4: Dysmenorrhea

Question 1

NSAIDs are more effective for primary or secondary dysmenorrhea?

Answer 1

Primary (prostaglandin reduction)

Question 2

How do s/s differ between primary and secondary dysmenorrhea?

Answer 2

Clinical findings may differ from primary dysmenorrhea in that they may include reports of dyspareunia (pain with intercourse), postcoital bleeding, and abnormal uterine bleeding. The pelvic pain associated with secondary dysmenorrhea may occur before, during, or after menses.

Question 3

Pharmacologic treatment for dysmenorrhea.

Answer 3

1. NSAIDs: diclofenac ibuprofen ketoprofen meclofenamate mefenamic acid naproxen (take 2-3 days before start of cycle)
2. Oral contraceptives
3. Progestin implants
4. Levnorgestrel IUD
5. Depo injection

Question 4

The most common form of dysmenorrhea.

Answer 4

Primary

Question 5

T/F The difference between primary dysmenorrhea and normal somatic and psychological changes prior to menses is that primary dysmenorrhea is perceived as more severe, with chronic, sometimes debilitating symptoms.

Answer 5

True

Question 6

Pelvic pathology such as adenomyosis, leiomyomata, irritable bowel syndrome, interstitial cystitis, endometriosis, PID, UTI, hernia, and pelvic prolapse may lead to what condition?

Answer 6

Secondary dysmenorrhea

Question 7

Name the 2 categories of dysmenorrhea.

Answer 7

1. primary (absence of pelvic pathology)
2. secondary (occurring from identifiable organic pathology)

Question 8

T/F Pain that has increased over time is usually associated with primary dysmenorrhea.

Answer 8

False. It is usually associated with secondary dysmenorrhea.

Question 9

Abnormal levels of what hormone correlate with pain sensitivity of women with dysmenorrhea?

Answer 9

Cortisol (depression, stress, anxiety increase this hormone)

Question 10

The most common gynecological problem in women of all ages and ethnicities.

Answer 10

Menstrual pain

Question 11

T/F There is no evidence of organic pathology in the uterus, fallopian tubes, or ovaries with secondary dysmenorrhea.

Answer 11

False. There is no evidence of organic pathology in the uterus, fallopian tubes, or ovaries with primary dysmenorrhea.

Question 12

There is a higher prevalence of _____ and _____ in women who experience pelvic pain or dysmenorrhea.

Answer 12

There is a higher prevalence of depression** and **anxiety in women who experience pelvic pain or dysmenorrhea.

Question 13

Alternative and complementary therapies for dysmenorrhea.

Answer 13

1. Heat
2. Lifestyle changes (exercise, daily breakfast)
3. Vitamin and herbs (Vitamin E, Shirzai Thymus Vulgaris)
4. Accupuncture (Vitamin K injection, vibratory stimulation through intravaginal tampon application VIPON)

Question 14

T/F Premenstrual symptoms may include psychological, physical, and behavioral changes and are collectively termed premenstrual syndrome (PMS).

Answer 14

True

Question 15

How does surgical intervention help with dysmenorrhea?

Answer 15

While at least two surgical procedures have been developed to treat dysmenorrhea, these should be considered to be extreme measures that are generally not recommended. Both of these surgeries involve dissecting or destroying the uterine nerves, which prevents the transmission of pain signals. The surgery itself can be associated with adhesions and chronic pelvic pain, and has not been found to provide long-term benefits for dysmenorrhea.

Question 16

Significant menstrual pain that disrupts a woman’s lifestyle.

Answer 16

Dysmenorrhea

Question 17

What is the etiology of dysmenorrhea?

Answer 17

The pain of dysmenorrhea originates from intense uterine contractions during the menstrual phase of the cycle, triggering endometrial prostaglandin production and release. The excessive amount of prostaglandins causes the uterus to contract further, reducing uterine blood flow and causing ischemia and pain. While the etiology of dysmenorrhea is not completely understood, studies support the hypothesis that uterine inflammation with menstrual cycles may also promote cross-organ pain sensitization, a mechanism by which dysfunction in one organ elicits neurogenic inflammation in another organ. The uterus lies in close proximity to the bladder, the bowel, and the peritoneum, and its contraction may elicit pain in those structures during the menstrual cycle. This theory, along with the current knowledge about prostaglandins’ major role in dysmenorrhea, may help explain the chronicity of pain that may occur throughout the pelvic area during the menstrual cycle.

Question 18

Risk factors for dysmenorrhea.

Answer 18

1. Age < 30 years
2. Body mass index < 20
3. Smoking
4. Early menarche
5. History of sexual abuse
6. Premenstrual emotional symptoms (dysphoria)
7. History of pelvic surgery
8. Pelvic pain history
9. Depression

Question 19

What is the most common cause of secondary dysmenorrhea?

Answer 19

Endometriosis

Question 20

The _____ of 1993 required that research include women, and funding was provided for research that focused on women’s health.

Answer 20

The Women’s Health Equity Act of 1993 required that research include women, and funding was provided for research that focused on women’s health.

Question 21

Should dysmenorrhea, in the medical setting, be considered a symptom / source of discomfort or a disease-oriented syndrome?

Answer 21

Focusing on dysmenorrhea as a symptom or source of discomfort rather than as a disease-oriented syndrome provides a model for understanding complex gender-specific conditions that include biologic, psychosocial, and sociocultural factors. This holistic model can also be applied to other women’s health problems, such as stress-related conditions (e.g., heart disease, arthritis, and immune system disorders), psychiatric disorders, and normative menstrual-cycle transitions (e.g., menarche, postpartum, and menopause).

Question 22

Painful cramps that occur with menstruation.

Answer 22

Dysmenorrhea

Question 23

When does primary dysmenorrhea occur?

Answer 23

• Often begins 6 to 12 months after menarche.
• Typically symptoms are experienced with the onset of bleeding and continue for 8 to 72 hours into the menstrual cycle.