Dysmenorrhea Flashcards
What is the definition of dysmenorrhea?
Painful cramping with menses (caused by spasmodic uterine contractions due to increased prostaglandins)
MOTE: Dysmenorrhea = MOST common gynecological problem in adolescent and adult women
How many types are there of dysmenorrhea? What are they?
2 types:
- Primary: Since menarche
- Secondary: Usually mid-20’s - mid-30’s
Describe Primary Dysmenorrhea.
Primary Dysmenorrhea:
- Onset after menarche
- Stable severity
- Improves with parity
- Endometriosis/PID* = Rare
- Dyspareunia = Unusual
- NSAIDs & CHC** = Effective
- Manage in Primary Care
*PID = Pelvic Inflammatory Disease
**CHC = Combined Hormonal Contraceptives
Describe Secondary Dysmenorrhea.
Secondary Dysmenorrhea:
- Onset mid-20’s or older
- Increasing in severity
- Endometriosis/PID* = Common
- Questionable improvement with parity
- Dyspareunia** = Common
- NSAIDs & CHC*** = Variable relief
- REFER to OB/GYN
PID = Pelvic Inflammatory Disease
**Especially deep penetration
** CHC = Combined Hormonal Contraceptives
What are the important elements of the work-up for dysmenorrhea?
- History is key: Medical & menstrual
- Physical exam: to identify cause
- Pelvic exam: May defer if young/virgin
- Labs as indicated: Pregnancy, STIs
- Pelvic ultrasound: Consider (to ID pathology) or REFER
Describe non-pharmaceutical management of dysmenorrhea.
- Apply heat
- Exercise
If no relief, try pharmaceutical management
Describe the use of NSAIDs in management of dysmenorrhea.
NSAID efficacy = about 80% - 86%
- Start at onset of menses for 1 - 2+ days
- If no relief, consider starting 1 - 2+ days before menses
- If no relief, consider combination of NSAIDs and Combination Hormonal Contraceptives
Describe the use of hormonal contraceptives in management of dysmenorrhea.
- Combination Hormonal Contraceptives (CHC):
- Alone
- With NSAIDs
- May be quite effective - Intrauterine Contraceptive (IUC):
- Mirena* (6 years)
- Kyleena (5 years, smaller) - If no relief, refer for secondary cause
*Both contain levonorgestrel
