32 - 33 yo F with painful periods

Question 1

primary dysmenorrhea is associated with increased amounts of what molecules?

Answer 1

prostaglandins

Question 2

what are nabothain cysts? how are they formed?

Answer 2

• physiologically normal cysts on the cervix

- formed via metaplasia: normal columnar glands are covered by squamous epithelium (inclusion cysts)

Question 3

the absolute criterion for menorrhagia is blood loss of more than ____ mL

Answer 3

80 mL

Question 4

what is metrorrhagia? menometrorrhagia?

Answer 4

• metrorrhagia: irregular frequent bleeding (doesn’t have to be heavy)
• menometrorrhagia: irregular, frequent, and heavy

Question 5

what should be considered with significant dysmenorrhea which is not responsive to NSAIDs?

Answer 5

cervical stenosis

Question 6

what are the s/sx of cervical stenosis?

Answer 6

• significant dysmenorrhea which is not responsive to NSAIDs
• minimal flow

Question 7

what are protective factors for endometriosis?

Answer 7

• multiparity
• lactation
• late menarche

Question 8

dyspareunia is common with ________________ (endometriosis / leiomyoma) and is rare with _______________ (endometriosis / leiomyoma)

Answer 8

• common with endometriosis

- rare with leiomyoma

Question 9

the most common finding associated with fibroids is ________________

Answer 9

menorrhagia

Question 10

what is the initial treatment for primary dysmenorrhea in a women under 20 who is not sexually active with classic history of suprapubic pain in the first two days of menses? what is this is not effective?

Answer 10

• NSAIDs

- if NSAIDs are not effective - OCP with medium dose estrogen

Question 11

what is an effective option for reducing menstrual blood flow in women with menorrhagia secondary to fibroids? how does it work?

Answer 11

• progestrone releasing IUD

- decreases uterine volume and endometrial atrophy

Question 12

for dysmenorrhea related to anovulation only and without a structural problem, what is the best treatment?

Answer 12

OCP

Question 13

what are the treatments for PMS?

Answer 13

• danazol
• OCP
• SSRIs

Question 14

how does danazol work to treat PMS?

Answer 14

• androgenic medication with progesterone effects

- lowers estrogen and inhibits ovulation

Question 15

what are the contraindications to progestrone-releasing IUDs? what are the cautions?

Answer 15

CONTRAINDICATIONS:

• infection
• cancer

CAUTIONS:
- hx of headache or vascular disease