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Clinical - Winter > 13 - Dysmenorrhea & PMS > Flashcards

13 - Dysmenorrhea & PMS Flashcards

1
Q

What is menarche?

A

Time that a woman first has menstrual flow

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2
Q

What is menopause?

A

Cessation of menses for at least 12 consecutive months

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3
Q

What is peri-menopause?

A
  • Time leading up to menopause

- Typically px experiences missed periods w/ or w/o symptoms of hypoestrogen

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4
Q

What is dysmenorrhea?

A

Pain during menstruation

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5
Q

When is dysmenorrhea most common?

A

Between ages of 20-24 y/o (decreases w/ age)

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6
Q

When does dysmenorrhea occur?

A
  • Only occurs during ovulatory cycles (follicular phase)

- Usually begins w/ onset of menses (w/in first 6-12 months of menarche)

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7
Q

When do symptoms of dysmenorrhea begin and when do they end?

A
  • Begin w/ onset of menses (several hours prior)

- Last 2-3 days

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8
Q

What are common symptoms of dysmenorrhea?

A
  • Cramping in lower abdomen, can radiate into back and thighs
  • Other sx = headache, N/V, fatigue, IBS
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9
Q

What can be done to stop dysmenorrhea?

A

Preventing ovulation, which COC’s do

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10
Q

The ____ phase of ovulation is the only phase that varies in length

A

Follicular

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11
Q

What are the types of dysmenorrhea?

A
  • Primary (uterine contraction often involving increased PGs)
  • Secondary (pelvic inflammatory disease, endometriosis, uterine polyps/fibroids)
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12
Q

What is thought to cause primary dysmenorrhea?

A
  • Concentration of PGE2 and PGF2-alpha increase in endometrium, which correlates w/ pain severity
  • Causes increase in uterine activity, strength, and frequency of contractions
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13
Q

What is the difference in age of onset for primary and secondary dysmenorrhea?

A
  • Primary = typically 6-12 months after menarche

- Secondary = mid to late 20s through 30s and 40s

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14
Q

What is the difference in characteristics of menses for primary and secondary dysmenorrhea?

A
  • Primary = more likely to be regular w/ normal blood loss

- Secondary = more likely to be irregular, menorrhagia more common

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15
Q

What is the difference in pattern and duration for primary and secondary dysmenorrhea?

A
  • Primary = onset coincidental w/ menses; pain w/ each or most menses, lasting 2-3 days
  • Secondary = vary w/ cause, change in pain pattern or intensity may indicate secondary disease
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16
Q

Is pain experienced at other times of menstrual cycle besides follicular phase for primary or secondary dysmenorrhea?

A

Secondary, may occur before, during, or after menses

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17
Q

Does primary or secondary dysmenorrhea respond to NSAIDs and/or OCs?

A

Primary

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18
Q

What is a uterine fibroid?

A

Growth of muscle inside or outside of uterus or outside of reproductive system but attached to uterus

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19
Q

What are risk factors for dysmenorrhea?

A
  • Under 30 y/o
  • BMI under 20
  • Smoking
  • Menarche before 12 y/o
  • Longer menstrual cycles/duration of bleeding
  • Irregular or heavy menstrual flow
  • History of sexual assault
  • PMS or pelvic inflammatory disease
  • Sterilization
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20
Q

What are red flags for dysmenorrhea?

A
  • Onset of pain more than 2 years post-menarche
  • Sx occur outside of first 3 days of menses
  • Change in severity of pattern of pain
  • Change in characteristics of menstrual fluid
  • Trial of OTC tx fails
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21
Q

What are the non-pharm options for dysmenorrhea?

A
  • Heat therapy

- Lifestyle modifications (stop smoking, regular exercise, decrease fat intake)

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22
Q

What are some OTC options for primary dysmenorrhea?

A
  • Analgesics (NSAIDs first line; ibuprofen or naproxen)
  • Start at onset of pain/menses and continue on scheduled basis for 72 h
  • 3 month trial
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23
Q

What is the recommended tx for dysmenorrhea if the woman can’t take ibuprofen or naproxen?

A

Acetaminophen and heat

24
Q

What are the Rx options for primary dysmenorrhea?

A
  • NSAIDs (naproxen, ibuprofen, mefenamic acid, indomethacin)

- Oral contraceptives

25
What is the tx for secondary dysmenorrhea?
Referral and tx for underlying cause
26
What are the monitoring parameters for dysmenorrhea?
- Improvement may take up to 3 cycles - Most self-tx products are unlikely to have significant SEs - Max duration of tx = 3 days; treat cyclically - Refer if sx are severe or if endometriosis or other secondary causes are suspected
27
What is premenstrual syndrome?
Recurrent, physical, physiological, and behavioural sx which occur during luteal phase and are relieved by menstruation w/ a sx free week
28
What is the typical onset of PMS?
Anytime after puberty, typically in mid-twenties
29
When do symptoms of PMS occur?
- Anywhere from 7-14 days before menstruation | - Sx peak few days before
30
When do sx of PMS disappear?
During events that interrupt ovulation (ex: pregnancy, menopause)
31
What are some common sx of PMS?
- Aggression, anger, anxiety - Depression - Fatigue, irritability - Acne - Appetite change - Breast pain or swelling - N/V - Weight gain
32
What are the possible causes of PMS?
- Exaggerated response to normal hormone changes (estradiol and progesterone) - Serotonin deficiencies (may lead to depressed mood, irritability, anger, aggression, appetite disturbances) - Abnormalities in catecholaminergic, GABA, and opioid NT systems
33
What are risk factors for PMS?
- Low intake of vitamin D - Genetic predisposition - High BMI - Stress - Traumatic life events
34
What is PMDD?
- Premenstrual dysphoric disorder | - Severe form of PMS
35
How is PMDD diagnosed?
Criteria in DSM-5
36
When do sx of PMDD peak?
- 3rd or 4th decade of life | - May become severe during perimenopause
37
What is the tx for suspected PMDD?
Referral
38
What are red flags for PMS?
- Severe case (PMDD or unrelenting or progressive sx) - Uncertain or unusual patterns of sx - Affective disorder (depression, anxiety) - Onset of sx associated w/ oral contraceptive or hormone replacement therapy - Sx related to other medical conditions - Other conditions (anemia, thyroid disorder, diabetes, endometriosis, chronic fatigue syndrome, psychiatric disorders) - Peri-menopause - Signs of infection, ovarian cysts - Individuals who don't respond to tx or sx become worse
39
What is the tx approach for PMS?
- Tx should be selected to address the px most bothersome sx | - Generally, combined tx is necessary
40
What are some non-pharms for PMS?
- Education - Support - Behavioural therapy to emphasize relaxation techniques and stress reduction - Dietary (decrease salt intake and caffeine); recommended 7-14 days before menses begins - Aerobic exercise
41
What are the OTC options for PMS?
- PG inhibitors and analgesics (ibuprofen, naproxen) - Diuretic (pamabrom) - Antihistamine (pyrilamine) - NHPs (calcium, vit B6, chasteberry)
42
Is evening primrose recommended as a tx for PMS?
Efficacy is similar to placebo, so not recommended
43
What benefit does chasteberry have on PMS?
May be helpful to reduce breast discomfort and other sx of PMS
44
What are SE of chasteberry?
- GI problems - Acne-like rashes - Headache, dizziness - Fatigue - Dry mouth
45
Who shouldn't take chasteberry?
- Pregnant women - Women on birth control - Women w/ a hormone sensitive condition (ex: breast cancer) - Women taking dopamine-related medications (ex: selegiline, amatadine, levodopa)
46
What is the recommended dose of pyridoxine (vitamin B6) for PMS?
- 50-100 mg daily | - 200 mg/day can cause risk of neuropathy
47
Is magnesium recommended for PMS? Why?
- Not recommended - Evidence not definitive - Too many SE - Mg deficiency is rare, diet is usually enough
48
Is calcium recommended for PMS? Why?
- Yes b/c helps w/ mood, abdominal pain, water retention, cramps, and food cravings - Proven to have lower plasma Ca premenstrually
49
Calcium is considered a ____ tx option for PMS
Preventative or corrective option
50
Is pamabrom a good option for PMS?
- Promotes diuresis, but is very weak b/c wouldn't be available OTC if strong
51
What is the main effect of pyrilamine for PMS?
Sedative effects
52
Are pamabrom and pyrilamine recommended for PMS?
No, have not shown to add benefit over tx w/ an analgesic
53
What is the recommended pharm tx for PMS?
- Ibuprofen or naproxen when pain begins and used short term at lowest effective dose - Provides pain relief for sx of headache, breast pain, and muscle aches
54
What are the Rx options for PMS?
- PG inhibitors (NSAIDs - naproxen, mefenamic acid) - SSRIs - Diuretics (spironolactone) - Androgens (danazol) - Oral contraceptives - Gonadotropin releasing hormone (leuprolide)
55
What is the overall recommended tx for PMS?
- Start w/ non-pharms - Consider options like calcium - Add on NSAIDs if required for headache, muscle and breast pain
56
What is the monitoring for PMS?
- Sx should be improved or alleviated w/in 1-3 cycles
57
When should a px w/ PMS be referred after attempting tx?
- If sx don't alleviate w/in 1-3 months or worsen - Sx are disruptive to personal relationship - Inability to engage in usual activities or function productively - Any sx associated w/ negative outcomes of PMDD

Clinical - Winter (24 decks)

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