Dysmenorrhea Flashcards
What is primary dysmenorrhea?
Happens 6-12 months after menarche, only happens during ovulatory cycles and no pelvic pathology
What is secondary dysmenorrhea?
2+ years after menarche
Pain at times other than during menses
Typically associated with pelvic pathology
What is the etiology of primary dysmenorrhea?
Know for sure that prostaglandins and leukotrienes are involved, nitric oxide may be involved as it stops uterine contractions
How are progesterone and prostaglandin levels related?
Levels are inversely related
How does dysmenorrhea present clinically?
Mid-abdominal pain or cramping that is worse in the first 48-72 hours
Can have nausea/vomiting, dizziness, diarrhea and headache
What are risk factors for dysmenorrhea?
Young age Nulliparity (have never given birth) Early menarche Smoking Stress Positive family history
What are protective factors for dysmenorrhea?
Exercise
Higher parity
Use of hormonal contraceptives (some prevent ovulation, no progesterone secreted)
Consumption of a Mediterranean diet
What are red flags when assessing for dysmenorrhea (8)?
- Signs of systemic infection
- IUD inserted in last 6 months
- Pain outside he first 3 days of menses or for more than 5 days
- Sudden onset of pain
- Unilateral or non-midline pain
- lump
- changes in severity or pattern of pain
- new onset of pain with a history of pain-free periods
What is the first line therapy for dysmenorrhea?
NSAIDs and hormonal contraceptives
Drug therapy is required for most women, and non-pharm strategies are used adjunctively
What are adjunctive non-pharmacological therapies to treat dysmenorrhea?
Exercise
Tobacco cessation
Topical heat therapy
TENS
What are first line non-Rx pharmacological therapies for mild primary dysmenorrhea?
Ibuprofen: 200-400mg q4-6h
Naproxen: 220mg q8-12h
What do we use to treat moderate primary dysmenorrhea?
Prescription pharmacologic therapy– NSAIDs, combined oral contraceptives, NSAID + COC, or progestin only contraceptives
What is the recommended prescription dose of ibuprofen?
600-800mg q8h or a loading dose of 800mg, then 400-800mg q8h
What is the recommended Rx dose of mefenamic acid?
Loading dose of 500mg then 250mg q6h
What is the recommended Rx dose for naproxen base?
Loading dose of 500mg initially then 250mg q6-8h or
500mg BID
