4: Dysmenorrhea Flashcards
NSAIDs are more effective for primary or secondary dysmenorrhea?
Primary (prostaglandin reduction)
How do s/s differ between primary and secondary dysmenorrhea?
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.
Pharmacologic treatment for dysmenorrhea.
- NSAIDs: diclofenac ibuprofen ketoprofen meclofenamate mefenamic acid naproxen (take 2-3 days before start of cycle)
- Oral contraceptives
- Progestin implants
- Levnorgestrel IUD
- Depo injection
The most common form of dysmenorrhea.
Primary
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.
True
Pelvic pathology such as adenomyosis, leiomyomata, irritable bowel syndrome, interstitial cystitis, endometriosis, PID, UTI, hernia, and pelvic prolapse may lead to what condition?
Secondary dysmenorrhea
Name the 2 categories of dysmenorrhea.
- primary (absence of pelvic pathology)
- secondary (occurring from identifiable organic pathology)
T/F Pain that has increased over time is usually associated with primary dysmenorrhea.
False. It is usually associated with secondary dysmenorrhea.
Abnormal levels of what hormone correlate with pain sensitivity of women with dysmenorrhea?
Cortisol (depression, stress, anxiety increase this hormone)
The most common gynecological problem in women of all ages and ethnicities.
Menstrual pain
T/F There is no evidence of organic pathology in the uterus, fallopian tubes, or ovaries with secondary dysmenorrhea.
False. There is no evidence of organic pathology in the uterus, fallopian tubes, or ovaries with primary dysmenorrhea.
There is a higher prevalence of _____ and _____ in women who experience pelvic pain or dysmenorrhea.
There is a higher prevalence of depression** and **anxiety in women who experience pelvic pain or dysmenorrhea.
Alternative and complementary therapies for dysmenorrhea.
- Heat
- Lifestyle changes (exercise, daily breakfast)
- Vitamin and herbs (Vitamin E, Shirzai Thymus Vulgaris)
- Accupuncture (Vitamin K injection, vibratory stimulation through intravaginal tampon application VIPON)
T/F Premenstrual symptoms may include psychological, physical, and behavioral changes and are collectively termed premenstrual syndrome (PMS).
True
How does surgical intervention help with dysmenorrhea?
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.
Significant menstrual pain that disrupts a woman’s lifestyle.
Dysmenorrhea
What is the etiology of dysmenorrhea?
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.
Risk factors for dysmenorrhea.
- Age < 30 years
- Body mass index < 20
- Smoking
- Early menarche
- History of sexual abuse
- Premenstrual emotional symptoms (dysphoria)
- History of pelvic surgery
- Pelvic pain history
- Depression
What is the most common cause of secondary dysmenorrhea?
Endometriosis
The _____ of 1993 required that research include women, and funding was provided for research that focused on women’s health.
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.
Should dysmenorrhea, in the medical setting, be considered a symptom / source of discomfort or a disease-oriented syndrome?
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).
Painful cramps that occur with menstruation.
Dysmenorrhea
When does primary dysmenorrhea occur?
- 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.
