32- painful periods Flashcards
Primary dysmenorrhea is defined as
the onset of painful menses without pelvic pathology.
Risk Factors for Primary Dysmenorrhea
depression, anxiety
smoking
lower state of health
teens, twenties
NOT SES, multiparity
a normal uterus in not larger than how many “pregnant weeks”
8 weeks in size- clenched fist
is mild tenderness on palpation of the ovaries normal?
yes
Nabothian cysts
physiologically normal on the cervix.
formed during the process of metaplasia where normal columnar glands are covered by squamous epithelium. They are merely inclusion cysts that may come and go and are of no clinical significance
Menorrhagia is blood loss of more than
blood loss of more than 80 milliliters.
Metrorrhagia
irregular frequent bleeding but it doesn’t have to be heavy.
Menometrorrhagia
irregular frequent and heavy bleeding.
Premenstrual dysphoric disorder criteria
A minimum of five symptoms need to begin the week prior to menses, start to improve during menses and then become minimal the week after menses.
The patient must have one of the following: marked mood lability, irritability or anger, depressed mood or feeling hopeless, or anxiety and edginess.
The patient must also have one of the following: food cravings, changes in sleep, being “out of control”, decreased energy, anhedonia, and some physical symptoms.
cervical stenosis acquired vs congenital
congenital: adolescent will have significant dysmenorrhea not responsive to NSAIDs. Minimal menstrual flow
Acquired: related to cryotherapy or LEEP procedures. This causes dysmenorrhea as the uterus is distended with blood.
On exam the uterus will feel diffusely enlarged.
Ovarian cysts presentation
commonly cause recurrent and chronic pelvic pain.
more likely to occur midcycle, although the patient may have pain associated with menses.
Location: one of the lower quadrants and not as much midline.
uterine polyps presentation
may be associated with abnormal bleeding–specifically intermenstrual or postcoital bleeding–but there will also be menorrhagia.
Polyps do not typically present with dysmenorrhea, but this may occur later.
Adenomyosis presentation
60% of women complain of menorrhagia.
The uterus is typically enlarged and diffusely boggy, but symmetric and should still be mobile.
may be some urinary or GI symptoms secondary to size and mass effect on the bladder and rectum.
Adenomyosis diagnosis
Ultrasound may demonstrate a heterogeneously boggy uterus.
MRI is more specific for diagnosis.
Chronic pelvic inflammatory disease presentaion
Cardinal symptom is lower abdominal pain, usually unrelated to menses.
Menorrhagia
infertility
Chronic pelvic inflammatory disease will have what type of cells on endometrial biopsy
plasma cells
risk factors and protective factors of endometriosis
Risk factors (MORE ESTROGEN): nulliparity, early menarche or late menopause, short menstrul cycles, and long menses.
protective factors (LESS ESTROGEN): multiparity, lactating, and late menarche.
endometriosis on physical exam
pain in the pain cul-de-sac, immobile and retroflexed uterus, nodules on the uterosacral ligaments, or just pain with uterine motion.
does endometriosis or fibroids have dyspaureinia?
endometriosis
endometriosis presentation
women 25-35
dyspareunia, bowel or bladder symptoms that cycle with menses, fatigue, abnormal vaginal bleeding, and some effects on fertility, chronic pelvic pain or dysmenorrhea
risk and protective factors for Uterine leiomyomas
risk: early menarche, family history of fibroids, and increased alcohol use.
protective: oral contraceptive use, increasing parity, and smoking
fibroids on physical exam
enlarged uterus that is freely mobile. The uterus may feel “knobby” from an irregular contour, and occasionally be minimally tender on exam.
fibroids presentation
**menorrhagia/anemia, dysmenorrhea,
pressure symptoms like increased urinary frequency related to fibroid location,
potentially can have trouble getting pregnant.
Evaluation of Differential of Secondary Dysmenorrhea / Menorrhagia
CBC
pregnancy test
TSH
US
Treatment for Leiomyomas and Associated Symptoms
Progesterone-releasing intrauterine device (IUD) Depo Combined hormonal contraceptives Acupuncture Myomectomy/hysterectomy
how does mirena help fibroids
reduces menstrual blood flow
decreases overall uterine volume (but not prior fibroids)
decrease dysmennorhea
depo provera side effects
bone density loss after several years
affects fertility- take nine to 18 months for a woman to regain regular menses
weight gain, irregular menses for weeks to several months, and potential mood changes.
how long does bc patch last
one week
You place a new patch weekly for three weeks, then during the fourth week you do not place any patch and have your period.
vaginal ring lasts
3 weeks (4th week remove- period)
Premenstrual Syndrome Treatment
Danazol
Oral contraceptive
SSRIs during menses- fluoxetine, sertraline, venlafaxine
Danazol
Androgenic medication with progesterone effects. It lowers estrogen and inhibits ovulation.
androgenic side effects: weight gain, suppressing high density lipids, and hirsutism
two methods of using intermittent SSRIs during menses:
One method is to start therapy 14 days prior to menses (luteal phase of cycle) and continue until menses starts.
The second method is to start on the first day a woman has symptoms and continue until the start of menses or three days later.
Contraindications and cautions to mirena
contra: Infection or cancer
Cautions: History of headache or vascular disease.
