DYSMENORRHEA

Question 1

Dysmenorrhea

Answer 1

Painful menses
Most common GYN problem
Primary: no pelvic pathology, begins 1 to 2 years after onset of menstruation; associated with ovular cycle
Secondary: accompanied by pelvic pathology such as endometriosis, PID, fibroids, adenomyosis, and endometrial polyps

Question 2

Dysmenorrhea: Clinical Presentation

Answer 2

• Type, severity, and duration of pain to be noted
• Sharp, stabbing pain and cramping, low back pain, nausea and sometimes vomiting, bowel changes, and fatigue
• Patient may complain of being immobilized, loss of appetite, and pain during intercourse

Question 3

Dysmenorrhea: Diagnostic Testing

Answer 3

• History of symptoms for 1–2 days/month
• If a complaint of painful intercourse, a diagnosis of secondary dysmenorrhea related to endometriosis should be explored
• Lab tests: quantitative hCG and CBC, urinalysis, ESR, stool for occult blood, and serum CA-125 levels
• Imaging studies, such as ultrasound

Question 4

Dysmenorrhea: Differential Diagnosis

Answer 4

• Ultimate goal is to exclude underlying pelvic pathology such as:
  o Endometriosis (most common cause)
  o Ovarian cysts
  o Ectopic pregnancy
  o UTI
  o Vaginitis
  o DUB
  o Uterine leiomyomas
  o Appendicitis
  o PID

Question 5

Dysmenorrhea: Management

Answer 5

• Primary: relieve pain
• Secondary: find a diagnosis
• Aspirin 325 mg two tabs (650 mg) PO q4h
• Dietary changes and exercise can be helpful
• Quit smoking
• NSAIDs mainstay of dysmenorrhea therapy
• Hot water bottle to abdomen or hot bath
• Recommend acupuncture, TENS therapy, yoga

Question 6

Dysmenorrhea: Follow-up and Education

Answer 6

• Treatment is ongoing and requires further evaluation of relief of symptoms or additional diagnostic evaluation for continued symptoms
• Ordinary aspirin can significantly reduce prostaglandin levels
• Educate about diet and exercise changes
• Promote omega-3 fatty acid supplements and avoidance of cigarettes and alcohol intake

Question 7

Pelvic Pain

Answer 7

Acute, chronic or recurrent
Presents as both pelvic or lower abdominal pain
GU, GI, or MSK
Chronic pain related to benign or malignant neoplasms or characterized as psychogenic

Question 8

Pelvic Pain: Differential Diagnosis

Answer 8

• Acute onset: pelvic inflammatory disease (PID); ruptured ovarian cyst; torsion of ovarian cyst, ovary, or fallopian tube; and ectopic pregnancy
• Recurring pain with menstruation: primary or secondary dysmenorrhea, endometriosis, adenomyosis, chronic PID, or related to intrauterine devices (IUDs)
• Not associated with menses: Mittelschmerz, leaking ovarian cysts, recurrent pelvic infections, urinary tract infections (UTIs)