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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
Q

What is the tx for secondary dysmenorrhea?

A

Referral and tx for underlying cause

26
Q

What are the monitoring parameters for dysmenorrhea?

A
  • 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
Q

What is premenstrual syndrome?

A

Recurrent, physical, physiological, and behavioural sx which occur during luteal phase and are relieved by menstruation w/ a sx free week

28
Q

What is the typical onset of PMS?

A

Anytime after puberty, typically in mid-twenties

29
Q

When do symptoms of PMS occur?

A
  • Anywhere from 7-14 days before menstruation

- Sx peak few days before

30
Q

When do sx of PMS disappear?

A

During events that interrupt ovulation (ex: pregnancy, menopause)

31
Q

What are some common sx of PMS?

A
  • Aggression, anger, anxiety
  • Depression
  • Fatigue, irritability
  • Acne
  • Appetite change
  • Breast pain or swelling
  • N/V
  • Weight gain
32
Q

What are the possible causes of PMS?

A
  • 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
Q

What are risk factors for PMS?

A
  • Low intake of vitamin D
  • Genetic predisposition
  • High BMI
  • Stress
  • Traumatic life events
34
Q

What is PMDD?

A
  • Premenstrual dysphoric disorder

- Severe form of PMS

35
Q

How is PMDD diagnosed?

A

Criteria in DSM-5

36
Q

When do sx of PMDD peak?

A
  • 3rd or 4th decade of life

- May become severe during perimenopause

37
Q

What is the tx for suspected PMDD?

38
Q

What are red flags for PMS?

A
  • 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
Q

What is the tx approach for PMS?

A
  • Tx should be selected to address the px most bothersome sx

- Generally, combined tx is necessary

40
Q

What are some non-pharms for PMS?

A
  • 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
Q

What are the OTC options for PMS?

A
  • PG inhibitors and analgesics (ibuprofen, naproxen)
  • Diuretic (pamabrom)
  • Antihistamine (pyrilamine)
  • NHPs (calcium, vit B6, chasteberry)
42
Q

Is evening primrose recommended as a tx for PMS?

A

Efficacy is similar to placebo, so not recommended

43
Q

What benefit does chasteberry have on PMS?

A

May be helpful to reduce breast discomfort and other sx of PMS

44
Q

What are SE of chasteberry?

A
  • GI problems
  • Acne-like rashes
  • Headache, dizziness
  • Fatigue
  • Dry mouth
45
Q

Who shouldn’t take chasteberry?

A
  • 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
Q

What is the recommended dose of pyridoxine (vitamin B6) for PMS?

A
  • 50-100 mg daily

- 200 mg/day can cause risk of neuropathy

47
Q

Is magnesium recommended for PMS? Why?

A
  • Not recommended
  • Evidence not definitive
  • Too many SE
  • Mg deficiency is rare, diet is usually enough
48
Q

Is calcium recommended for PMS? Why?

A
  • Yes b/c helps w/ mood, abdominal pain, water retention, cramps, and food cravings
  • Proven to have lower plasma Ca premenstrually
49
Q

Calcium is considered a ____ tx option for PMS

A

Preventative or corrective option

50
Q

Is pamabrom a good option for PMS?

A
  • Promotes diuresis, but is very weak b/c wouldn’t be available OTC if strong
51
Q

What is the main effect of pyrilamine for PMS?

A

Sedative effects

52
Q

Are pamabrom and pyrilamine recommended for PMS?

A

No, have not shown to add benefit over tx w/ an analgesic

53
Q

What is the recommended pharm tx for PMS?

A
  • 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
Q

What are the Rx options for PMS?

A
  • PG inhibitors (NSAIDs - naproxen, mefenamic acid)
  • SSRIs
  • Diuretics (spironolactone)
  • Androgens (danazol)
  • Oral contraceptives
  • Gonadotropin releasing hormone (leuprolide)
55
Q

What is the overall recommended tx for PMS?

A
  • Start w/ non-pharms
  • Consider options like calcium
  • Add on NSAIDs if required for headache, muscle and breast pain
56
Q

What is the monitoring for PMS?

A
  • Sx should be improved or alleviated w/in 1-3 cycles
57
Q

When should a px w/ PMS be referred after attempting tx?

A
  • 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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