29 Menstrual Disorders/Suppression Besinque Flashcards
What are some characteristics of a normal menstrual cycle?
Menstruation lasts on average of 4-7 days. Average blood loss is 35 mL. 90% of menstrual blood loss is completed by the end of the third day. Chronic menstrual blood loss > 80 mL per cycle leads to anemia
What phase do the majority of menstrual disorders take place?
Luteal
What are some common menstrual disorders?
Disorders associated with menstruation (primary dysmenorrhea, menonrrahgia). Disorders associated with cyclic patters (pre-menstrual syndrome (PMS, PMDD). Menstrual migraine. Catamenial disorders (epilepsy, asthma)). Other disorders (endometriosis, PCOS)
What is Menorrhagia?
Bleeding occurs at normal intervals but is prolonged or excessive (can be > 7 days)
What is Metrorrhagia?
Irregular, noncyclic bleeding that is prolonged or excessive
What is Polymenorrhea?
Bleeding interval is less than 21 days (short cycle)
What is Oligomenorrhea?
Bleeding interval greater than 35 days (long cycle)
Whay is Hypermenorrhea/Hypomenorrhea?
Amount of menses is abnormally high (hyper) or low (hypo)
What may be the most common gynecological problem in menstruating women?
Primary Dysmenorrhea
Who is affected by Primary Dysmenorrhea?
Onset in early adolescence. Usually begins within 3 years of menarche (start of menstruation)
What is the Etiology of Primary Dysmenorrhea?
Symptoms may be related to increased PGF-2 alpha released by sloughing of the endometrial cells. PGF-2 alpha stimulates myometrial contractions, ischemia and sensitizes nerve endings
During menstruation, what happens that can lead to Dysmenorrhea?
Increased prostaglandin synthesis. Increased markers of inflammation
What are the actual causes of dysmenorrhea?
Decreased uterine blood flow. Increased uterine contractility. Peripheral nerve hypersensitivity. All of these happen because of the increase in prostaglandins
What does progesterone withdrawal lead to?
Arachidonic acid is made, which can be converted by COX, which eventually turns into PGF2-alpha, which causes myometrial contraction and vasoconstriction, and eventually pain
What is the DOC for dysmenorrhea?
NSAIDs (only used during actual menstrual phase)
What are the other treatment options for dysmenorrhea?
Hormonal contraceptives (second line; suppres ovulation and lower prostaglandin levels, which lead to decreased menstrual blood loss). Danazol. GnRH agonists. Complementary and alternative approaches
How should NSAIDs be used for dysmenorrhea?
Begin the day before menses or as soon as flow begins. Scheduled doses for 3-5 days (not PRN). OTC doses are insufficient, take higher doses
What is secondary dysmenorrhea?
Dysmenorrhea that is due to genital tract pathology
What duration of bleeding is considered heavy menstrual bleeding?
> 7 days
What amount of blood loss is considered heavy menstrual bleeding?
> 80 mL
What are some risk factors for heavy menstrual bleeding?
Age. Uterine fibroids. Endometrial polyps. Bleeding disorders
What is the prevalence and consequence of heavy menstrual bleeding?
Affects many women. Common indicator for hysterectomy. Important cause of anemia. Affects quality of life