Dysmenorrhea

Question 1

What is dysmenorrhea?

Answer 1

Painful menstrual cycles

Question 2

Definition of primary dysmenorrhea?

Answer 2

Painful menstruation in the absence of pelvic pathology

Question 3

Definition of secondary dysmenorrhea?

Answer 3

Painful menstruation in the presence of pelvic pathology or recognized medical condition

Question 4

What is the leading cause of secondary dysmenorrhea in adolescents?

Answer 4

Endometriosis

Question 5

How do you manage primary dysmenorrhea?

Answer 5

Empiric therapy with NSAIDs or Combined hormonal contraception or both for 3-6 months. If no improvement investigate for secondary causes

Question 6

How do endometriosis lesions appear in adolescents?

Answer 6

Clear or red

Question 7

What is the recommended treatment for endometriosis in adolescents?

Answer 7

Conservative surgical therapy with hormonal suppression

Question 8

Differential for secondary dysmenorrhea?

Answer 8

Endometriosis
Adenomyosis
Fibroids
Polyps
Ovarian cysts
Infection (PID)
Obstructive reproductive tract anomalies
Pelvic adhesions
Cervical stenosis

Question 9

How do you evaluate dysmenorrhea?

Answer 9

History
includes medical gynecological menstrual family and psychosocial

Question 10

What history things would make you think of secondary amenorrhea instead of primary dysmenorrhea?

Answer 10

1. Dysmenorrhea immediately after starting cycle
2. Progressively worsening dysmenorrhea
3. Associated with AUB
4. Infertility
5. Dyspareunia

Question 11

What NSAIDs can be used to treat primary dysmenorrhea? and how should you use them?

Answer 11

Ibuprofen 800mg TID
Naproxen 550mg BID

Started 1-2 days prior to start of menstrual cycle and taken with first 2-3 days of cycle

Question 12

What hormonal therapies can be used for management of dysmenorrhea?

Answer 12

Combined hormonal therapy
Progestin therapy (norethindrone, depo, implant, IUD)

Question 13

What complimentary or alternative therapies are recommended for management of dysmenorrhea?

Answer 13

Exercise
Modification of diet
smoking cessation
Acupuncture

Question 14

What is the evaluation for secondary dysmenorrhea and when should you consider endometriosis?

Answer 14

Failed medical management for primary dysmenorrhea

Normal dysmenorrhea workup

Question 15

What is the risks and benefits of diagnostic laparoscopy for endometriosis?

Answer 15

Benefits= confirm the absence or presence of endometriotic lesions; assess for adhesions; treat endometriosis or adhesions if present

Risks= bleeding, infection, injury to surrounding structures, wound infection, VTE

Question 16

What is the recommended management of endometriosis in adolescence?

Answer 16

Conservative surgical management for diagnosis and treatment + hormonal suppressive therapy

Could also do empiric hormonal suppressive therapy with continuous combined hormonal contraceptive or progestin only contraceptive

Question 17

What is recommended management for refractory endometriosis in adolescent?

Answer 17

GnRH agonist with add back therapy

Question 18

What is add back therapy with GnRH agonist therapy?

Answer 18

Conjugated estrogen 0.625mg + norethindrone 5mg