Dysmenorrhea Flashcards
Define dysmenorrhea
Painful menstruation
- Occurs before and/or during the beginning of menstruation
What is primary dysmenorrhea? (3)
- Painful menstruation with normal pelvic anatomy
- Associated with normal ovulatory cycles
- Typically begins in adolescence once ovulatory cycles established (within first few years after menarche; on average 6-12 months later)
What is secondary dysmenorrhea? (2)
- Painful menstruation associated with underlying anatomic or pathologic pelvic abnormalities
- More likely to experience other symptoms like:
- Irregular uterine bleeding
- Chronic pelvic pain
- Mid-cycle pain
- Dyspareunia
What is the pathophysiology of primary dysmenorrhea? (5)
- Although the exact cause is unknown, prostaglandins are known to have a significant role
- People with dysmenorrhea have increased production of endometrial PGs prior to menstruation
- PGs result in stronger, more frequent uterine contractions (and vasoconstriction)
- Increased vasopressin and leukotriene levels
- End result = increased myometrial contractions, reduced uterine blood flow, which leads to PAIN
What are some risk factors for primary dysmenorrhea? (7)
- Early menarche (<12yo)
- Age <30
- Family history of dysmenorrhea
- Heavy menses/longer menstrual periods
- Smoking
- Weight (BMI <20)
- Nulliparity
What is the main symptom of dysmenorrhea?
Spasmodic (cramping) pain in lower abdominal region
- May radiate to lower back or thighs
With dysmenorrhea, other symptoms may include: (5)
- Headache
- NVD
- Fatigue or trouble sleeping
- Dizziness
- Bloating
What is the symptom timeframe of dysmenorrhea?
Few hours before menstruation –> peaks –> lasts 2-3 days
How is primary dysmenorrhea diagnosed?
Based upon symptoms and response to therapy and on clinical history and physical exam
Diagnosis of either type of dysmenorrhea requires a thorough medical history, which would include assessing what things? (5)
- Pain: onset, severity, type, location, duration
- Associated symptoms
- Family history of endometriosis
- Sexual activity
- Menstrual history: age at menarche, cycle regularity, time since menarche, estimated menstrual flow
When diagnosing dysmenorrhea, we would consider secondary if the person has any one or multiple of the following: (8)
- Menstrual pain after several years of painless periods
- Sudden occurrence when normally have mild to no pain
- Complaints of heavy bleeding
- Dyspareunia
- Rectal pain
- Pain at times other than during menstruation
- Pain persists beyond first couple days of menstruation
- Little to no response to drug therapy
(Symptoms overlap with other conditions so a thorough history is necessary)
What are the goals of therapy for dysmenorrhea treatment? (3)
- Relieve symptoms
- Minimize time lost from work, school, etc.
- Identify patients with possible secondary dysmenorrhea for further assessment
If history does not suggest a secondary cause, a presumptive diagnosis of primary dysmenorrhea may be made and confirmed with a _ month trial of pharmacotherapy (empiric therapy is initiated)
3
A history suggestive of secondary dysmenorrhea requires:
referral to a physician
What are 6 potential non-pharm treatment options for dysmenorrhea?
- Exercise
- TENS (transcutaneous electrical nerve stimulation)
- Acupuncture/accupressure
- Spinal manipulation
- Topical heat
- Others
- Vitamins, minerals, supplements
