32- painful periods

Question 1

Primary dysmenorrhea is defined as

Answer 1

the onset of painful menses without pelvic pathology.

Question 2

Risk Factors for Primary Dysmenorrhea

Answer 2

depression, anxiety
smoking
lower state of health
teens, twenties

NOT SES, multiparity

Question 3

a normal uterus in not larger than how many “pregnant weeks”

Answer 3

8 weeks in size- clenched fist

Question 4

is mild tenderness on palpation of the ovaries normal?

Answer 4

yes

Question 5

Nabothian cysts

Answer 5

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

Question 6

Menorrhagia is blood loss of more than

Answer 6

blood loss of more than 80 milliliters.

Question 7

Metrorrhagia

Answer 7

irregular frequent bleeding but it doesn’t have to be heavy.

Question 8

Menometrorrhagia

Answer 8

irregular frequent and heavy bleeding.

Question 9

Premenstrual dysphoric disorder criteria

Answer 9

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.

Question 10

cervical stenosis acquired vs congenital

Answer 10

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.

Question 11

Ovarian cysts presentation

Answer 11

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.

Question 12

uterine polyps presentation

Answer 12

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.

Question 13

Adenomyosis presentation

Answer 13

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.

Question 14

Adenomyosis diagnosis

Answer 14

Ultrasound may demonstrate a heterogeneously boggy uterus.

MRI is more specific for diagnosis.

Question 15

Chronic pelvic inflammatory disease presentaion

Answer 15

Cardinal symptom is lower abdominal pain, usually unrelated to menses.

Menorrhagia

infertility

Question 16

Chronic pelvic inflammatory disease will have what type of cells on endometrial biopsy

Answer 16

plasma cells

Question 17

risk factors and protective factors of endometriosis

Answer 17

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.

Question 18

endometriosis on physical exam

Answer 18

pain in the pain cul-de-sac, immobile and retroflexed uterus, nodules on the uterosacral ligaments, or just pain with uterine motion.

Question 19

does endometriosis or fibroids have dyspaureinia?

Answer 19

endometriosis

Question 20

endometriosis presentation

Answer 20

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

Question 21

risk and protective factors for Uterine leiomyomas

Answer 21

risk: early menarche, family history of fibroids, and increased alcohol use.
protective: oral contraceptive use, increasing parity, and smoking

Question 22

fibroids on physical exam

Answer 22

enlarged uterus that is freely mobile. The uterus may feel “knobby” from an irregular contour, and occasionally be minimally tender on exam.

Question 23

fibroids presentation

Answer 23

**menorrhagia/anemia, dysmenorrhea,

pressure symptoms like increased urinary frequency related to fibroid location,

potentially can have trouble getting pregnant.

Question 24

Evaluation of Differential of Secondary Dysmenorrhea / Menorrhagia

Answer 24

CBC
pregnancy test
TSH
US

Question 25

Treatment for Leiomyomas and Associated Symptoms

Answer 25

Progesterone-releasing intrauterine device (IUD) 
Depo
Combined hormonal contraceptives
Acupuncture
Myomectomy/hysterectomy

Question 26

how does mirena help fibroids

Answer 26

reduces menstrual blood flow
decreases overall uterine volume (but not prior fibroids)
decrease dysmennorhea

Question 27

depo provera side effects

Answer 27

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.

Question 28

how long does bc patch last

Answer 28

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.

Question 29

vaginal ring lasts

Answer 29

3 weeks (4th week remove- period)

Question 30

Premenstrual Syndrome Treatment

Answer 30

Danazol
Oral contraceptive
SSRIs during menses- fluoxetine, sertraline, venlafaxine

Question 31

Danazol

Answer 31

Androgenic medication with progesterone effects. It lowers estrogen and inhibits ovulation.

androgenic side effects: weight gain, suppressing high density lipids, and hirsutism

Question 32

two methods of using intermittent SSRIs during menses:

Answer 32

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.

Question 33

Contraindications and cautions to mirena

Answer 33

contra: Infection or cancer

Cautions: History of headache or vascular disease.