Dysmenorrhea Flashcards
What is dysmenorrhea?
Painful menstruation
Occurs before and/or during the beginning of menstruation
How common is dysmenorrhea?
Affects 50-90% of people who menstruate
Highest incidence in late adolescence to early 20s
10-15% are incapacitated for 1-3 days/month
Undertreated condition
What is primary dysmenorrhea?
Painful menstruation with normal pelvic anatomy and normal ovulatory cycles
Develops within first few years after menarche
What is secondary dysmenorrhea?
Painful menstruation associated with underlying anatomic or pathologic pelvic abnormalities
ex. endometriosis
More likely to experience other symptoms:
- irregular uterine bleeding
- chronic pelvic pain
- mid-cycle pain
- dyspareunia
What is the role of prostaglandins in dysmenorrhea?
Patients with dysmenorrhea have elevated levels of endometrial PG before menstruation
PGs cause a stronger, and more frequent uterine contractions and vasoconstriction which causes reduced uterine blood flow
Therefore, elevated endometrial PGs cause increased pain
What are some risk factors associated with developing dysmenorrhea?
- early menarche (before 12yo)
- age under 30
- family history of dysmenorrhea
- heavy and longer menses
- smoking
- underweight (BMI under 20)
- Nulliparity (never had a child before)
What are some symptoms associated with dysmenorrhea?
Most common is spasmodic pain (cramping) in lower abdominal region
Other symptoms:
- headache
- NVD
- Fatigue or trouble sleeping
- dizziness
- bloating
Most symptoms manifest a few hours before menstruation and peaks 48h after menses and lasts for 2-3 days
What are some factors that may suggest a diagnosis of secondary dysmenorrhea?
- Menstrual pain after years of painless periods
- Complaints of heavy bleeding
- Dyspareunia
- Rectal pain
- Pain at times outside of menstruation
- Pain lasts longer than a few days after menstruation
- Little to no response to drug therapy
When is primary dysmenorrhea diagnosed?
If history does not suggest a secondary cause, a presumptive diagnosis may be made and confirmed with a 3-month trial of pharmacotherapy
What are some non-pharm options for dysmenorrhea?
Exercise (regular, low intensity)
TENS (transcutaneous electrical nerve stimulation)
- Alternative for those wanting non-drug options
Topical heat (comparable to ibuprofen and combo may be beneficial)
What is first-line therapy for pain relief in dysmenorrhea?
NSAIDs (efficacious in 80% of patients if taken early enough, therefore pt needs to know their cycle well)
Initiate therapy with onset of symptoms OR onset of bleeding and continue for 3 days
Help relieve cramps, headache, and muscle aches
What can pharmacists prescribe for in dysmenorrhea?
Sufficient quantity of select NSAID for 3 consecutive cycles (and for up to 5 days of treatments for 6 cycles)
Ibuprofen, Mefenamic acid, naproxen, diclofenac, and flurbiprofen are the available options
What are some second line options for treatment of dysmenorrhea?
Combined hormonal contraception (supresses PG and LT production which inhibits endometrial proliferation and ovulation)
50-90% of pts achieve pain control within 3-6 months
can combine with NSAIDs
What are some third line options for dysmenorrhea treatment?
Progestin products (depo medroxyprogesterone, LNG IUS, nexplenon)
Cause amenorrhea which is the MOA for why it may help with dysmenorrhea
