra o#ter%or"5 Uk+ran ,a*%a $aora a.a ;an%ta .e;a#a

an?ang 9 8 -$> ,e*ar F 3 -$> te*a, 1 F 1>! -$5 Pa.a anakanak .an n+,,%ara ke.+a ,a*%a$aora #angat *er.ekatan5


10/52

5 La*%a $%nora

L%atan ?ar%ngan t%%# .% *a,%k ,a*%a $aora> t%.ak $e$+na% 'o,%ke, ra$*+t5 Banak

ter.aat e$*+,+/ .ara/> otot o,o# .an +?+ng #era*+t #ara'5 D% B%*%r ke-%, %n% $enge,%,%g%

or%'%#%+$ 7ag%na *a;a/na akan *er#at+ $e$*ent+k 'o+r-/ette

!5 .an

-or+#-,%tor%.%# ang tertana$ .% .a,a$ .%n.%ng anter%or 7ag%na5 4o$o,og e$*r%o,og%k

.engan en%# a.a r%a5 Ter.aat ?+ga re#etor an.rogen a.a -,%tor%#5 Banak

e$*+,+/.ara/ .an +?+ng #era*+t #ara'> #angat #en#%t%'5

@5 6e#t%*+,+$

Daera/ .engan *ata# ata# -,%tor%#> *ata# *a;a/ 'o+r-/et> *ata# ,atera, ,a*%a $%nora5

Bera#a,.ar% #%n+# +rogen%ta,5 Ter.aat @ ,+*ang=or%'%-%+$> a%t+ or%'%-%+$ +ret/rae etern+$>

%ntro%t+# 7ag%nae> .+-t+# g,an.+,ae Bart/o,%n%% kanank%r% .an .+kt+# Skene kanank%r%5

Antara 'o+r-/et .an 7ag%na ter.aat 'o##a na7%-+,ar%#5

95 Intro%t+# = or%'%-%+$ 7ag%na

Ter,etak .% *ag%an *a;a/ 7e#t%*+,+$5 Pa.a ga.%# (7%rgo" tert+t+ ,a%#an t%%#

*er$+ko#a a%t+ #e,a+t .ara = /$en> +t+/ tana ro*ekan5 4$en nor$a, ter.aat ,+*ang

ke-%, +nt+k a,%ran .ara/ $en#tr+a#%> .aat *er*ent+k *+,an #a*%t> *+,at> o7a,> -r%*%'or$%#>

#et+$ ata+ '%$*r%ae5 Ak%*at -o%t+# ata+ tra+$a ,a%n> /$en .aat ro*ek .an *ent+k ,+*ang

$en?a.% t%.ak *erat+ran .engan ro*ekan ($%#a,na *er*ent+k '%$*r%ae"5 Bent+k /%$en

o#tart+$ .%#e*+t aro+#5 .an 'orn%,atera, kanan .an k%r%5 6ag%na $e$%,%k% .%n.%ng 7entra,

.an .%n.%ng .or#a, ange,a#t%#5 D%,a%#% e%te, #k+a$o#a *er,a%#> *er+*a/ $eng%k+t% #%k,+#

/a%.5 +ng#% 7ag%na: +nt+k $enge,+arkan ek#kre#% +ter+# a.a /a%.> +nt+k ?a,an ,a/%r .an

+nt+k ko+,a#% (er#et+*+/an"5Bag%an ata# 7ag%na ter*ent+k .ar% .+kt+# M+,,er%> *a;a/ .ar%

#%n+# +rogen%ta,%#5 Bata# .a,a$#e-ara k,%n%# a%t+ 'orn%-e# anter%or> o#ter%or .an ,atera,%# .%#ek%tar -er7% +ter%5 T%t%k )raen*erg/ ()#ot"> $er+akan t%t%k .aera/ #en#or%k .% #ek%tar

1=3 anter%or .%n.%ng7ag%na> #angat #en#%t%' ter/a.a #t%$+,a#% orga#$+# 7ag%na,5

25 Per%ne+$

Daera/ antara te% *a;a/ 7+,7a .engan te% .ean an+#5 Bata# otototot .%a'rag$a

e,7%# ($5,e7ator an%> $5-o--ge+#" .an .%a'rag$a +rogen%ta,%# ($5er%nea,%# tran#7er#+#

ro'+n.a>$5-on#tr%-tor +ret/ra"5 Per%nea, *o. a.a,a/ ra/e $e.%an $5,e7ator an%> antara

an+# .an 7ag%na5 Per%ne+$$eregang a.a er#a,%nan> ka.ang er,+ .%otong (e%#%oto$%"

+nt+k $e$er*e#ar ?a,an ,a/%r.an $en-ega/ r+t+r5


11/52

Pe'"a'aa#

Per.ara/an a,at rero.+k#% ;an%ta *era#a, .ar% A5 %,%a-a %nterna -a*ang .ar% A5 %,%a-a

-o$$+n%#5 A5 %,%a-a %nterna %n% ke$+.%an akan *er-a*ang $en?a.% A5 /%oga#tr%-a .an

#e,an?+tna akan *er-a*ang ke organorgan:

15 Uter+#: A5 /%oga#tr%-a akan *er-a*ang ke +ter+# $en?a.% A5 +ter%na5 A5 +ter%ne %n%

ke$+.%an akan *er?a,an keara/ o7ar%+$ (A5 +ter%ne rr5 O7a%ana" .an $e$er.ara/%o7ar%+$ .an akan $e$er.ara/% t+*a (A5 +ter%na rr5 T+*a"

5 6ag%na: A5 /%oga#tr%-a ?+ga akan *er?a,an kea ra/ 7ag%na .an $e$er.ara/% 7ag%na

#e*aga% (A5 7ag%na,%#"

35 O7ar%+$

Arter% : Arter% +ter%na $er+akan -a*ang arter% %,%a-a %nterna #e.angkan arter%

o7ar%-a -a*ang .ar%aorta a*.o$%na,%#5

6ena : 6ena +ter%na

A,%ran L$'e : Pe$*+,+/ ,$'e $eng%k+t% ?a,anna arter% .an *er$+ara ke no.%

%,%a-a %ntern% .an araaort-%5

Per#ara'an : Sara' #%$at%# .an ara#%$at%# *era#a, .ar% ,e+# /oga#tr%-+#

%n'er%or55 T+*a Uter%na

Arter%a : Arter% o7ar%-a ang *era#a, .ar% aorta a*.o$%na,%# #et%ngg% 6L 1

6ena : 6enae o7ar%-a .etra *er$+ara ke 7ena -a7a %n'er%or #e.angkan 7ena

o7ar%-a #%n%#tra ke7ena rena,%# #%n%#tra5A,%ran

A,%ran L%$'e : Pe$*+,+/ ,$'e o7ar%+$ $eng%k+t% arter% o7ar%-a .an $enga,%rkan

,%$'e ke no.% araaort%-%> #et%ngg% 6L1

Per#ara'an : Per#ara'an o7ar%+$ *era#a, .ar% ,e+# o7ar%-a .an $eng%k+t%

er?a,anan arter% o7ar%-a

!5 Uter+#

Arter% : Arter% +ter%na> #e*aga% -a*ang arter% %,%a-a %nterna

6enae : 6ena +ter%na $eng%k+t% arter% +etr%na .an *er$+ara ke .a,a$ 7ena

%,%a-a %nterna5

A,%ran ,$'e : Pe$*+,+/ ,$'e .ar% '+n.+# +ter% *er?a,an *er#a$a arter% o7ar%-a .an

$enga,%rkan ,$'eke no.% ara aort%-%#et%ngg% 7erte*ra L15

Per#ara'an : Sara' #%$at%# .an ara#%$at%#> *era#a, .ar% ,e+# /oga#tr%-+#

%n'er%or5

LO 1.+ M!k'o(kop!(

Pa.a $a#a +*erta# o7ar%+$ *er+k+ran >!!-$ an?ang> 1>!3-$ ,e*ar>.an 0>@1>!te*a,5Pa.a #a,a/ #at+ %ngg%rna ter.aat /%,+#> te$at ke,+ar$a#+kna e$*+,+/e$*+,+/

.ara/ .an #era*+t #era*+t #ara' > o7ar%+$ .%/+*+ngkan o,e/ $e#o7ar%+$ .engan

,%ga$entr+$ ,at+$ > .an o,e/ ,%ga$ent+$ o7ar%% ror%+$ .engan +ter+#5 Per$+kaan

o7ar%+$ .%t+t+% o,e/ #at+ #e, ,a%# #e, k+*%k ang .%#e*+t ger$%na, e%t/e,%+$5 D%*a;a/na

ter.aat t+n%ka a,*+gen%a ang ke*anakan ter.%r% .ar% #era*+t#era*+t ?ar%ngan %kat5 Pa.a

gar%# *e#arna o7ar%+$ ter*ag% ata# .+a *ag%an a%t+ kortek# .an $e.+,,a5Kortek# ter.%r% ata#

#tro$a ang a.at> .%$ana ter.aat 'o,%ke,'o,%ke, .engan #e, te,+rna5


12/52

o,%ke, .aat .%?+$a% .a,a$ *er*aga% t%ngkat erke$*angan a%t+ 'o,%ke,

r%$er>#ek+n.er>.an 'o,%ke, ang $a#ak ('o,%ke, .e )raa'" > ?+ga a.a 'o,%ke, ang te,a/

$enga,a$% .egenera#% ang .%#e*+t atre#%a 'o,%ke,5 Da,a$ kortek# ?+ga .aat .%?+$a% kor+#

r+*r+$>kor+# ,+te+$> .an kor+# a,*%kan#5Mak%n $+.a +#%a ;an%ta $ak%n *anak 'o,%ke,

.%?+$a%5 Pa.a *a% *ar+ ,a/%r ter.aatJ 005000 'o,%ke, a.a ke.+a o7ar%+$5 Rata rata

/ana 30000 o7+$ ang .%,ea#kan#e,a$a $a#a rero.+k#%5Pa.a $a#a a#-a$enoa+#e #angat ?arang .%?+$a% 'o,%ke, karena ke*anakan te,a/

$enga,a$% atre#%a5 Da,a$ $e.+,,a o7ar%+$ ter.aat e$*+,+/e$*+,+/ .ara/> #era*+t

#era*+t #ara'> .an ?ar%ngan %kat e,a#t%#5 Pa.% $a#a kanakkanak o7ar%+$ *o,e/ .%katan $a#%/

*er%#%ra/at .an *ar+ a.a $a#a+*erta# $+,a% $en+na%kan 'aa,na5 Per+*a/aner+*a/an

ang ter.aat a.a o7ar%+$ a.a#%k,+# /a%. %a,a/ #e*aga% *er%k+t 5 D% *a;a/ engar+/ S4

*e*eraa 'o,%ke, $+,a% *eke$*ang> akan teta% /ana #at+ ang t+$*+/ ter+# #a$a% $atang5

Pa.a 'o,%ke, %n% $+,a$+,a #e, F #e, #eke,%,%ng o7+$ *er,%at gan.a .an ke$+.%an .%

antara #e,#e, %+ t%$*+, #+at+ rongga ang *er%#% -a%ran ang .%#e*+t L%+or 'o,%k+,%5 O7+$

#en.%r% ter.e#ak ke %ngg%r> .an ter.aat .% tenga/ t+$+kan #e, ang$enon?o, ke .a,a$

rongga 'o,%ke,5 T+$+kan #e, .engan o7+$ .% .a,a$na %t+ .%#e*+tk+$+,+# oo'or+#5 Antara

o7+$ .an #e, F #e, #ek%tarna ter.aat &ona e,,+#%.a5 #e, #e, ,a%nna ang $e$*at#% r+angan

'o,%ke, .%#e*+t $e$*rana gran+,o#a5 Dengan t+$*+/na 'o,%ke,> ?ar%ngan o7ar%+$ #ek%tar

'o,%ke, ter#e*+t ter.e#ak ke,+ar .an $e$*ent+k .+a ,a%#an a%t+ teka %ntern ang *anak

$engan.+ng e$*+,+/ .ara/ .an teka ek#terna ter.%r% .ar% ?ar%ngan %kat ang a.at5Dengan

*erta$*a/ $atang 'o,%ke, /%ngga ak/%rna $atang *enar .ano,e/ karena e$*ent+kan -a%ran

'o,%ke, $ak%n *erta$*a/>$aka 'o,%ke, $ak%n ter.e#ak keer$+kaan o7ar%+$>$a,a/an

$enon?o, ke,+ar5

Se,#e, gan+,o#a ang $enge,%,%ng% o7+$ang *e*a# .%#e*+t korona ra.%ata5Se,#e,

$e$*rana gran+,o#a .an teka %nterna ang t%ngga, a.a o7ar%+$ $e$*ent+k kor+# r+*r+$

ang *er;arna $era/ o,e/ karena er.ara/an ;akt+ o7+,a#% .an ke$+.%an$en?a.% kor+#

,+te+$ ang *er;arna k+n%ng karena $engan.+ng &at k+n%ng ang .%#e*+t,+te%n($enge,+arkan /or$on roge#teron .an e#trogen"5 %ka t%.ak ter?a.%

e$*+a/an(kon#e#%">#ete,a/ 8 /ar% kor+# ,+te+$ $+,a% *er.egenera#% .an #ete,a/ 1 /ar%

$enga,a$%atro'% $en?a.% kor+# a,*%kan# (?ar%ngan er+t"5kor+# ,+te+$ ta.% .%#e*+t kor+#

,+te+$$en#tr+a#%on%# 5 %ka ter?a.% kon#e#% kor+# ,+te+$ .%e,%/ara o,e/ /or$on

-/or%on%-gona.tro%n (4-g" ang .%/a#%,kan o,e/ #%n#%#%otro'o*,a# .ar% kar%on ata+ kor+#

,+te+$gra7%.%at%# *er,ang#+ng /%ngga 210 $%ngg+ 5

O,a'!&m

O7ar%+$ .%,a%#% o,e/ #at+ ,a%# #e, k+*o%. ren.a/ ata+ geeng a%t+ e%te, ger$%na,>

ang *er#a$*+ngan .engan $e#ote,%+$ er%tone+$ 7%#-era,e5 D%*a;a/ e%te, ger$%na,

a.a,a/ ?ar%ngan %kat a.at ang .%#e*+t t+n%a a,*+g%nea5


13/52

O7ar%+$ $e$%,%k% kortek# .%te%> .an $e.+,a .%tenga/> te$at .%te$+kanna *anak

e$*+,+/ .ara/> #ara'> .an e$*+,+/ ,%$'e5 Daera/ kortek# $engan.+ng *anak 'o,%ke,

te,+r ang $a#%ng$a#%ng ter.%r% .ar% #e*+a/ oo#%t ang .%#e,a+t% o,e/ #e,#e, 'o,%ke,5 Se,#e,

'o,%ke, a.a,a/ oo#%t *e#erta #e, gran+,o#e ang $enge,%,%ng%na5 Se,a%n 'o,%ke,> kortek#

$engan.+ng '%*ro#%t .engan #erat o,agen .a, ret%k+,ar5 Me.+,a a.a,a/ ?ar%ngan %kat a.at

t%.ak terat+r ang *er#a$*+ngan .engan ,+ga$ent+$ $e#o7ar%+$ ang $enggant+ngkano7ar%+$5 Pe$*+,+/ .ara/ *e#ar .% $e.+,a $e$*ent+k e$*+,+/ .ara/ ang ,e*%/ ke-%, ang

$ene*ar .%#e,+r+/ kortek# o7ar%+$5

Ma-a$$a-a$ 'o,%ke, a%t+ :

15 Folikel primordial: ter.%r% ata# oo#%t r%$er ang *er%nt% agak ke te%ang .%a,a%#% #e,

'o,%ke, *er*ent+k %%/5

5 Folikel primer: ter.%r% oo#%t r%$er ang .%,a%#% #e, 'o,%ke, (#e, gran+,o#e" *er*ent+k

k+*+# .an ter?a.% e$*ent+kan &ona e,+#%.a a%t+ #+at+ ,a%#an g,%korote%n ang

ter.aat .%antara oo#%t .an #e,#e, gran+,o#e5

35 Folikel sekunder : ter.%r% oo#%t r%$er ang .%,a%#% #e, gran+,o#e *er*ent+k k+*+#

*er,a%# *anak ata+ .%#e*+t #tarat+$ gran+,o#e55 Folikel tersier : ter.%r% .ar% oo#%t r%$er> 7o,+$e #trat+$ gran+,o#ana *erta$*a/

*e#ar5 Ter.aat *e*era -e,a/ antr+$ .%antara #e,#e, gran+,o#e5 Dan ?ar%ngan %kat #tro$a

.% ,+ar #trat+$ gran+,o#e $e$*ent+k t/e-a %ntern ($engan.+ng *anak e$*+,+/ .ara/"

.an t/e-a etern (*anak $engan.+ng#erat ko,agen"5

!5 Folikel Graff : .%#e*+t ?+ga 'o,%ke, $atang5 Pa.a 'o,%ke, %n%> oo#%t #+.a/ #%a

.%o7+,a#%kan .ar% o7ar%+$5 Oo#%t #ek+n.er .%,a%#% o,e/ *e*eraa ,a%##e, gran+,o#e

*era.a .a,a$ #+at+ ?orokan ke .a,a$ #trat+$ .%#e*+t -+$+,+# oo'or+5 Se,#e, gran+,o#e

ang $enge,%,%ng% oo#%t .%#e*+t korona ra.%ate5 Antr+$ *er%#% ,%+or 'o,,%-+, ang

$engan.+ng /or$one e#terogen5

T&a allop!!

Ber.a#ar #tr+kt+r /%#to,og% ter.%r% .ar% ,a%#an $+ko#a> ,a%#an otot> .an ,a%#an #ero#a5

15 La%#an $+ko#a : ter#+#+n ata# e%te, #e,a%# #%,%n.r% .an ter.aat ?en%# #e, :

a5 E%t/e,%o-t+# -%,%at+# = e%te, *er#%,%a : *er'+ng#% $en-%takan ar+# ke ara/ +ter+#

ang $en+nt+n oo#%t ke.a,a$ %n'+n.%*+,+$t+*a +ter%na5

*5 E%t/e,+o-t+# t+*ar%+# ang+t+# = e%te, t%.ak *er#%,%a : *er'+ng#% #e*aga% #e, #ekretor%

.engan $eng/a#%,kan *a/an n+tr%t%' ang ent%ng *ag% o7+$5

5 La%#an otot : *er+a otot o,o# #%rk+,ar .a,a$> *er'+ng#% +nt+k kontra#% er%#ta,t%k ang

$en+nt+n o7+$ .an $e$*+at '%$*rae *er.ekatan .engan o7+$ +nt+k $enangka o7+$5

35 La%#an #ero#a

U%e'&(

Uter+# $an+#%a a.a,a/ organ *er*ent+k *+a/ %r .engan .%n.%ng *erotot te*a,5 Ba.an

ata+ kor+# $e$*ent+k *ag%an +ter+#5 Bag%an ata# +ter+# ang $e$*+,at .an ter,etak .%ata#

%nt+ $a#+k t+*a +ter%na .%#e*+t '+n.+#5 Bag%an *a;a/ +ter+# ang ,e*%/ #e$%t .an ter,etak

.%*a;a/ kor+# a.a,a/ #er7%k#5 Ser7%k# $enon?o, .an *er$+ara ke .a,a$ 7ag%na5

D%n.%ng +ter+# ter.%r% .ar% 3 ,a%#an:

15 Per%$etr%+$: *ag%an ,+ar ang .%,a%#% o,e/ #ero#a ata+ a.7ent%t%a

5 M%o$etr%+$: ter.aat 3 ,a%#an otot ang *ata#*ata#na k+rang ?e,a#5 T%ga ,a%#an

otot ter#e*+t a.a,a/:

a5 Lapisan Sub vascular : #erat#erat otot ter#+#+n $e$an?ang

*5 Lapisan Vaskular : ,a%#an otot tenga/ te*a,> #erat ter#+#+n $e,%ngkar .an #erong.engan *anak e$*+,+/ .ara/5


14/52

-5 Lapisan Supravaskular : ,a%#an otot ,+ar $e$an?ang t%%#5

35 En.o$etr%+$: .%,a%#% o,e/ e%te, #e,a%# #%,%n.r%# ang t+r+n ke.a,a$ ,a$%na ro%a

+nt+k $e$*ent+k *anak ke,en?ar +ter+#5 U$+na en.o$etr%+$ .%*ag% $en?a.% .+a

,a%#an '+ng#%ona,> S%'a%&m /%!o#ale .% ,+$%na,> .an (%'a%&m a(ale .% *a#a,5 Pa.a

;an%ta ang t%.ak /a$%, > #trat+$ '+n-t%ona,e #+er'%#%a, .engan ke,en?ar +ter+# .ane$*+,+/ .ara/ ter,ea# ata+ terke,+a# #e,a$a $en#tr+a#%> $en%ngga,kan #trat+$ *a#a,e

ang +t+/ .engan #%#a#%#a ke,en?ar +ter+# *a#a, F #e*aga% #+$*er +nt+k regenera#%

#trat+$ '+n-t%ona,e ang *ar+5

Arter% +ter%na .% ,+ga$ent+$ ,at+$ $e$*ent+k arter% ark+ata5 Arter% %n% $ene$*+#

.an *er?a,an $e,%ngkar% $%o$etr%+$ +ter+#5 Pe$*+,+/ .ara/ ar+ata $e$*ent+k arter%

re-tae (,+r+#" .an #%ra,%# ang $en.ara/% en.o$etr%+$5

Pe'&aa# (!kl!k &%e'&(

15 a#e Pro,%'erat%'

Pa.a 'a#e ro,%'erat%' .a+r /a%. .an .%*a;a/ engar+/ e#trogen o7ar%+$> #trat+$

'+n-t%ona,e #e$ak%n te*a, .an ke,en?ar +ter+# $e$an?ang .an *er?a,an ,+r+# .% er$+aan5Arter% #%ra,%# $e$an?ang .an *erke,okke,ok

5 a#e Sekretor%

a#e #ekretor% .a+r /a%. .%$+,a% #ete,a/ 'o,ke, $at+r5 Per+*a/an .% en.o$etr%+$

.%#e*a*an o,e/ engar+/ e#trogen .an roge#teron ang .%#ekre#% o,e/ kor+# ,+te+$

'+ng#%ona,5 Ak%*atna> #trat+$ '+n-t%ona,e .an #trat+$ *a#a,e en.o$entr%% $en?a.% ,e*%/

te*a, karena *erta$*a/na #ekre#% ke,en?ar .an e.e$a ,a%na ro%a> e%te, ke,en?ar +ter+#

$enga,a$% /%ertro'% ak%*at a.ana ak+$+,a#% #ekretor%k5 Ke,en?ar +ter+# ?+ga #e$ak%n

*ere,okke,ok> .an ,+$enna $e,e*ar o,e/ *a/an #ekretor%k ang aa ar*o/%.rat5 Arter%

#%ra,%# ter+# *er?a,an ke *ag%an ata# en.o$etr%+$ .an ta$ak ?e,a# karena .%n.%ngna te*a,5

Se,a$a 'a#e #ekretor%> #trat+$ '+n-t%ona,e en.o$entr%% .%tan.a% o,e/ er+*a/an e%te,

er$+kaan #%,%n.r%#> ke,en?ar +ter+#> .an ,a$%na ro%a5 Strat+$ *a#a,e $en+n?+kan

er+*a/an $%n%$a,5

35 a#e Men#tr+a#%

Se,a$a 'a#e $en#tr+a#%> en.o$etr%+$ .% #trat+$ '+n-t%ona,e $enga,a$% .egenera#% .an

ter,ea#5 En.o$etr%+$ ang ter,ea# $engan.+ng ke%nganke%ngan #tro$a ang /an-+r>

*ek+an .ara/> .an ke,en?ar +ter+# *e#erta ro.+kna5 Strat+> *a#a, en.o$entr%% teta t%.ak

terengar+/ #e,a$a 'a#e %n%5 Bag%an .%#ta, arter% #%ra,%# $enga,a$% nekro#%#> #e.angkan

*ag%an arter% ang ,e*%/ .a,a$ teta +t+/5

LI.+. !(!olo$! a!"

LO.+.1 S!#%e(!( "a# Sek'e(! o'mo#

O7ar%+$ #e*aga% organ rero.+k#% r%$er ;an%ta> $e,ak+kan t+ga# gan.a> a%t+

$eng/a#%,kan o7+$ (oogene#%#" .an $enge,+arkan /or$on/or$on #ek# ;an%ta> e#trogen

.an roge#teron5 Ke.+a /or$on %n% *eker?a *er#a$a +nt+k $en.orong 'ert%,%#a#% o7+$ .an

+nt+k $e$er#%akan #%#te$ rero.+k#% ;an%ta +nt+k ke/a$%,an5

15 4or$on E#trogen

a5 4or$on %n% .%#ekre#%kan ter+ta$a o,e/ #e, gran+,o#a 'o,%ke, o7ar%+$> kor+# ,+te+$>

.an ,a#enta5

*5 4a$%r #e$+a e#trogen %n% *era#a, .ar% o7ar%+$ .an ter.aat .+a +n-ak #ekre#% :

+n-ak erta$a ter?a.% teat #e*e,+$ o7+,a#% .an #at+ ,ag% ter?a.% #e,a$a 'a#e$%.,+tea,5


15/52

-5 E'ek 4or$on :

E'ek a.a a.a gen%ta,%a ;an%ta : e#trogen $e$*ant+ ert+$*+/an 'o,%ke,

o7ar%+$ .an $en%ngkat $ot%,%ta# t+*a +ter%na5 4or$on %n% $en%ngkatkan a,%ran

.ara/ +ter+# .an $e$%,%k% e'ek ent%ng a.a oto o,o# +ter+#5

E'ek a.a organ en.okr%n : e#trogen $eng+rang% #ekre#% S45 Pa.a kea.aan

tertent+ e#trogen $eng/a$*at #ekre#% L4 ('ee.*a-k negat%'"> a.a kea.aan ,a%n>e#trogen $en%ngkatkan #ekre#% L4 ('ee.*a-k %#%t%'"

E'ek a.a SSP : /or$on %n% $en%ngkatkan ,%*%.o a.a $an+#%a5

E'ek a.a a+.ara : e#trogen $ene*a*kan ert+$*+/an .+kt+# a.a a+.aran

.an ter+ta$a *ereran .a,a$ e$*e#aran a+.ara #e,a$a +*erta# a.a ga.%#>

e#trogen ?+ga .%#e*+t #e*aga% /or$on ert+$*+/an a+.ara5

.5 +ng#% e#trogen:

Pe$atangan e$e,%/araan #e,+r+/ #%#te$ rero.+k#% ;an%ta>

Pe$*ent+kan karakter%#t%k #ek# #ek+n.er ;an%ta>

Pent%ng a.a $a#a rakon#e#%>

Pent%ng +nt+k e$atangan .an enge,+aran o7+$>

Pe$*ent+kan *er*aga% karakter%#t%k '%#%k ang $enar%k er/at%an r%a #e-ara

#ek#+a,>

Mengangk+t #er$a .ar% 7ag%na ke te$at 'ert%,%#a#% .% o7%.+kt+#>

Ik+t *ereran .a,a$ erke$*angan a+.ara #e*aga% ant%#%a#% ,akta#%5

5 4or$on Proge#teron

a5 Pa.a 'a#e 'o,%k+,ar ,an?+t> #ekre#% roge#teron $+,a% $en%ngkat5 Se,a$a 'a#e ,+tea,>

kor+# ,+te+$ $eng/a#%,kan *anak roge#teron> .an rroge#teron ,a#$a $en%ngkat

e#at /%ngga $en-aa% ka.ar +n-ak #ek%tar 18 ng=$L5

*5 E'ek 4or$on :

D% +ter+# : $eng+*a/ roge#ta#%ona, .% en.o$etr%+$5

D% a+.ara : roge#teron $erang#ang ert+$*+/an ,o*+,+# .an a,7eo,+#5

U#%a nor$a, *ag% #eorang ere$+an $en.aatkan $en#tr+a#% +nt+k ka,% erta$a

a.a,a/ 1 ata+ 13 ta/+n5 Na$+n ka,a+ #a$a% +#%a 1@ ta/+n *e,+$ ?+ga .atang *+,an er,+ .%

;a#a.a%> $+ngk%n a.a ke,a%nan5 Men#tr+a#% %t+ #en.%r% nant%na akan *er/ent% #aat

ere$+an $e$a#+k% $a#a $enoa+#e> akn% #ek%tar +#%a !0 ta/+n5 Na$+n #e*e,+$

$e$a#+k% $a#a $enoa+#e> /a%. teta .atang /ana ?angka ;akt+na ,e*%/ ,a$a .an

ro#e#na -eat> a,%ng /ana 3 /ar%5S%k,+# /a%.= $en#tr+a#% a.a ere$+an (rero.+k#%"

nor$a,na ter?a.% #et%a 33! /ar% #eka,% .engan ,a$a /a%. *erk%#ar !9 /ar%5 Na$+n a.a

#e*ag%an ere$+an ang $enga,a$% /a%. t%.ak nor$a,5 D%antarana $+,a% .ar% +#%a /a%.

ang .atang ter,a$*at> .ara/ /a%.#angat *anak #a$a% /ar+# *er+,ang ka,% $enggant%

e$*a,+t ;an%ta> ner% ata+ #ak%t #aat /a%.> ge?a,a PMS (ree $en#tr+a#% #n.ro$"> #%k,+#

/a%. ang t%.ak terat+r .an $a#%/ *anak ,ag%5

)angg+an %n% ?angan .%.%a$kan karena .aat *er.a$ak #er%+#> /a%. ang t%.ak terat+r

$%#a,na .aat $en?a.% ertan.a #eorang ere$+an k+rang #+*+r (%n'ert%,"5)angg+an ang

ter?a.% #aat /a%. .%n%,a% $a#%/ nor$a, ?%ka ter?a.% #e,a$a .+a ta/+n erta$a #ete,a/ /a%. ka,%

erta$a5 Art%na> *%,a #eorang ere$+an te,a/ $en.aatakan /a%. erta$ana #aat *er+#%a

11 ta/+n> $aka /%ngga +#%a 13 ta/+n /a%.na $a#%/ t%.ak terat+r5Ta% *%,a #ete,a/ +#%a 13

ta/+n /a%.na $a#%/ t%.ak terat+r ?+ga> .%a#t%kan %a $enga,a$% gangg+an /a%.5 4a%.D%engar+/% *er*aga% /or$on:


16/52

LO.+.+. S!kl&( a!"

S%k,+# $en#tr+a#% nor$a, .aat .%*ag% $en?a.%:

15 S%k,+# o7ar%+$ (%n.+ng te,+r"

a5 a#e 'o,%ke,

a;a,

ak/%r

*5 'a#e o7+,a#%

-5 a#e ,+tea,

5 S%k,+# en.o$etr%+$

a5 a#e $en#tr+a#% ata+ .ek+a$a#%

*5 a#e a#-a /a%. ata+ regenera#%

-5 a#e ro,%'era#%

.5 a#e #ekre#% ata+ ra /a%.

Ke.+a #%k,+# ter#e*+t *er?a,an *er#a$aan5

Pa.a #et%a #%k,+# $en#tr+a#%> S4 ang .%ke,+arkan o,e/ /%o'%#%# $erang#ang

erke$*angan 'o,%ke,'o,%ke, .% .a,a$ o7ar%+$ (%n.+ng te,+r"5 Pa.a +$+$na /ana 1

'o,%ke, ang terang#ang na$+n .aat erke$*angan .aat $en?a.% ,e*%/ .ar% 1> .an 'o,%ke,ter#e*+t *erke$*ang $en?a.% 'o,%ke, .e graa' ang $e$*+at e#trogen5

E#trogen %n% $enekan ro.+k#% S4> #e/%ngga /%o'%#%# $enge,+arkan /or$on ang

ke.+a a%t+ L45 Pro.+k#% /or$on L4 $a++n S4 *era.a .% *a;a/ engar+/ re,ea#%ng

/or$one# ang .%#a,+rkan /%ota,a$+# ke /%o'%#%#5

Pena,+ran R4 .%engar+/% o,e/ $ekan%#$e +$an *a,%k e#trogen ter/a.a

/%ota,a$+#5 Pro.+k#% /or$on gona.otro%n (S4 .an L4" ang *a%k akan $ene*a*kan

e$atangan .ar% 'o,%ke, .e graa' ang $engan.+ng e#trogen5

E#trogen $e$engar+/% ert+$*+/an .ar% en.o$etr%+$5 D% *a;a/ engar+/ L4>

'o,%ke, .e graa' $en?a.% $atang #a$a% ter?a.% o7+,a#%5 Sete,a/ o7+,a#% ter?a.%> .%*ent+k,a/

kor+# r+*r+$ ang akan $en?a.% kor+# ,+te+$> .% *a;a/ engar+/ /or$on L4 .an LT4

(,+teotro/%- /or$one#> #+at+ /or$on gona.otro%k"5


17/52

Kor+# ,+te+$ $eng/a#%,kan roge#teron ang .aat $e$engar+/% ert+$*+/an

ke,en?ar en.o$etr%+$5 B%,a t%.ak a.a e$*+a/an $aka kor+# ,+te+$ *er.egenera#% .an

$engak%*atkan en+r+nan ka.ar e#trogen .an roge#teron5 Pen+r+nan ka.ar /or$on %n%

$ene*a*kan .egenera#%> er.ara/an> .an e,ea#an .ar% en.o$etr%+$5 Pro#e# %n% .%#e*+t

/a%. ata+ $en#tr+a#%5 Aa*%,a ter.aat e$*+a/an .a,a$ $a#a o7+,a#%> $aka kor+# ,+te+$

ter#e*+t .%erta/ankan5

Pa.a #%k,+# en.o$etr%+$> ter*ag% ?a.% 'a#e> a%t+:

15 Ma#a $en#tr+a#% ang *er,ang#+ng #e,a$a 8 /ar%5 Pa.a #aat %t+ en.o$etr%+$

(#e,a+t ra/%$" .%,ea#kan #e/%ngga t%$*+, er.ara/an .an /or$on/or$on o7ar%+$

*era.a .a,a$ ka.ar a,%ng ren.a/5 Da,a$ 'a#e %n% en.o$etr%+$ .%,ea#kan .ar%

.%n.%ng +ter+# .%#erta% er.ara/an /ana#trat+$ *a#a,e ang t%ngga, +t+/5 Dara/ /a%.

$engan.+ng .ara/ 7ena .an arter% .angan#e,#e, .ara/ $era/ .a,a$ /e$o,%#%# ata+

ag,+t%na#%> #e,#e, e%te, .an #tr+$a ang$enga,a$% .%#%ntegra#% .an oto,%#%#> .an

#ekret .ar% +ter+#> -er7%k> .an ke,en?arke,en?ar7+,7a5 a#e %n% *er,ang#+ng 3F /ar%5

5 Da,a$ 'a#e %n% en.o$etr%+$ .%,ea#kan .ar% .%n.%ng +ter+# .%#erta% er.ara/an/ana#trat+$ *a#a,e ang t%ngga, +t+/5 Dara/ /a%. $engan.+ng .ara/ 7ena .an arter%

.angan#e,#e, .ara/ $era/ .a,a$ /e$o,%#%# ata+ ag,+t%na#%> #e,#e, e%te, .an #tr+$a

ang$enga,a$% .%#%ntegra#% .an oto,%#%#> .an #ekret .ar% +ter+#> -er7%k> .an ke,en?ar

ke,en?ar7+,7a5 a#e %n% *er,ang#+ng 3F /ar%5

35 Ma#a ro,%'era#% .ar% *er/ent% .ara/ $en#tr+a#% #a$a% /ar% ke15 Sete,a/ $en#tr+a#%

*erak/%r> .%$+,a%,a/ 'a#e ro,%'era#% .%$ana ter?a.% ert+$*+/an .ar% .e#%.+a

'+ng#%ona,%# +nt+k $e$er#%akan ra/%$ +nt+k er,ekatan ?an%n5 Pa.a 'a#e %n%

en.o$etr%+$ t+$*+/ ke$*a,%5 Antara /ar% ke1 #a$a% 1 .aat ter?a.% e,ea#an

#e, te,+r .ar% %n.+ng te,+r (.%#e*+t o7+,a#%"5

Da,a$ 'a#e %n% en.o$etr%+$ t+$*+/ $en?a.% #ete*a, 3>! $$5 a#e %n% *er,ang#+ng

.ar%/ar% ke! #a$a% /ar% ke1 .ar% #%k,+# /a%.5 a#e Pro,%'era#% .aat .%*ag% ata# 3

#+*'a#e> a%t+:

a5 a#e ro,%'era#% .%n% (ear, ro,%'erat%on /a#e"

Ber,ang#+ng antara /ar% ke #a$a% /ar% ke95 a#e %n% .aat .%kena, .ar%

e%te, er$+kaan ang t%%# .an a.ana regenera#% e%te,> ter+ta$a .ar% $+,+t

ke,en?ar5

*5 a#e ro,%'era#% $a.a ($%. ro,%'erat%on /a#e"

Ber,ang#+ng antara /ar% ke8 #a$a% /ar% ke105 a#e %n% $er+akan *ent+k

tran#%#%.an .aat .%kena, .ar% e%te, er$+kaan ang *er*ent+k torak .ant%ngg%5 Ta$ak a.ana *anak $%to#%# .engan %nt% *er*ent+k te,an?ang

(nake. n+k,e+#"5

-5 a#e ro,%'era#% ak/%r (,ate ro,%'erat%on"

a#e %n% *er,ang#+ng a.a /ar% ke11 #a$a% /ar% ke15 a#e %n% .aat

.%kena, .ar%er$+kaan ke,en?ar ang t%.ak rata .an .engan *anak $%to#%#5

Int% e%te, ke,en?ar$e$*ent+k #e+.o#trat%'%ka#%5 Sto$a *ert+$*+/ akt%' .an

a.at5

5 Ma#a #ekre#%5 Ma#a #ekre#% a.a,a/ $a#a #e#+.a/ ter?a.%na o7+,a#%5 4or$on

roge#teron .%ke,+arkan .an $e$engar+/% ert+$*+/an en.o$etr%+$ +nt+k

$e$*+at kon.%#% ra/%$ #%a +nt+k %$,anta#% (er,ekatan ?an%n ke ra/%$"5


18/52

a#e %n% .%$+,a% #e#+.a/ o7+,a#% .an *er,ang#+ng .ar% /ar% ke1 #a$a% ke

85 Pa.a'a#e %n% en.o$etr%+$ te*a,na teta> *ent+k ke,en?ar *er+*a/

$en?a.% an?ang> *erke,+kke,+k> .an $enge,+arkan geta/ ang $ak%n ,a$a

$ak%n nata5 D% .a,a$ en.%$etr%+$tert%$*+n g,%kogen .an ka+r ang ke,ak

.%er,+kan #e*aga% $akanan +nt+k te,+r ang.%*+a/%5

S%k,+# o7ar%+$:

15 a#e 'o,%k+,ar5 Pa.a 'a#e %n% /or$on rero.+k#% *eker?a $e$atangkan #e, te,+r ang

*era#a, .ar% 1 'o,%ke, ke$+.%an $atang a.a ertenga/an #%k,+# .an #%a +nt+k ro#e#

o7+,a#% (enge,+aran #e, te,+r .ar% %n.+ng te,+r"5 Wakt+ ratarata 'a#e 'o,%k+,ar a.a

$an+#%a *erk%#ar 101 /ar%> .an 7ar%a*%,%ta#na $e$engar+/% an?ang #%k,+#

$en#tr+a#% ke#e,+r+/an5

D%$+,a% .ar% /ar% 1 #a$a% #e#aat #e*e,+$ ka.ar L4 $en%ngkat .an ter?a.%

e,ea#an #e, te,+r (o7+,a#%"5 D%na$akan 'a#e 'o,%k+,er karena a.a #aat %n% ter?a.%

ert+$*+/an 'o,%ke,.% .a,a$ o7ar%+$5 Pa.a ertenga/an 'a#e 'o,%k+,er> ka.ar S4

#e.%k%t $en%ngkat#e/%ngga $erang#ang ert+$*+/an #ek%tar 3F 30 'o,%ke, ang$a#%ng$a#%ng$engan.+ng 1 #e, te,+r> teta% /ana 1 'o,%ke, ang ter+# t+$*+/> ang

,a%nna /an-+r5Pa.a #+at+ #%k,+#> #e*ag%an en.o$etr%+$ .%,ea#kan #e*aga% re#on

ter/a.a en+r+nanka.ar /or$on e#trogen .an roge#teron5 En.o$etr%+$ ter.%r% .ar%

3 ,a%#an5 La%#ana,%ng ata# .an ,a%#an tenga/ .%,ea#kan> #e.angkan ,a%#an

.a#arna teta.%erta/ankan .an $eng/a#%,kan #e,#e, *ar+ +nt+k ke$*a,%

$e$*ent+k ke.+a ,a%#anang te,a/ .%,ea#kan5 Per.ara/an $en#tr+a#% *er,ang#+ng

#e,a$a 3F9 /ar%> ratarata#e,a$a ! /ar%5 Dara/ ang /%,ang #e*anak 8 83 gra$5

Dara/ $en#tr+a#% *%a#anat%.ak $e$*ek+ ke-+a,% ?%ka er.ara/anna #angat /e*at5

5 a#e o7+,a#%

a#e %n% .%$+,a% ket%ka ka.ar L4 $en%ngkat .an a.a 'a#e %n% .%,ea#kan #e, te,+r5

Se,te,+r *%a#ana .%,ea#kan .a,a$ ;akt+ 1@F 3 ?a$ #ete,a/ ter?a.% en%ngkatan

ka.ar L45o,%ke, ang $atang akan $enon?o, .ar% er$+kaan o7ar%+$> ak/%rna

e-a/ .an $e,ea#kan #e, te,+r5 Pa.a #aat o7+,a#% %n% *e*eraa ;an%ta $era#akan

ner% t+$+, a.a er+t *ag%an *a;a/na> ner% %n% .%kena, #e*aga% $%tte,#-/$er&>

ang *er,ang#+ng #e,a$a *e*eraa $en%t #a$a% *e*eraa ?a$5

35 a#e ,+tea,5

a#e ,+tea, a.a,a/ 'a#e .ar% o7+,a#% /%ngga $en#tr+a#% .engan ?angka ;akt+ ratarata

1 /ar%5 a#e %n% ter?a.% #ete,a/ o7+,a#% .an *er,ang#+ng #e,a$a #ek%tar 1 /ar%5

Sete,a/ $e,ea#kan te,+rna> 'o,%ke, ang e-a/ ke$*a,% $en+t+ .an$e$*ent+k kor+# ,+te+$ ang $eng/a#%,kan #e*ag%an *e#ar roge#teron5

Proge#teron $ene*a*kan #+/+ t+*+/ #e.%k%t $en%ngkat #e,a$a 'a#e ,+t+e, .an teta

t%ngg% #a$a% #%k,+# ang *ar+ .%$+,a%5 Pen%ngkatan #+/+ %n% *%#a .%g+nakan +nt+k

$e$erk%rakan ter?a.%na o7+,a#%5 Sete,a/ 1 /ar%> kor+# ,+te+$ akan /an-+r .an

#%k,+# ang *ar+ akan .%$+,a%> ke-+a,% ?%ka ter?a.% e$*+a/an5 %ka te,+r .%*+a/%>

kor+# ,+te+$ $+,a% $eng/a#%,kan 4


19/52

S%k,+# /or$ona, .an /+*+nganna .engan #%k,+# o7ar%+$ #erta +ter+# .% .a,a$ #%k,+#

$en#tr+a#% nor$a,:

15 Set%a er$+,aan #%k,+# $en#tr+a#%> ka.ar /or$on gona.otro%n (S4> L4" *era.a

a.a ,e7e, ang ren.a/ .an #+.a/ $en+r+n #e?ak ak/%r .ar% 'a#e ,+tea, #%k,+#

#e*e,+$na5 4or$on S4 .ar% /%ota,a$+# er,a/an $enga,a$% en%ngkatan #ete,a/ ak/%r .ar%

kor+# ,+te+$ .an ert+$*+/an 'o,%ke, .%$+,a% a.a 'a#e 'o,%k+,ar5 4a, %n%

$er+akan e$%-+ +nt+k ert+$*+/an ,a%#an en.o$etr%+$

35 Pen%ngkatan ,e7e, e#trogen $ene*a*kanfeedbacknegat%' a.a enge,+aran S4

/%o'%#%#5 4or$on L4 ke$+.%an $en+r+n #e*aga% ak%*at .ar% en%ngkatan ,e7e,

e#tra.%o,> teta% a.a ak/%r .ar% 'a#e 'o,%k+,ar ,e7e, /or$on L4 $en%ngkat .ra#t%#

(re#on *%'a#%k"

5 Pa.a ak/%r 'a#e 'o,%k+,ar> /or$on S4 $erang#ang re#etor (ener%$a" /or$on L4

ang ter.aat a.a #e, gran+,o#a> .an .engan rang#angan .ar% /or$on L4> ke,+ar,a/

/or$on roge#teron!5 Sete,a/ erang#angan o,e/ /or$on e#trogen> /%o'%#%# L4 ter%-+ ang $ene*a*kan

ter?a.%na o7+,a#% ang $+n-+, 3@ ?a$ ke$+.%an5 O7+,a#% a.a,a/ enan.a 'a#e

tran#%#% .ar% 'a#e ro,%'era#% ke #ekre#%> .ar% 'o,%k+,ar ke ,+tea,

@5 Ke.ar e#trogen $en+r+n a.a a;a, 'a#e ,+tea, .ar% #e#aat #e*e,+$ o7+,a#% #a$a% 'a#e

ertenga/an> .an ke$+.%an $en%ngkat ke$*a,% karena #ekre#% .ar% kor+# ,+te+$

95 Proge#teron $en%ngkat #ete,a/ o7+,a#% .an .aat $er+akan enan.a *a/;a #+.a/

ter?a.% o7+,a#%

85 Ke.+a /or$on e#trogen .an roge#teron $en%ngkat #e,a$a $a#a /%.+ kor+# ,+te+$

.an ke$+a.%an $en+r+n +nt+k $e$er#%akan #%k,+# *er%k+tna

Ko#%'ol /$(! o,a'!&m

Ta/ata/a a;a, ert+$*+/an 'o,%ke, raantr+$ .an e$atangan oo#%t t%.ak $e$er,+kan

#t%$+,a#% gona.otro%k> na$+n *ant+an /or$on .%er,+kan +nt+k $e$*ent+k antr+$>

erke$*angan 'o,%ke, ,e*%/ ,an?+t> .an #ekre#% e#trogen5 E#trogen> S4> .an L4 #e$+ana

.%er,+kan5 Pe$*ent+kan antr+$ .%%n.+k#% o,e/ S45 Ba%k S4 $a++n e#trogen

$erang#ang ro,%'era#% #e,#e, gran+,o#a5 Ba%k S4 $a++n L4 .%er,+kan +nt+k #%nte#%# .an#ekre#% e#trogen o,e/ 'o,%ke,5 Ba%k #e, gran+,o#a $a++n #e, teka *erart%a#% .a,a$


20/52

e$*ent+kan e#trogen5 Per+*a/an ko,e#tero, $en?a.% e#trogen $e$er,+kan #e?+$,a/ ,angka/

*er+r+tan> .engan ,angka/ terak/%r a.a,a/ er+*a/an an.rogen $en?a.% e#trogen5 Se,#e, teka

*anak $eng/a#%,kan an.rogen teta% kaa#%ta# $ereka $eng+*a/ an.rogen $en?a.%

e#trogen ter*ata#5 Se,#e, gran+,o#a> .%%/ak ,a%n $+.a/ $eng+*a/ an.rogen $en?a.%

e#trogen teta% t%.ak $a$+ $e$*+at an.rogen #en.%r%5 L4 *eker?a a.a #e,#e, teka +nt+k$erang#ang e$*ent+kan an.rogen> #e$entara S4 *eker?a a.a #e,#e, gran+,o#a +nt+k

$en%ngkatkan er+*a/an an.rogen teka $en?a.% e#trogen5 Karena ka.ar *a#a, S4 ang

ren.a/ #+.a/ -+k+ +nt+k $en.orong er+*a/an $en?a.% e#trogen %n%> ke-eatan #ekre#%

e#trogen o,e/ 'o,%ke, ter+ta$a *ergant+ng a.a ka.ar L4 .a,a$ .ara/> ang ter+# $en%ngkat

#e,a$a 'a#e 'o,%ke,5 Se,a%n %t+> #e;akt+ 'o,%ke, ter+# t+$*+/> e#trogen ang .%/a#%,kan ?+ga

$en%ngkat karena *erta$*a/na ?+$,a/ #e, 'o,%ke, eng/a#%, e#trogen5

Se*ag%an .ar% e#trogen ang .%/a#%,kan o,e/ 'o,%ke, ang t+$*+/ .%#ekre#%kan ke .a,a$ .ara/

.an $en?a.% ene*a* $en%ngkatna ka.ar e#trogen ,a#$a #e,a$a 'a#e 'o,%ke,5 S%#a

e#trogen tetea *era.a .%.a,a$ 'o,%ke, .an %k+t #erta $e$e*ent+k -a%ran antr+$ .an

$erang#ang ro,%'era#% ,e*%/ ,an?+t #e,#e, gran+,o#a5

E#trogen ang .%#ekre#%kan> #e,a%n *eker?a a.a ?ar%ngan #e#%'%k#ek# #eert% +ter+#> ?+ga

$eng/a$*at /%ota,a$+# .an /%o'%#%# anter%or $e,a,+% $ekan%#$e +$an *a,%k negat%'5

Ka.ar e#trogen ang ren.a/ teta% $en%ngkat a.a 'a#e 'o,%ke, *eker?a #e-ara ,ang#+ng a.a

/%ota,a$+# +nt+k $eng/a$*at #ekre#% )nR4> #e/%ngga enge,+aran S4 .an L4 .ar%

/%o'%#%#% anter%or ang .%%-+ o,e/ )nR4 ?+ga tertekan5 Na$+n e'ek r%$er e#trogen a.a,a/

,ang#+ng a.a /%o'%#%# %t+ #en.%r%5 E#trogen $en+r+nkan keekaan #e, eng/a#%, S45

Per*e.aan keekaan #e,#e, eng/a#%, S4 .an L4 ang .%%n.+k#% o,e/ e#trogen %n% a,%ng

t%.ak %k+t *ereran a.a kenataan *a/;a ka.ar S4 ,a#$a> $e+r+n #e,a$a 'a#e 'o,%ke,

#e%r%ng .engan en%ngkatan ka.ar e#trogen5'aktor ,a%n ang $ene*a*kan t+r+nna S4

#e,a$a 'a#e 'o,%ke, a.a,a/ #ekre#% %n/%*%n o,e/ #e,#e, 'o,%ke,5 In/%*%n -en.er+ng $eng/a$*at

#ekre#% S4 .engan *eker?a a.a /%o'%#%# anter%or> #eert% ang ter?a.% a.a r%a5 Pen+r+nan

#ekre#% S4 $ene*a*kan atre#%a #e$+a 'o,%ke, ang #e.ang *erke$*ang ke-+a,% #at+ ang

a,%ng $atang5

Ber*e.a .engan S4> #ekre#% L4 ter+# $en%ngkat #e-ara er,a/an #e,a$a 'a#e 'o,%ke,;a,a++n ter?a.% %n/%*%#%# ter/a.a #ekre#% )nR4 (.an .engan .e$ek%an #e-ara t%.ak


21/52

,ang#+ng> L4"5 4a, ang ta$ak ara.ok# %n% .%#e*a*kan o,e/ kenataan *a/;a e#trogen

#en.%r% t%.ak .aat #e-ara tota, $enekan #ekre#% L %o#!k (ter+# $ener+# .engan ka.ar

ren.a/" +nt+k $eng/a$*at #e-raa tota, #ekre#% L4 ton%k ter#e*+t .%er,+kan *a%k e#trogen

$a++n roge#teron5 Karena roge#teron *e,+$ $+n-+, #a$a% 'a#e ,+tea, #%k,+# ter#e*+t>

ka.ar L4 *a#a, #e-ara er,a/an $en%ngkat #e,a$a 'a#e 'o,%ke, .% *a;a/ %n/%*%#%# %nko$,%te#trogen5

Ko#%'ol o,&la(!

O7+,a#% .an ,+te%n%#a#% #e,an?+tna 'o,%ke, ang r+t+r .%%-+ o,e/ en%gkatan #ekre#% L4

ang $a#%' .an $en.a.ak5 Lon?akan L4 %n% $en%$*+,kan e$at r+*a/an +ta$a a.a

'o,%ke, : Lon?akan ter#e*+t $eng/ent%kan #%nte#%# e#trogen o,e/ #e, 'o,%ke,

Lon?akan ter#e*+t $e$+,a% ke$*a,% $e%o#%# .% oo#%t a.a 'o,%ke, ang #e.ang

*erke$*ang

Lon?akan ter#e*+t $e$%-+ e$*ent+kan ro#tag,an.%n #e#%'%k ang *eker?a ,oka,5

Pro#tag,an.%n ter#e*+t $eng%n.+k#% o7+,a#% .engan $en.orong er+*a/aner+*a/an

7a#k+,er ang $ene*a*kan e$*engkakan 'o,%ke, .engan -eat #e$entara

$eng%n.+k#% en-ernaan .%n.%ng 'o,%ke, o,e/ en&%$en&%$5 E'eke'ek ter#e*+t

*er#a$a#a$a $ene*a*kan r+t+rna .%n.%ng ang $e$*+ngk+# 'o,%ke,5

Lon?akan te#e*+t $ene*a*kan .%'eren#%a#% #e,#e, 'o,%ke, $en?a.% #e, ,+tea,5

D+a -ara #ekre#% L4> a%t+ .engan #ekre#% ton%k L4 ang $ene*a*kan #ekre#%

/or$on o7ar%+$ #erta .%%-+ o,e/ +$an *a,%k negat%' .an ,on?akan L4 ang

$ene*a*kan o7+,a#%> ang .%%-+ o,e/ +$an *a,%k o#%t%'5


22/52

Ko#%'ol Ko'p&( l&%e&m

L4 $e$erta/ankan kor+# ,+te+$> a%t+ #ete,a/ $e$%-+ erke$*angan kor+# ,+te+$> L4

$erang#ang #tr+kt+r o7ar%+$ %n% +nt+k ter+# $enge,+arkan /or$on #tero%.5 D%*a;a/

engar+/ L4> kor+# ,+te+$ $enge,+arkan roge#teron .an e#trogen> .engan ?+$,a/

roge#teron ang ,e*%/ *e#ar5 Ka.ar roge#teron ,a#$a $en%ngkat +nt+k erta$a ka,%na

#e,a$a 'a#e ,+tea,5

Pen+r+nan #e#aat ka.ar e#trogen .a,a$ .ara/ ter?a.% a.a ertenga/an #%k,+# #e;akt+ 'o,%ke,

eng/a#%, e#trogen $at%5 Ka.ar e#trogen ke$*a,% na%k #e,a$a 'a#e ,+tea, karena akt%7%ta#

kor+# ,+te+$> ;a,a++n t%.ak $en-aa% +n-ak ang #a$a #eert% 'a#e 'o,%ke,5 Proge#teron

$en-ega/ ka.ar e#trogen ang -+k+ t%ngg% #e,a$a 'a#e ,+tea, $e$%-+ ke$*a,% ,on?akan L45

Wa,a++n e#trogen ka.ar t%ngg% $erang#ang #ekre#% L4> roge#teron> ang $en.o$%na#% 'a#e,+tea,> .engan k+at $eng/a$*at #ekre#% L4 .an S45 In/%*%#% L4 .an S4 o,e/ roge#teron

$en-ega/ e$atangan 'o,%ke, .an o7+,a#% *ar+ #e,a$a 'a#e ,+tea,5 D% *a;a/ engar+/

roge#teron> #%#te$ rero.+k#% .%er#%akan +nt+k $en+n?ang o7+$ ang *ar+ .%,ea#kan5

Se,#e, ,+tea, t%.ak $enge,+arkan %n/%*%n5 Kor+# ,+te+$ *er'+ng#% #e,a$a .+a $%ngg+>

ke$+.%an *er.egenera#% ?%ka t%.ak ter?a.% e$*+a/an5

LI 3. Memaam! "a# me#$e%a&! %e#%a#$ kela!#a# a!"

LO.3.1. De/!#!(!Ke,a%nan /a%. ($en#tr+a#%" a.a,a/ $a#a,a/ '%#%k ata+ $enta, ang $e$engar+/%#%k,+#

$en#tr+a#%> $ene*a*kan ner%> er.ara/an ang t%.ak *%a#a ang ,e*%/ *anak ata+ #e.%k%t>

ter,a$*atna $enar-/e ata+ /%,angna #%k,+# $en#tr+a#% tertent+5Ke,a%nan /a%. #er%ng

$en%$*+,kan ke-e$a#an a.a ;an%ta karena ke/a;at%ranakan engar+/ ke,a%nan /a%.

ter/a.a ke#+*+ran .an ke#e/atan ;an%ta a.a +$+$na5

LO.3.+. E%!olo$!

Ke,a%nan /a%. *%a#ana ter?a.% karena ket%.ak #e%$*angan /or$on/or$on ang $engat+r

/a%.> na$+n .aat ?+ga .%#e*a*kan o,e/ kon.%#% $e.%# ,a%nna5Banakna er.ara/an

.%tent+kan o,e/ ,e*arna e$*+k+/ .ara/> *anakna e$*+,+/ .ara/ ang ter*+ka> .an


23/52

tekanan %ntra7a#k+,ar5 La$ana e.ara/an .%tent+kan o,e/ .aa ene$*+/an ,+ka ata+ .aa

regenera#%5 Daa regenera#% *erk+rang a.a %n'ek#%> $%o$a> o,% .an a.a kar#%no$a

LO.3.3. Kla(!/!ka(!

)angg+an /a%. .an #%k,+#na .a,a$ $a#a rero.+k#% .aat .%go,ongkan .a,a$:

15 Ke,a%nan .a,a$ *anakna .ara/ .an ,a$ana er.ara/an a.a /a%.: 4%er$enorea ata+$enorag%a .an 4%o$enorea

5 Ke,a%nan #%k,+#: Po,%$enoreaG O,%go$enoreaG A$enorea

35 Per.ara/an .% ,+ar /a%.: Metrorag%a

5 )angg+an ,a%n ang a.a /+*+ngan .engan /a%. : Pre $en#tr+a, ten#%on (ketegangan ra

/a%."G Ma#to.%n%aG M%tte,#-/$er& (ra#a ner% a.a o7+,a#%" .an D%#$enorea

1 Kela!#a# "alam a#2ak#2a "a'a "a# lama#2a pe'"a'aa# pa"a a!"

a 4%er$enorea ata+ $enorag%a

Menorr/ag%a a.a,a/ enge,+aran .ara/ /a%. ang ter,a,+ *anak .an *%a#ana.%#erta% .engan a.a #%k,+# ang terat+r5 Menorr/ag%a *%a#ana *er/+*+ngan

.engan no-t+rr/ag%a a%t+ #+at+ kea.aan .%$ana $en#tr+a#% $e$engar+/% o,a

t%.+r ;an%ta .%$ana ;a%ta /ar+# $enggant% e$*a,+t a.a tenga/ $a,a$5

Menorr/ag%a ?+ga *er/+*+ngan .engan kra$ #e,a$a /a%. ang t%.ak *%#a

.%/%,angkan .engan o*ato*atan5 Pen.er%ta ?+ga #er%ng $era#akan ke,e$a/an>

+#%ng> $+nta/ .an $+a, *er+,ang #e,a$a /a%.5

Etiologi $enorr/ag%a .%ke,o$okan .a,a$ kategor% a%t+>

1 )angg+an Pe$*ek+an

Wa,a++n kea.aan er.ara/an tertent+ #eert% ITP .an enak%t 7on ;%,,e*ran.#

*er/+*+ngan .engan en%ngkatan $enorr/ag%a> na$+n e'ek ke,a%nan e$*ek+an

ter/a.a %n.%7%.+ *er7ar%a#%5 Pa.a ;an%ta .engan tro$*o%toen%a ke/%,angan .ara/

*er/+*+ngan .engan ?+$,a/ tro$*o#%t #e,a$a /a%.5 S,enekto$% ter*+kt%

$en+r+nkan ke/%,angan .ara/5

D%#'+n-t%ona, Uter%ne B,ee.%ng (DUB"

Pa.a .a#arna e,+r+/an #aat /a%. *er#%'at #e,' ,%$%te. karena /a%. *er,ang#+ng

#e-ara #%$+,tan .% #e,+r+/ en.o$etr%+$ #erta ?ar%ngan en.o$etr%+$ ang ter*ent+k

o,e/ e#trogen .an roge#terone nor$a, *er#%'at #ta*%,5 Pa.a DUB> kea.aan %n%

#er%ng tergangg+5

DUB .aat ter?a.% .%#erta% o7+,a#% $a++n ano7+,a#%5 Pa.a kea.aan ter?a.%nao7+,a#%> er.ara/an *er#%'at ,e*%/ *anak .an #%k,%k /a$%r #e#+a% .engan #%k,+#

/a%.5 Pa.a kea.aan ano7+,a#%> er.ara/an *er#%'at na$+n .engan #%k,+# ang t%.ak

terat+r #e/%ngga #er%ng .%#e*+t $eno$etrorr/ag%a5 DUB .aat .%#e*a*kan e#trogen

;%t/.ra;, *,ee.%ng> roge#teron ;%t/.ra;, *,ee.%ng> e#trogen *reakt/ro+g/

*,ee.%ng> roge#terone *reakt/ro+g/ *,ee.%ng5 E#trogen ;%t/.ra;, *,ee.%ng ter?a.%

a.a kea.aan #ete,a/ ooarekto$% *%,atera,> ra.%a#% 'o,%ke, ang $at+r ata+

eng/ent%an t%*at%*a o*ato*atan ang $engan.+ng e#trogen5

E#trogen *reakt/ro+g/ *,ee.%ng $ene*a*kan ,a%#an en.o$etr%+$ $en?a.%

#e$ak%n $ene*a, na$+n ak/%rna r+nt+/ karena k+rang #e$+rnana #tr+kt+r

en.o$etr%+$ karena t%.ak #e*an.%ngna ?+$,a/ roge#terone ang a.a .%#*an.%ng

?+$,a/ e#trogen5 Per.ara/an *%a#ana *er#%'at #ott%ng5 E#trogen *reakt/ro+g/


24/52

*,ee.%ng ang *erke,an?+tan $enga-+ a.a kea.aan a$enorr/ea na$+n #e-ara

t%*at%*a .aat $engak%*atkan er.ara/an ang *anak5

Proge#teron ;%t/.ra;, *,ee.%ng ter?a.% *%,a kor+# ,+te+$ .%/%,angkan5

Proge#teron ;%t/.ra;, *,ee.%ng /ana akan ter?a.% *%,a .%a;a,% ro,%'era#%

en.o$etr%+$ ang .%at+r o,e/ e#trogen5 Na$+n *%,a ka.ar e#trogen $en%ngkat 10

0 ka,% ,%at> roge#teron ;%t/.ra;, *,ee.%ng t%.ak akan ter?a.%5Proge#terone *reakt/ro+g/ *,ee.%ng ter?a.% *%,a ka.ar roge#terone $e,e*%/%

ke#e%$*angan .engan e#trogen5 D%n.%ng en.o$etr%+$ ang $ene*a, akan $e,+r+/

#e.%k%t .e$% #e.%k%t ak%*at #tr+kt+r ang t%.ak k+at5 4a, %n% ter?a.% #aat

$engg+nakan %, kontra#e#% .a,a$ ?angka ;akt+ ,a$a5

Pa.a kea.aan roge#teron ;%t/.ra;, *,ee.%ng .an e#trogen *reakt/ro+g/

*,ee.%ng .%*er%kan tera% roge#teron #e/%ngga ter-aa% ke#e%$*angan ?+$,a/

roge#teronee#trogen5 Proge#terone *er#%'at ant%e#trogen .%$ana $en#t%$+,a#%

er+*a/an e#tra.%o, $en?a.% e#tron #+,'at a%t+ *ent+k t%.ak akt%' e#trogen5

Proge#terone ?+ga $eng/a$*at e$*ent+kan re#etor e#trogen5 E#trogen ?+ga

$en-ega/ tran#kr%#% onkogen ang .%$e.%a#% o,e/ e#trogen5

Pa.a o,%go$enorr/ea (e#trogen *reakt/ro+g/ *,ee.%ng" rearat roge#teroneang .%g+nakan a.a,a/ $e.rooge#terona#eta> !10 $g=/ar% #e,a$a 10 /ar%5

Pa.a $enorr/ag%a (e#trogen *reakt/ro+g/ *,ee.%ng ang *er,ang#+ng ,a$a .an

roge#teron ;%t/.ra;, *,ee.%ng" roge#t%n .%g+nakan #e,a$a 10 /ar% /%ngga

$%ngg+ +nt+k $en#ta*%,kan .%n.%ng en.o$etr%+$ ,a,+ .%/ent%kan #e-ara t%*at%*a

.engan $ak#+. $eng%k%# #e$+a .%n.%ng en.o$etr%+$ .an *er#%'at k+reta#e a,a$%5

Tera% e#trogen .%*er%kan a.a E#trogen ;%t/.ra;, *,ee.%ng .an roge#terone

*reakt/ro+g/ *,ee.%ng +nt+k $e$erk+at #tro$a te$at ke,en?ar ang /%er,a#%a

karena .%rang#ang roge#terone5 Pa.a kea.aan %n% .%*er%kan ! $g e#trogen

terkon?+ga#% #e-ara %ntra 7ena t%a ?a$ /%ngga er.ara/an *er/ent% ata+ #e,a$a

?a$ +nt+k $eng/%n.ar% ter*ent+kna tro$*+# a.a ka%,er +ter+#5 Se$+a tera%

e#trogen /ar+# .%%k+t% tera% roge#teron .an ;%t/.ra;, *,ee.%ng5

Daat ?+ga .%*er%kan ant% ro#tag,an.%n +nt+k 7a#okontr%k#% .ara/ #e/%ngga

er.ara/an .aat *er/ent%5 De#$ore#%n a#etat (ana,og #%ntet%k .ar% arg%n%n

7a#ore#%n" .%g+nakan +nt+k $engo*at% DUB a.a a#%en gangg+an e$*ek+an

ter+ta$a a.a enak%t 7on ;%,,e*ran.# .an .aat .%*er%kan %ntrana#a, $a++n

%ntra7ena5 Pengo*atan .aat $en%ngkatkan ka.ar 'aktor 6III .an 'aktor 7on

;%,,e*ran.# ang *er,ang#+ng #ek%tar 8 ?a$5

3 )angg+an a.a organ .a,a$ e,7%#

Menorrr/ag%a *%a#ana *er/+*+ngan .engan '%*ro%. a.a +ter+#> a.eno$$%o#%#>

%n'ek#% e,7%#> o,%# en.o$etr%a,> .an a.ana *en.a a#%ng #eert% IUD5 Wan%ta.engan er.ara/an /a%. $e,e*%/% 00 -- !0 $enga,a$% '%*ro%.5 0 a#%en

.engan a.eno$%o#%# $enga,a$% er.ara/an /a%. $e,e*%/% 800--5 Menorr/ag%a

a.a retro',ek#% .%#e*a*kan karena *en.+ngan a.a 7ena +ter+# #e.angkan a.a

$%o$a +ter%> $enorr/ag%a .%#e*a*kan o,e/ kontrak#% otot ang k+rang k+at>

er$+kaan en.o$etr%+$ ang ,+a# .an *en.+ngan 7ena +ter+#5

)angg+an $e.%# ,a%nna

)angg+an $e.%# ,a%nna ang .aat $ene*a*kan $enorr/ea .%antarana

/%ot%ro%. .an #%n.ro$ -+#/%ng> at%'%#%o,og% ter?a.%na *e,+$ .%keta/+% .engan

a#t%5 Daat ?+ga ter?a.% a.a /%erten#%> .eko$#at%o -or.%# .an %n'ek#% .%$ana

.aat $en+r+nkan k+a,%ta# e$*+,+/ .ara/5 Menorr/ag%a .aat ter?a.% a.a orang


25/52

a#t/en%a .an ang *ar+ #e$*+/ .ar% enak%t *erat karena $ene*a*kan k+a,%ta#

$%o$etr%+$ ang ?e,ek5

Terapi

Tera% $enorr/ag%a #angat tergant+ng +#%a a#%en> ke%ng%nan +nt+k $e$%,%k%

anak> +k+ran +ter+# ke#e,+r+/an> .an a.a t%.akna '%*ro%. ata+ o,%5 Sektr+$engo*atanna #angat ,+a# $+,a% .ar% enga;a#an #e.er/ana> tera% /or$on>

oera#% %n7a#%' $%n%$a, #eert% engangkatan .%n.%ng en.o$etr%+$

(en.o$%o$etr%a, re#e-t%on ata+ EMR"> o,% (o,%ekto$%"> ata+ '%*ro%.

($%o$ekto$%" .an /%#terekto$% (a.a ka#+# ang re'rakter"5

Daat ?+ga .%g+nakan /er*a, arro;> nett,e# +r#e> agr%$on> ra$+an -%na>

,a.%e# $ant,e> 7er7a%n .an ra#*er $era/ ang .%erk%rakan .aat $e$erk+at

+ter+#5 6%te ?+ga .%an?+rkan +nt+k $engo*at% $enorr/ea .an #%n.ro$ re

$entr+a,5 D%an?+rkan ?+ga e$*er%an #+,e$en *e#% +nt+k $enggant% *e#% ang

/%,ang $e,a,+% er.ara/an5 6%ta$%n ang .%*er%kan a.a,a/ 7%ta$%n A karena ;an%ta

.engan ,e/%,angan .ara/ /e*at *%a#ana $enga,a$% en+r+nan ka.ar 7%ta$%n A .an

K ang .%*+t+/kan +nt+k e$*ek+an .ara/5 6%ta$%n &%n- .an *%o',a7%no%.#.%*+t+/kan +nt+k $e$erk+at 7ena .an ka%,er5

Prognosis

Progno#%# a.a #e$+a ket%.akterat+ran a.a,a/ *a%k *%,a .%tera% .ar% a;a,5

* 4%o$enorea

4%o$enorr/ea a.a,a/ #+at+ kea.an .%$ana ?+$,a/ .ara/ /a%. #angat #e.%k%t

(30--"> ka.angka.ang /ana *er+a #ott%ng5 Daat .%#e*a*kan o,e/ #teno#%#

a.a /%$en> #er7%k ata+ +ter+#5 Pa#%en .engan o*at kontra#e#% ka.ang

$e$*er%kan ke,+/an %n%5 4a, %n% ?+ga .aat ter?a.% a.a /%o,a#%a +ter% .%$ana

?ar%ngan en.o$etr%+$ #e.%k%t5

+ Kela!#a# (!kl&(

a Po,%$enorea

Ke,a%nan /a%. .%$ana #%k,+# k+rang .ar% 1 /ar% .an $en+r+t ,%terat+r ,a%n #%k,+#

,e*%/ en.ek .ar% ! /ar%5

Etiologi

B%,a #%k,+# en.ek na$+n terat+r a.a ke$+ngk%nan #ta.%+$ ro,%'era#% en.ekata+ #ta.%+$ #ekre#% en.ek ata+ ke.+a #ta.%+$ $e$en.ek5 Yang a,%ng #er%ng

.%?+$a% a.a,a/ e$en.ekan #ta.%+$ ro,%'era#%5 B%,a #%k,+# ,e*%/ en.ek .ar% 1

/ar% ke$+ngk%nan $e,%*atkan #ta.%+$ #ekre#% ?+ga .an /a, %n% $ene*a*kan

%n'ert%,%ta#5 S%k,+# ang ta.%na nor$a, $en?a.% en.ek *%a#ana .%#e*a*kan

e$en.ekan #ta.%+$ #ekre#% karena kor+# ,+te+$ ,eka# $at%5 4a, %n% #er%ng

ter?a.% a.a .%#'+ng#% o7ar%+$ #aat k,%$akter%+$> +*erta# ata+ enak%t kron%k

#eert% TB


26/52

* O,%go$enorea

O,%go$enorr/ea .%#e*+t ?+ga #e*aga% /a%. ?arang ata+ #%k,+# an?ang5

O,%go$enorr/ea ter?a.% *%,a #%k,+# ,e*%/ .ar% 3! /ar%5 Dara/ /a%. *%a#ana

*erk+rang5

Etiologi

O,%go$enorr/ea *%a#ana *er/+*+ngan .engan ano7+,a#% ata+ .aat ?+ga

.%#e*a*kan ke,a%nan en.okr%n #eert% ke/a$%,an> gangg+an /%o'%#e/%ota,a$+#>

.an $enoo+#e ata+ #e*a* #%#te$%k #eert% ke/%,angan *erat *a.an *er,e*%/5

O,%go$enorr/ea #er%ng ter.aat a.a ;an%ta a#ten%#5 Daat ?+ga ter?a.% a.a

;an%ta .engan #%n.ro$ o7ar%+$ o,%k%#t%k .%$ana a.a kea.aan %n% .%/a#%,kan

an.rogen ang ,e*%/ t%ngg% .ar% ka.ara a.a ;an%ta nor$a,5 O,%go$enorr/ea

.aat ?+ga ter?a.% a.a #tre## '%#%k .an e$o#%ona,> enak%t kron%#> t+$or ang

$en#ekre#%kan e#trogen .an n+tr%#% *+r+k5 O,%go$enorr/e .aat ?+ga .%#e*a*kan

ket%.ak#e%$*angan /or$ona, #eert% a.a a;a, +*erta#5 O,%go$enorr/ea ang

$eneta .aat ter?a.% ak%*at eran?angan #ta.%+$ 'o,%k+,ar> eran?angan#ta.%+$ ,+tea,> ata++n eran?ang ke.+a #ta.%+$ ter#e*+t5 B%,a #%k,+# t%*at%*a

$e$an?ang $aka .aat .%#e*a*kan o,e/ engar+/ #%k%# ata+ engar+/ enak%t5

Gejala

)e?a,a o,%go$enorr/ea ter.%r% .ar% er%o.e $en#tr+a#% ang ,e*%/ an?ang .ar%

3! /ar% .%$ana /ana .%.aatkan 2 er%o.e .a,a$ 1 ta/+n5 Be*eraa ;an%ta

.engan o,%go$enorr/ea $+ngk%n #+,%t /a$%,5 B%,a ka.ar e#trogen ang $en?a.%

ene*a*> ;an%ta ter#e*+t $+ngk%n $enga,a$% o#teooro#%# .an enak%t

kar.%o7a#k+,ar5 Wan%ta ter#e*+t ?+ga $e$%,%k% re#%ko *e#ar +nt+k $enga,a$%

kanker +ter+#5

Pengobatan

Pengo*atan o,%go$enorr/ea tergant+ng .engan ene*a*5 Pa.a

o,%go$enorr/ea .engan ano7+,ato%r #erta a.a re$a?a .an ;an%ta ang $en.ekat%

$enoo+#e t%.ak $e$er,+kan tera%5 Per*a%kan #tat+# g%&% a.a en.er%ta .engan

gangg+an n+tr%#% .aat $e$er*a%k% kea.aan o,%go$enorr/ea5 O,%go$enorr/ea

#er%ng .%o*at% .engan %, KB +nt+k $e$er*a%k% ket%.ak#e%$*angan /or$ona,5

Pa#%en .engan #%n.ro$ o7ar%+$ o,%k%#t%k ?+ga #er%ng .%tera% .engan /or$ona,5

B%,a ge?a,a ter?a.% ak%*at a.ana t+$or> oera#% $+ngk%n .%er,+kan5 Pengo*atan

a,ternat%' ,a%nna .aat $engg+nakan ak++nt+r ata+ ra$+an /er*a,5

Komplikasi

Ko$,%ka#% ang a,%ng $enak+tkan a.a,a/ tergangg+na 'ert%,%ta# .an #tre##

e$o#%ona, a.a en.er%ta #e/%ngga .aat $eer*+r+k ter?a.%na ke,a%nan /a%.

,e*%/ ,an?+t5

Prognosis

Progno#a akan *+r+k *%,a o,%go$enorr/ea $engara/ a.a %n'ert%,%ta# ata+

tan.a .ar% kegana#an5

- A$enorea

Kea.aan .%$ana t%.ak a.ana /a%. +nt+k #e.%k%tna 3 *+,an *ert+r+tt+r+t5D%*ag% ata# a$enorea r%$er (+#%a 18 ta/+n ke ata# t%.ak .aat /a%." .an


27/52

#ek+n.er en.er%ta erna/ $en.aat /a%. .an ke$+.%an t%.ak /a%. ,ag%"5 I#t%,a/

kr%to$enorea $er+akan kea.aan .%$ana t%.ak ta$ak a.ana /a%. karena

.ara/ t%.ak ke,+ar *er/+*+ng a.a ang $eng/a,ang%> #eert% a.a /%$en ang

nggak *er,+*ang> en+t+an #a,+ran #er7%k%#> .an ,a%n,a%n5

Klasifikasi1 A$enorea Pr%$er : ?%ka #eorang ere$+an *e,+$ $enga,a$% /a%./a%.

#ete,a/ +#%a 1@ ta/+n teta% te,a/ ter.aat tan.atan.a #ek# #ek+n.er ata+

t%.ak ter?a.% /a%. #a$a% 1 ta/+n tana a.ana tan.atan.a #ek# #ek+n.er5

A$enorr/ea *%a#ana ter?a.% a.a ;an%ta $+.a .engan +n.er;e%g/t ata+

a.a akt%7%ta# *erat .%$ana -a.angan ,e$ak $e$engar+/% +nt+k $e$a-+

e,ea#an /or$on5

A$enorea Sek+n.er> aa*%,a *er/ent% /a%. #ete,a/ $enar-/e ata+ erna/

$enga,a$% /a%. teta% *er/ent% *ert+r+tt+r+t #e,a$a 3 *+,an5 A$enorr/ea

#ek+n.er *erart% te,a/ ter?a.% /a%.> teta% /a%. ter/ent% +nt+k $a#a t%ga

#%k,+# ata+ ,e*%/ .ar% ena$ *+,an5

Fisiologis

Ter?a.% #e*e,+$ +*erta#> .a,a$ ke/a$%,an> .a,a$ $a#a ,akta#% $a++n

.a,a$ $a#a $enoa+#e> gangg+an a.a ak#%# /%ota,a$+#/%o'%#%#o7ar%+$>

ke,a%nan kongen%ta,> gangg+an #%#te$ /or$ona,> ket%.ak#ta*%,an e$o#%> k+rang

&at $akanan ang $e$+na% n%,a% g%&% ,e*%/5

Etiologi

A$enorr/ea .aat ter?a.% ak%*at gangg+an a.a ko$onen ang *ereran

a.a ro#e# /a%.5 Ko$onen ter#e*+t antara ,a%n:

L%ngk+ngan

Ko$arte$en I6

o SSP

o 4%ota,a$+#

Ko$arte$en III )nR4

o 4%o'%#e anter%or

Ko$arte$en II S4 L4

o O7ar%+$

Ko$arte$en I roge#teron e#trogen

o

Uter+#

Sebab-sebab pada amenorea primer dan sekunder

15 )angg+an organ%k +#at

5 )angg+an ke?%;aan : #ok e$o#%ona,> #%ko#%#> #e+.o#%e#%# (/a$%, a,#+"

35 )angg+an oro# /%ota,a$+# F /%o'%#%# : #%n.ro$ a$enorea ga,aktorea>

#%n.ro$ Ste%n Le7ent/a,> a$enorea /%ota,a$%k

5 )angg+an /%o'%#%#: #%n.ro$ S/ee/an> enak%t S%$$on.#> t+$or

!5 )angg+an gona. : Ke,a%nan kongen%ta,> Menoa+#e re$at+r> eng/ent%an

'+ng#% o7ar%+$ karena oera#%> ra.%a#%> ra.ang .an #e*aga%na5

@5 )angg+an g,an.+,a #+rarena,%# : S%n.ro$ a.renogen%ta,> S%n.ro$

-r+#/%ng> enak%t A..%#on95 )angg+an g,an.+,a t%ro%.ea : 4%ot%ro%.ea> /%ert%ro%.ea> kret%n%#$e


28/52

85 )angg+an ankrea#

25 )angg+an +ter+# .an 7ag%na

105Penak%tenak%t +$+$

Pen!akit !ang dapat disertai amenorea Kelainan Keji"aan

1 P#%ko#%#: #er%ng .%?+$a% *er#a$a a$enorea %a,a/ enak%t ang .%#erta%.ere#%5

Anorek#%a ner7o#a:Ter+ta$a .%te$+kan a.a ;an%ta $+.a ang $en.er%ta

gangg+an e$o#%ona, ang -+k+ *erat5 Penanganan anorek#%a ner7o#a

/ar+# .%,ak+kan o,e/ a/,% #%k%atr%5 %ka *erat *a.an *erta$*a/> *%a#ana

/a%. .aat ke$*a,% .a,a$ 3 *+,an5

3 P#e+.o#%e#%#:a.a,a/ #+at+ kea.aan .%$ana ter.aat k+$+,an tan.atan.a

ke/a$%,an a.a #eorang ;an%ta ang t%.ak /a$%,5 D%agno#%# .%*+at .engan

$ene$+kan +ter+# ang #e*e#ar *%a#a a.a e$er%k#aan g%neko,og%k .an

te# /a$%, ang negat%'5

Gangguan Poros #ipotalamus-#ipofisis S%n.ro$ a$enorea ga,aktorea: .%te$+kan a$enorea> .an a.a $a$$a

.aat .%ke,+arkan a%r #+#+5 Da#arna %a,a/ gangg+an en.okr%n *er+a

gangg+an ro.+k#% re,ea#%ng 'a-tor .engan ak%*at $en+r+nna ka'ar S4

.an L4 .an gangg+an ro.+k#% Pro,a-t%ng In/%*%t%ng a-tor .engan ak%*at

en%ngkatan enge,+aran ro,akt%n5 Daat .%te$+kan #ete,a/ ke/a$%,an>

.%#%n% $a#a ,akta#% $en?a.% ?a+/ ,e*%/ an?ang .ar% *%a#ana (#%n.ro$

/%r#+t%#$e .an

e$*e#aran o,%k%#t%k o7ar%+$5 A$enorea /%ota,a$%k

Gangguan #ipofisis

1 In#+'%#%en#% /%o'%#%# (S%n.ro$ S/ee/an .an Penak%t S%$$on.#"5

)e?a,ana a.a,a/ a$enorea> /%,angna ,akta#%> /%ot%ro%.ea> atro'% a,ata,at

gen%ta, .an #e*aga%na5 Tera% ter.%r% ata# e$*er%an /or$on #e*aga%

#+*#%t+#%> antara ,a%n kort%#on> *+*+k t%ro%.> .an #e*aga%na5

T+$or 4%o'%#%#

3 Ke,a%nan kongen%ta, a.a 4%o'%#%#

Gangguan Gonad D%#gene#%#= Agene#%# o7ar%% (S%n.ro$ T+rner": Tr%a# k,#%kna :

%n'ant%,%#$e> ;e**e. ne-k .an k+*%t+# 7ag+#5 Pen.er%ta %n% $e$%,%k%

gen%ta,%a ek#terna ;an%ta .engan k,%tor%# aga? $e$*e#ar a.a *e*eraa

ka#+#> #e/%ngga $ereka .%*e#arkan #e*aga% ;an%ta5 Po,a kro$o#o$

ke*anakan !QO> a.a #e*ag%an .a,a$ *ent+k !QO=@QQG a.a

#e*ag%an .a,a$ ke,a/%ran *a% ;an%ta5 Se,a%n tr%a#> *%a#ana .%?+$a%

t+*+/ ang en.ek t%.ak ,e*%/ .ar% 1!0-$> .a.a *er*ent+k er%#a% .engan

+t%ng #+#+ ?a+/ ke ,atera,> a+.ara t%.ak *erke$*ang> ra$*+t ket%ak .an

+*%# #e.%k%t ata+ t%.ak a.a> a$enorea> koarkta#% ata+ #teno#%# aorta> *ata#

ra$*+t *e,akang ang ren.a/> r+a# t+,ang tangan .an kak% en.ek>

o#teooro#%#> gangg+an eng,%/atan> gangg+an en.engaran> ano$a,%

g%n?a, .an #e*aga%na5


29/52

S%n.ro$ 'e$%n%#a#% Te#t%k+,er

Menoa+#e re$at+r

S%n.ro$ o7ar%+$ ang T%.ak Peka (T/e %n#en#%t%7e o7ar #n.ro$e"

T+$ort+$or o7ar%+$

Gangguan Glandula suprarenalis

1 S%n.ro$ A.renogen%ta,: *er#%'at kongen%ta,> akan teta% .aat t+$*+/

ke$+.%an5 Pene*a*na %a,a/ /%er,a#%a a.rena,5 B%a#ana *a%

.engan #%n.ro$ %n% a.a,a/ *a% ;an%ta> .engan e$*e#aran k,%tor%#

.engan ka.angka.ang /%o#a.%a5 Pa.a ;an%ta ang ,e*%/ .e;a#a

ter.aat a$enorea> k,%tor%# $e$*e#ar> atro'% $a$$a .an

$e$*e#arna #+ara5

S%n.ro$ ter+ta$a ko$onen kort%ko#tero%. ang a.a #angk+t

a+tna .engan $eta*o,%#$e kar*o/%.rat> rote%n .an e,ektro,%t5

)e?a,ana %a,a/ o*e#%ta#> $oon 'a-e> a$enorea> /%r#+t%#$e>o#teooro#%#> /%erten#%> #tr%ae ter+ta$a a.a .%n.%ng er+t5

3 Penak%t A..%#on

Gangguan $terus dan vagina

1 S%n.ro$ A#/er$an: ter?a.% karena .e#tr+k#% en.o$etr%+$ #erta

t+$*+/na #%nek%a a.a .%n.%ng ka7+$ +ter% #e*aga% ak%*at kerokan

ang *er,e*%/an> *%a#ana a.a a*ort+# ata+ o#tart+$5

En.o$etr%t%# t+*erk+,o#a: +$+$na #k+n.er a.a en.er%ta #a,%ng%t%#

t+*erk+,o#a5 Tera% ang ka+#a, ter/a.a t+*erk+,o#%# *%a#ana .aat

$ene*a*kan t%$*+,na /a%. ,ag%5

%menorr&ea pada atlet dengan lati&an berlebi&

Saat .%,ak+kan ,at%/an *er,e*%/> .%*+t+/kan ka,or% ang *anak

#e/%ngga -a.angan ko,e#tero, t+*+/ /a*%# .an *a/an +nt+k e$*ent+kan

/or$on #tero%. #ek#+a, (e#trogen roge#teron" t%.ak ter-+k+%5 Pa.a

kea.aan ter#e*+t ?+ga ter?a.% e$e-a/an e#trogen *er,e*%/ +nt+k $en-+k+%

ke*+t+/an *a/an *akar .an ter?a.%,a/ .e'%#%en#% e#trogen .an rogeteron ang

$e$%-+ ter?a.%na a$enorr/ea5 Pa.a kea.aan ,at%/an *er,e*%/ *anak

.%/a#%,kan en.or%n ang $er+akan .er%'at $or'%n5 En.or%n $ene*a*kan

en+r+nan )nR4 #e/%ngga e#trogen .an roge#teron $en+r+n5 Pa.a kea.aan

#tre## *er,e*%/>corticotropin releasing &ormon.%,ea#kan> a.a en%ngkatan

ter?a.% en%ngkatan oo%. ang .aat $enekan e$e*ent+kan )nR45

Terapi

Pa.a a$enorea> tergant+ng .engan et%o,og%na5 Se-ara +$+$ .aat

.%*er%kan /or$on/or$on ang $erang#ang o7+,a#%> %ra.%a#% .ar% o7ar%+$ .an

enge$*a,%an kea.aan +$+$> $ene%$*angkan antara ker?arekrea#% .an

%#t%ra/at5

Pengelolaan ' prognosa

Penge,o,aan a.a a#%en %n% tergant+ng .engan ene*a*5 B%,a

ene*a* a.a,a/ ke,a%nan genet%k> rogno#a ke#e$*+/an *+r+k5 Men+r+t

*e*eraa ene,%t%an> .aat .%,ak+kan tera% #+,%/ /or$on> na$+n 'ert%,%ta#

*e,+$ tent+ .aat .%erta/ankan5


30/52

Komplikasi

Ko$,%ka#% ang a,%ng .%tak+tkan .ar% a$enorr/ea a.a,a/ %n'ert%,%ta#5

Ko$,%ka#% ,a%nna a.a,a/ t%.ak er-aa .%r%na en.er%ta #e/%ngga .aat

$enggang+ ko$arte$en I6 .an ter?a.%,a/ ,%ngkaran #etan ter?a.%na

a$enorr/ea5 Ko$,%ka#% ,a%nna $+n-+,na ge?a,age?a,a ,a%n ak%*at%n#+'%#%en#% /or$on #eert% o#teooro#%#5

3 Pe'"a'aa# "! l&a' a!"

Metrorag%a

Metrorr/ag%a a.a,a/ er.ara/an t%.ak terat+r .an t%.ak a.a

/+*+nganna .engan /a%. na$+n kea.aan %n% #er%ng .%angga o,e/ ;an%ta

#e*aga% /a%. ;a,a++n *er+a *er-ak5

Metrorr/ag%a .aat .%#e*a*kan o,e/ ke/a$%,an #eert% a*ort+# ata++n

ke/a$%,an ekto%k .an .aat ?+ga .%#e*a*kan o,e/ 'aktor ,+ar ke/a$%,an

#eert% o7+,a#%> o,% en.o$etr%+$ .an kar#%no$a #er7%k#5 Ak/%rak/%r %n%>

e#trogen ek#ogen $en?a.% ene*a* ter#er%ng $etrorr/ag%a5 Tera% ang

.%*er%kan tergant+ng et%o,og%5

*a#$$&a# la!# 2a#$ a"a &$a# "e#$a# a!"

a Pre $en#tr+a, ten#%on (ketegangan ra /a%."

Ketegangan #e*e,+$ /a%. ter?a.% *e*eraa /ar% #e*e,+$ /a%. *a/kan

#a$a% $en#tr+a#% *er,ang#+ng5 Ter?a.% karena ket%.ak#e%$*angan /or$on

e#trogen .an roge#tero$ $en?e,ang $en#tr+a#%5 Pre $en#tr+a, ten#%on ter?a.%

a.a +$+r 300 ta/+n5

Gejala klinik)angg+an e$o#%ona,G ge,%#a/> #+#a/ t%.+rG er+t ke$*+ng> $+a,

$+nta/G a+.ara tegang .an #ak%tG terka.ang $era#a tertekan

Terapi

O,a/raga> er+*a/an .%et (tana gara$> ko% .an a,ko/o,"G $eng+rang%

#tre##G kon#+$#% ant%.ere##an *%,a er,+G $enekan '+ng#% o7+,a#% .engan

kontra#e#% ora,> roge#t%nG kon#+,ta#% .engan tenaga a/,%> KIEM +nt+k

e$er%k#aan ,e*%/ ,an?+t5

* Ma#to.%n%a

A.a,a/ ra#a tegang a.a a+.ara $en?e,ang /a%.5

Sebab-sebab

D%#e*a*kan o,e/ .o$%na#% /or$on e#trogen> #e/%ngga ter?a.% reten#% a%r .an

gara$ ang .%#erta% /%ere$%a .%.aera/ a+.ara5

- M%tte,#-/$er& (ra#a ner% a.a o7+,a#%"

A.a,a/ ra#a #ak%t ang t%$*+, a.a ;an%ta #aat o7+,a#%> *er,ang#+ng

*e*eraa ?a$ #a$a% *e*eraa /ar% .% ertenga/an #%k,+# $en#tr+a#%5 4a, %n%

ter?a.% karena e-a/na 'o,%ke, )ra''5 La$ana *%#a *e*eraa ?a$ *a/kan

#a$a% 3 /ar%5 Terka.ang M%tte,#-/$er& .%%k+t% o,e/ er.ara/an ang

*era#a, .ar% ro#e# o7+,a#% .engan ge?a,a k,%n%# #eert% ke/a$%,an ekto%k ange-a/5


31/52

. D%#$enorea

Ner% a.a .aeara/ angg+, ak%*at $en#tr+a#% .an ro.+k#% &at

ro#tag,an.%n5 Ser%ngka,% .%$+,a% #egera #ete,a/ $enga,a$% /a%. erta$a

($enar-/e"5 Ner% *erk+rang #ete,a/ $en#tr+a#%> na$+n a.a *e*eraa ;an%ta

ner% *%#a ter+# .%a,a$% #e,a$a er%o.e $en#tr+a#%5Pene*a* ner% *era#a, .ar% otot ra/%$5 Seert% #e$+a otot ,a%nna>

otot ra/%$ .aat *erkontrak#% .an re,ak#a#%5 Saat /a%. kontrak#% ,e*%/ k+at5

Kontrak#% ang ter?a.% a.a,a/ ak%*at #+at+ &at ang na$ana ro#tag,an.%n# 5

Pro#tag,an.%n# .%*+at o,e/ ,a%#an .a,a$ .ar% ra/%$5 Se*e,+$ $en#tr+a#%

ter?a.% &at %n% $en%ngkat .an*eg%t+ /a%. ter?a.%> t%ngkat ro#tag,an.%n

$en+r+n5 4a, %n% .aat $en?e,a#kan $engaa #ak%t -en.er+ng *erk+rang

#ete,a/ *e*eraa /ar% erta$a /a%.5

D#$enorr/ea ter*ag% ?a.% .+a a%t+ r%$er ata+ #ek+n.er> r%$er

$+rn% karena ro#e# kontrak#% ra/%$ tana enak%t .a#ar #e*aga% ene*a*5

Se.angkan .#$enorr/ea #ek+n.er .%#e*a*kan #e,a%n ro#e# /a%. .an

ro.+k#% ro#tag,an.%n #e-ara a,a$%5

en.ote,%n> ro#tag,an.%n> 7a#ore##%n .an ker+#akan #ara' er%'er5

4%erakt%7%ta# +ter+# *er/+*+ngan .engan a,%ran .ara/ +ter+#5

4%erakt%7%ta# +ter+# ter?a.% a.a en.o$etr%o#%# .an a.eno$%o#%#5 Uter+#

ang *erkontrak#% $ene*a*kan Hang%na #e/%ngga ter?a.%,a/ ner%5

En.ote,%n a.a,a/ +teroton%n oten a.a +ter+# ang t%.ak /a$%,5

En.ote,%n *ereran $eng%n.+k#% kontrak#% otot o,o# a.a er*ata#an

.engan ke,en?ar en.o$etr%+$5 Te$at ang a,%ng *anak $engan.+ng%katan en.ote,%n a.a,a e%te, ke,en?ar a.a te$at ter#e*+t5 En.ote,%n

ter#e*+t .aat $eng%n.+k#% e,ea#an P) .an $eng%n.+k#% ke,en?ar

,a%nna +nt+k $eng/a#%,kan en.or%n ,a%nna (arakr%n"5 I#ke$% ang

ter?a.% ak%*at kontrak#% #e,an?+tna $erang#ang e,ea#an en.or%n .an

P) #e/%ngga akan $ene*a*kan .%#er%#ta,t%# ,e*%/ ,an?+t5

En.o$etr%+$ ;an%ta .engan .%#$enorr/ea $eng/a#%,kan P) ,e*%/

*anak .ar%a.a ;an%ta nor$a,5 P) a.a,a/ ok#%tok#% .an

7a#okon#tr%ktor ang oten ang *%,a .%*er%kan a.a +ter+# akan

$eng/a#%,kan ner% .an $engak%*atkan enge,+aran .ara/ /a%.5 A,a#an

$engaa P) ,e*%/ t%ngg% a.a ;an%ta tertent+ *e,+$ .%keta/+% .engan

a#t%5 Pa.a *e*eraa ;an%ta> ro#tag,an.%n .aat $engak%*atkan otot o,o#


32/52

.a,a$ #%#te$ ga#tro%nte#t%na, *erkontrak#% #e/%ngga $ene*a*kan $+a,>

$+nta/ .an .%are5

6a#ore#%n $er+akan 7a#okon#tr%ktor ang $en#t%$+,a#% $%o$etr%+$

*erkontrak#%5 Pa.a /ar% erta$a $en#tr+a#%>ka.ar 7a#ore#%n $en%ngkat

a.a ;an%ta .engan .%#$enorr/ea5

Ker+#akan #ara' er%'er a.a $%o$etr%+$ .an #er7%k# o,e/ er#a,%nan54a, %n% $en?e,a#kan $engaa a.a ;an%ta ang te,a/ $e,a/%rkan

.%#$enorr/ea .aat *erk+rang5

D%#$enorr/ea #ek+n.er

D%#$enorr/ea #ek+n.er *%a#ana ter?a.% ke$+.%an #ete,a/ $enar-/e5

B%a#ana .%#e*a*kan /a, ,a%n5 Ner% *%a#ana *er#%'at reg+,ar a.a #et%a

/a%. na$+n *er,ang#+ng ,e*%/ ,a$a .an *%#a *er,ang#+ng #e,a$a #%k,+#5

Ner% $+ngk%n ner% a.a #a,a/ #at+ #%#% a*.o$en5

D%#$enorr/ea #ek+n.er .aat .%#e*a*kan o,e/ en.o$etr%o#%# .%$ana

?ar%ngan +ter+# t+$*+/ .% ,+ar +ter+# .an %n% .aat ter?a.% a.a ;an%ta t+a

$a++n $+.a5 I$,an %n% $a#%/ *ereak#% ter/a.a e#trogen .anroge#teron #e/%ngga .aat $e,+r+/ #at /a%.5 4a#%, e,+r+/an *%,a ?at+/ ke

.a,a$ rongga a*.o$en .an $erang#ang er%tone+$ akan $eng/a#%,kan

ner%5 En.o$etr%o#%# .%te$+kan a.a 101! ;an%ta +#%a !33 ta/+n5

D%#$enorr/ea #ek+n.er .aat ?+ga .%#e*a*kan '%*ro%.> enak%t ra.ang

angg+,G IUDG t+$or a.a t+*a 'a,,o%> +#+# ata+ 7e#%ka +r%nar%aG o,%

+ter%G %n',$ator *o;e, .e#ea#eG #kar ata+ er,engketan ak%*at oera#%

#e*e,+$na .an a.eno$%o#%# a%t+ #+at+ kea.aan .%$ana en.o$etr%+$

t+$*+/ $ene$*+# $%o$etr%+$5

Terapi D%#$enorr/ea r%$er *%a#ana .%o*at% o,e/ NSAID #eert% %*+ro'en

.an naroen ang .aat $eng+rang% ner% a.a @ en.er%ta

.%##$enorr/ea r%$er5 P%, kontra#e#% $eng/%,angkan ner% .an ge?a,a ,a%nna

a.a 20 en.er%ta .engan $enekan o7+,a#% .an ?+$,a/ er.ara/an5 Tera%

%n% $e$*+t+/kan ;akt+ 3 #%k,+# +nt+k $eng/%,angkan ge?a,a5 Ko$re# ana#

?+ga .aat $eng+rang% ner%5

D%agno#%# .an enataan ang #ek+n.er #e#+%a .engan ene*a*na5

O*at tertent+> ang .%#e*+t NSAID# (non#tero%.a, ant%%n',a$at%on .r+g">

.aat $e$*,oka.e t+*+/ +nt+k $e$*+at ro#tag,an.%n5 Se*ag%an *e#ar

NSAID#> #eert% %*+ro'en .an naroen> .aat .%*e,% tana re#e5 NSAID#

*eker?a ter*a%k ?%ka .%$akan a.a a;a, #ak%t $+,a% tera#a5 -+k+ .%$akan .a/ar% 1 .an /a%.5 O*at %n% t%.ak *o,e/ .%$akan ?%ka a.a gangg+an er.ara/an>

ker+#akan /at%> gangg+an ,a$*+ng>

Kontra#e#% /or$ona,> #eert% %, KB> ?+ga *%#a $eng+rang% ra#a #ak%t

/a%.5 4or$on ang ter.aat a.a kontra#e#% $e$*ant+ $engontro,

ert+$*+/an ,a%#an .a,a$ ra/%$ #e/%ngga *%#a $eng+rang% ro.+k#%

ro#tag,an.%n5 Yang *erart% ,e*%/ #e.%k%t kra$ ra/%$> k+rang a,%ran .ara/> .an

*erk+rangna ra#a #ak%t5 %ka .%er,+kan> kontra#e#% .aat .%g+nakan .engan

o*at ,a%n ang $en+r+nkan t%ngkat e#trogen ata+ $eng/ent%kan #%k,+# /a%.5

%ka a.a '%*ro%.# ang $ene*a*kan #ak%t> .%,ak+kan oera#%5

Laaro#ko% .aat .%g+nakan +nt+k $engo*at% en.o$etr%o#%#5 ar%ngan

t+$*+/ .% ,+ar ra/%$ .aat .%*+ang .engan ,aaro#ko5 Unt+k ka#+# ang


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*erat> /%#terekto$% (engangkatan ra/%$" .aat .%,ak+kan5 4a, %n% *%a#ana

%,%/an terak/%r5

Pencega&an

Lat%/an aero*%k> #eert% *er?a,an kak%> *er#ee.a> ata+ *erenang>

$e$*ant+ $e$ro.+k#% *a/an a,a$% ang .aat $e$*,ok ra#a #ak%t5 Paka% ko$re## ana# ata+ .%ng%n a.a .aera/ er+t ?%ka ner% tera#a5

Pa#t%kan t%.+r ang -+k+ #e*e,+$ .an #e,a$a er%o.e /a%.5

Orga#$e .aat $er%ngankan kra$ /a%. a.a *e*eraa ere$+an5

Lat%/an re,ak#a#% ata+ Yoga> .aat $e$*ant+ $enangg+,ang% #ak%t5

Kelainan Kompartemen ( Kelainan saluran uterus

15 S%n.ro$ A#/er$an

Pa.a #%n.ro$ %n% ter?a.% a$enorr/ea #ek+n.er5 Kea.aan %n% ter?a.% ak%*at k+reta#e

o#tart+$ *er,e*%/an #e/%ngga ter?a.% #%katr%k .an er,engketan5 En.o$etr%+$ $+ngk%n$e$%,%k% tekanan ang *eg%t+ *e#ar5 Pa#%en .engan a#/er$an #%n.ro$ .aat $enga,a$a%

ke,+/an ,a%n #eert% .%#$enorr/ea .an /o$enorr/ea5

Pa.a $a#a ,a,+> a#/er$an #%n.or$ .%o*at% .engan .%,ata#% .an k+reta#e +nt+k

$eng/an-+rkan #%katr%k5 Sekarang .aat .%g+nakan /%#tero#ko% .engan $e,%#%#kan a./e#%

.engan $e$otong .an $e$*akar .engan /a#%, ang ,e*%/ *a%k .%*an.%ng k+reta#e ang t%.ak

terara/5 Sete,a/ .%,ak+kan /%#tero#ko%> er,+ .%-ega/ ter?a.%na ke$*a,% er,engketan

.engan $e$a#ang IUD5 Daat ?+ga $engg+nakan 'o,,e kateter e.%atr%k .engan

$e$a#+kan 3 -- .an *ar+ .%,ea# #ete,a/ 9 /ar%5

5 M+,,er%an ano$a,%

Pa.a kea.aan %n%> 7ag%na> #er7%k .an +ter+# $+ngk%n t%.ak a.a5 Ata+ a.a kea.aan,a%n> +ter+# $+ngk%n a.a na$+n t%.ak ter.aat rongga> ata+ ter.aatna rongga na$+n

en.o$etr%+$ #angat #e.%k%t5

Penanganan a.a a#%en %n% .%,ak+kanna oera#% .engan $engg+nakan tekn%k

7e--/%ett% ata+ tekn%k rank +nt+k $e$*ent+k #a,+ran 7ag%na *+atan5 Pen+n.aan oera#%

.aat $ene*a*kan ter?a.%na %n',a$a#%5

35 In#en#%t%7%ta# An.rogen (te#t%-+,ar 'e$%n%&at%on"

In#en%t%7%ta# an.rogen ko$,%t .%.%agno#a *%,a .%.aatkan kana,%# 7ag%na na$+n t%.ak

.%.aatkan +ter+#5 Pa#%en %n% *er+a r%a #e+.o/er$aro.%t .%$ana ketent+an r%a

.%tent+kan .ar% a.ana kro$o#o$ QY .an a#%en $e$%,,%k% te#te#5 P#e+.o/er$aro.%t *erart%

gen%ta,%a *er,a;anan .engan gona.5 Se/%ngga a.a a#%en %n% #e-ara 'enot% ta$ak #eert%

;an%ta ta% t%.ak .%te$+kanna ra$*+t +*%# .an ra$*+t ket%ak5 Pa.a a#%en %n% ter.aat

te#to#teron .ara/ ang nor$a, ata+ #e.%k%t $en%ngkat .an kena%kan L4

Pa.a %n#en#%t%7%ta# an.rogen %nko$,%t (1:10 .%*an.%ngkan ang ko$,%t"> %n.%7%.+

$en.aat #e.%k%t engar+/ an.rogen5 In.%7%.+ %n% $+ngk%n $e$%,%k% e$*e#aran k,%tor%#>

.an /a,,+# $+ngk%n a.a5 Ra$*+t +*%# .an ket%ak a.a .an ter.aat ert+$*+/an a+.ara5

Kelainan Kompartemen ((

15 Ke,a%nan o7ar%+$

Ke,a%nan o7ar%+$ .aat $ene*a*kan a$enorr/ea r%$er $a++n #ek+n.er5 300

a$enorr/ea r%$er $enga,a$% ke,a%nan erke$*angan o7ar%+$ ()ona.a, .%#gene#%#"5 Pa#%en%n% .aat ter.%r% .ar% a#%en .engan kar%ot% !Q (!0"> $o#a%k (!"> @QQ (!"5 Wan%ta


34/52

.engan gona.a, .%#gene#%# .%#erata% a$enorr/ea #ek+n.er *er/+*+ngan .engan kar%ot% @>

$o#a%k> 9 >.an !5

5 S%n.ro$ T+rner

Pa.a #%n.ro$ %n% ter?a.% ke/%,angan #at+ Q5 Kro$o#o#$ Q akt%' .a,a$ oo#%t +nt+k

$eng/%n.ar% er-eatan ke$at%an 'o,%ke,5 Karena a.a a#%en %n% ter?a.% kek+rangan 'o,%ke,>ter?a.% kek+rangan /or$on #e gona.a, #aat +*erta# #e/%ngga ter?a.% a$enorr/ea r%$er5

35 Kegaga,an o7ar%+$ re$at+r

Sek%tar 1 ;an%ta akan $enga,a$% /a, %n% #e*e,+$ +#%a 0 ta/+n5 4a, %n% ?+ga ter?a.%

a.a ;an%ta .engan a$enorr/ea5 Kegaga,an o7ar%+$ ang re$at+r .aat .%#e*a*kan

ke,a%nan genet%k .engan en%ngkatan ke$at%an 'o,%ke,5 Daat ?+ga $er+akan ro#e#

a+to%$+n .%$ana 'o,%ke, .%/an-+rkan5

5 E'ek ra.%a#% .an ke$otera%

E'ek ra.%a#% tergant+ng .ar% +$+r .an .o#%# ra.%a#%5 +ng#% *ar%+$ .aat ke$*a,%

#ete,a/ *erta/+nta/+n ke$+.%an5 D% ,a%n %/ak ker+#akan t%.ak akan $+n-+, /%nggater?a.%na kegaga,an o7ar%+$ re$at+r5 Ket%ka ra.%a#% .%*er%kan .% ,+ar e,7%#> ra.%a#% t%.ak

$e$*er%kan re#%ko ter?a.%na kegaga,an o7ar%+$ re$at+r5 )ona. t%.ak .a,a$ kea.aan

*a/aa ket%ka .% .a+r $engg+nakan o7en $%-ro;a7e ang *er.aa enetra#% ren.a/5

Kelainan Kompartemen (((

)angg+an a.a ko$arte$en %n% .aat *er+a gangg+an a.a /%o'%#e anter%or5

)angg+an .aat *er+a a.ana t+$or ang *er#%'at $en.e#ak ata++n $eng/a#%,kan /or$on

ang $e$*+at /a%. $en?a.% tergangg+5 T+$or $%kroa.eno$a .aat .%tera% .engan

$engg+nakan agon%# .oa$%n .%$ana .oa$%n .aat $eng/a$*at e,ea#an ro,akt%n ,e*%/

,an?+t #e/%ngga e$*e#aran t+$or /%o'%#e .an ro,akt%ne$%a .aat .%-ega/5 Oera#% .aat

.%,ak+kan ter+ta$a *%,a t+$or $a#%/ ke-%,5 Na$+n angka rek+ren#% #ete,a/ oera#% #angat

*e#ar ,ag%+,a #tr+kt+r t+$or #+,%t .%*e.akan .engan ?ar%ngan /%o'%#e #e/at #e/%ngga oera#%

#er%ng ka,% $en%ngga,kan #%#a5 Pa.a $akroa.eno$a .aat .%*er%kan agon%# .oa$%n ter,e*%/

.a/+,+ +nt+k $e$erke-%, +k+ran t+$or5 Sete,a/ oera#% .aat .%,an?+tkan .engan

e$*er%an ra.%a#% na$+n ra.%a#% %n% .aat $e$%-+ ter?a.%na t+$or .% te$at ,a%n a.a otak5

Kelainan Kompartemen (V

)angg+an a.a a#%en %n% .%#e*a*kan o,e/ gangg+an $enta, ang #e-ara t%.ak

,ang#+ng $ene*a*kan ter?a.%na e,ea#an ne+rotran#$%ter #eert% #eroton%n ang .aat

$eng/a$*at ,ea#na gona.otro%n5 )angg+an a.a ko$arte$en %n% .aat ter?a.% a.a

en.er%ta anorek#%a ner7o#a $a++n at,et ata+ enar% *a,et ang $enga,a$% ,at%/an .enganketegangan5 A$enorr/ea .aat ?+ga .%#e*a*kan o,e/ enak%tenak%t ,a%n #eert% enak%t

kron%# (TB ke,a%nan /ear .an g%n?a,5


35/52

Kegagalan fungsi hipotalamus-hiposis Kelainan genetik

Amenore primer

hipogonadotropin

Siklus menstruasi tidak terjadi

strogen & progesteron tidak dihasilkan

Ovarium tidakterangsang

FSH & LH

MK ansietas! n"eri! kerusakan integrita

#menore sekunder

$idak terjadi siklus menstrua

Siklus menstruasi terganggu

%en"akit stress! oat-oatan! dl

$anda seks sekunder tidak terjadi

$idak terjadi menstruasi

Ovarium erupa jaringan pengikat

$idak dapat mengalami menstruasi

Ovarium gagal erkemang

$estis menggantikan ovarium$idak pun"a uterus

'isgenesis gonad$estikular femini(ation

MK gangguan )itra tuuh! harga diri rendah

LO.3.. Pa%o/!(!olo$!

WO< AMENORE


36/52

%rogesterone menurun

En(im fosfolipase #* meningkat

ailisasi memrane lisosom +mudah pe)ah,

egresi korpus luteum

.ila tidak terjadi kehamilan

Hidrolisis sen"a/a fosfolipid

$erentuk asam arakidonat

prostaglandin

Meningkatkan kontraksi & disritmia uterus

iskemia

Miometrium terangsang

%0E * & %0F *1 dalam darah meningkat

%0F *1%0E *

Dismenore primer

Meningkatkan sensitisasi & menurunkan amang rasa sakit pada ujng saraf aferen nervus

MK ansietas

MK intoleransi aktivitas

MK n"eri

2"eri haid

MK3ntoleran aktivitasMKn"eri

2"eri haid

Dismenore sekunder

%en"akit endometriosis! in4amasi pelvis! adenomiosis! kista ovarium! kelainan otak

WO< DISMENORE


37/52

%rolaktin 5

Estrogen 5 dan progesteron6

%roses kimia tuuh terganggu

Metaolism vit7.8 +anti depresi, terganggu

MK gangguan integritas kulit

'e)it vit7 .8

%roduksi serotonin terganggu

Serotonin 6 depresiPre menstrual sindrom

Kelemahan umum 2"eri pa"udara a)ne Mood lail

MK intoleransi aktivitas MK n"eri

2eurotransmitter otak terganggu

0angguan metaolism prostaglandin

0amma linolei) a)id +0L#, 6

MK ansietas

WO< PMS (PRE MENSTRUAL SINDROM"

LO.3.4. D!a$#o(!( "a# D!a$#o(!( Ba#"!#$

Ana$ne#%#:

Dokter akan $enanakan #e?ara/ ang ,engka $e.%# a#%en5 In'or$a#% %n% .aat

$e$*ant+ $enent+kan aaka/ $a#a,a/ $en#tr+a#% .%#e*a*kan o,e/ kon.%#% $e.%# ,a%n5

Se*aga% -onto/> non$en#tr+a#% kon.%#% ang .aat $ene*a*kan #ak%t er+t ter$a#+k +#+#

*+nt+> %n'ek#% #a,+ran ken-%ng> ke/a$%,an ekto%k> .an #%n.ro$ %r%ta#% +#+# *e#ar5


38/52

En.o$etr%o#%# .an '%*ro%.# .aat $ene*a*kan er.ara/an *erat .an ner%5 Dokter $+ngk%n

*ertana ertanaanertanaan $engena%:

15 Po,a #%k,+# $en#tr+a#% an?ang ;akt+ antara er%o.e> ?+$,a/ /ar% ang er%o.e

terak/%r> ?+$,a/ /ar% er.ara/an *erat ata+ r%ngan

5 Ke/a.%ran ata+ #e?ara/ .ar% #et%a kon.%#% $e.%# ang $+ngk%n $ene*a*kan

$a#a,a/ /a%.35 Set%a r%;aat ke,+arga $a#a,a/ /a%.

5 Se?ara/ ner% angg+,

!5 Reg+,ar engg+naan o*at (ter$a#+k 7%ta$%n .an o7ert/e-o+nter o*ato*atan"

@5 D%et #e?ara/> ka'e%n ter$a#+k .an a#+an a,ko/o,

95 Ma#a ,a,+ ata+ #ekarang $engg+nakan kontra#e#%

85 Set%a #tre# er%#t%;a terak/%r

25 R%;aat #ek#+a,

105#arian menstruasi)Se*+a/ *+k+ /ar%an $en#tr+a#% a.a,a/ -ara ang $e$*ant+ +nt+k

$e,a-ak er+*a/an .a,a$ #%k,+# $en#tr+a#%5 Pa#%en .aat $ereka$ #aat er%o.e

$ereka $+,a%> *eraa ,a$a *er,ang#+ng> .an ?+$,a/ er.ara/an .an ner% ang

ter?a.% #e,a$a $en#tr+a#%5115Pemeriksaan panggul)Pe$er%k#aan angg+, a.a,a/ *ag%an #tan.ar .%agno#%#5 Te# Pa

.aat .%,ak+kan #e,a$a +?%an %n%5

Pe$er%k#aan ,+ar g%ne,ko,og%:

Pe$er%k#aan '%#%k +$+$

15 Ke#an +$+$: ta$ak #ak%t> ko$o# $ent%#> ane$%a> %kter+#5

5 Ke#a.aran F ko$+n%ka#% er#ona, F tekanan .ara/ F na.% F 'rek+en#% na'a# F #+/+

*a.an5

35 Pe$er%k#aan ?ant+ng .an ar+

Pe$er%k#aan '%#%k ,a%n ang .%an.ang er,+ (ke,en?ar t/ro%.> ke,en?ar geta/ *en%ng> .#*"5

15 Banak a/,% g%neko,og% ang #e-ara r+t%n $e$er%k#a kea.aan ke,en?ar t%ro%.

(e$*e#aran> e$*engkakan> *en?o,an ke-%,

5 Penak%t t%ro%. ,e*%/ #er%ng $engena% ;an%ta .an $en%ngkat .engan #e$ak%n

*erta$*a/na +#%a5

35 Be*eraa gangg+an /a%. *erka%tan .engan .%#'+ng#% t%ro%.5

Pe$er%k#aan k/+#+# g%neko,og%:

In#ek#% a*.o$en:

15 Pe$*e#aran er+t keara/ .ean ang *er*ata# ?e,a# +$+$na .%#e*a*kan

o,e/ke/a$%,an ata+ t+$or55 Pe$*e#aran er+t keara/ #a$%ng +$+$na ter?a.% a.a a#%te#5

35 Str%ae> ?ar%ngan ar+t> er%#ta,t%k5

Pa,a#% a*.o$en:

15 Pa#%en .%$%nta +nt+k $engo#ongkan kan.+ng ke$%/ .an ata+ re-t+$

ter,e*%/.a/+,+5

5 Pa#%en .%$%nta +nt+k *era.a a.a o#%#% .or#a, .an .a,a$ kea.aan

#anta%5

35 Pa,a#% .%,ak+kan .engan $engg+nakan #e,+r+/ te,aak tangan *er%k+t

?ar% ?ar% .a,a$ kea.aan raat ang .%$+,a% .ar% *ag%an /%o-/on.r%+$ #e-ara

er,a/an,a/an .an ke$+.%an .%ter+#kan ke#e$+a *ag%an a*.o$en .engantekanan

ang $en%ngkat #e-ara *erta/a5


39/52

5 Me,a,+% e$er%k#aan %n% .%tent+kan aaka/ : Ter.aat H.e'an-e

$+#-+,ar ak%*at er%ton%t%# ata+ rang#angan er%tone+$ang ,a%n5

!5 Aaka/ a.a ra#a ner% tekan ata+ ner% ,ea#

@5 Dengan tekanan ang agak k+at #erta $engg+nakan #%#% +,nar te,aak

tangankanan .%,ak+kan e$er%k#aan +nt+k $en-ar% ke,a%nan ,a%n .a,a$

-a7+$a*.o$en585B%,a .%?+$a% a.ana $a#a t+$or .a,a$ -a7+$ a*.o$en> tent+kan,e*%/,an?+t $engena% :

Perk+#% a*.o$en:

B%,a .%?+$a% a.ana e$*e#aran er+t> .engan erk+#% .aat .%tent+kanaaka/

e$*e#aran er+t ter#e*+t .%#e*a*kan o,e/ -a%ran *e*a#> +.ara($eteor%#$+#" ata+ t+$or

A+#k+,ta#% a*.o$en:

15 Pent%ng +nt+k $en%ngk%rkan ke$+ngk%nan ke/a$%,an (.engan $en-ar%.en+t

?ant+ng ?an%n"5

5 D%agno#a %,e+# (ara,%t%k ata+ /%er.%na$%k"5

35 Menent+kan +,%/na *%#%ng +#+# a#-a e$*e.a/an

)en%ta,%a Ek#terna:In#ek#% gen%ta,%a ek#terna :

Pa.a o#%#% ,%t/oto$%> gen%ta,%a ek#terna .aat .%,%/at .engan ?e,a#

15 Kea.aan 7+,7a *ag%an ,+ar:

a5 Kotor ata+ *er#%/> kea.aan ra$*+t +*%#5

*5 Ter.aat +,k+#> e$*engkakan5

5 .ara/> ,e+-orr/oe

Pe$er%k#aan Pen+n?ang:

1. Da'a "a# Te( o'mo#al

Te# .ara/ .aat $e$*ant+ $en%ngk%rkan kon.%#% ,a%n ang $ene*a*kan gangg+an

$en#tr+a#%5 Se*aga% -onto/> .okter $+ngk%n te# '+ng#% t%ro%. +nt+k $e$a#t%kan *a/;a t%ro%.

ren.a/ (/%ot%ro%.%#$e" t%.ak /a.%r5 Te# .ara/ ?+ga .aat $e$er%k#a 'o,,%-,e#t%$+,at%ng

/or$on> e#trogen> .an t%ngkat ro,akt%n5 Pa#%en ang $e$%,%k% $enorr/ag%a $+ngk%n

$en.aatkan te# +nt+k gangg+an er.ara/an5 %ka a#%en ke/%,angan *anak .ara/> $ereka

?+ga /ar+# $en.aatkan .%+?% +nt+k ane$%a5

Pa#%en ang $e$%,%k% a$enore $+ngk%n er,+ +nt+k $ener%$a te# /or$on k/+#+#5 U?%

Tantangan roge#ta#%ona, $engg+nakan roge#teron ora, ata+ .%#+nt%kkan +nt+k $eng+?%

,a%#an ra/%$ '+ng#%ona, (en.o$etr%+$":

a5 Per.ara/an ang ter?a.% #a$a% 3 $%ngg+ #ete,a/ .o#%# roge#teron $en+n?+kkan

*a/;a ;an%ta $e$%,%k% t%ngkat e#trogen ang nor$a, teta% t%.ak *ero7+,a#%> ter+ta$a

?%ka t%ro%. .an ro,akt%n t%ngkat nor$a,5 Da,a$ ka#+# ter#e*+t> .okter akan $e$er%k#a#tre#> *erat *a.an *ar+*ar+ %n%> .an #et%a o*ato*atan5 4a#%, ter#e*+t ?+ga *%#a

$enarankan o7ar%+$ o,%k%#t%k ata+ #tre#5

*5 Kegaga,an +nt+k *er.ara/ *%#a $en+n?+kkan ra/%$ ang a*nor$a, ang $en-ega/

ke,+ar ata+ e#trogen t%.ak -+k+5 Da,a$ ka#+# ter#e*+t> ,angka/ *er%k+tna $+ngk%n

+nt+k $enge,o,a e#trogen .%%k+t% o,e/ roge#t%n5 %ka er.ara/an ter?a.% #ete,a/ %t+>

ene*a* a$enore *erka%tan .engan ka.ar e#trogen ren.a/5 Dokter ke$+.%an akan

$e$er%k#a kegaga,an o7ar%+$> anorek#%a> ata+ ene*a* ,a%n .ar% e#trogen ren.a/5

%ka en.ara/an t%.ak ter?a.%> .okter akan $e$er%k#a eng/a,ang ang $en-ega/

a,%ran $en#tr+a#%5


40/52

+. US*

Tekn%k en-%traan ang #er%ng .%g+nakan +nt+k $en.etek

menstruasi tidak teratur (sk 3 endokrin)

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