dysmenorrhea

Question 1

primary dysmenorrhea

Answer 1

painful menses in women w/ normal anatomy and generally occurring in adolescent women

Question 2

what is the most likely cause of dysmenorrhea?

Answer 2

prostaglandin, too much E2 secretion in the menstrual fluid

Question 3

what does P. E2 do?

Answer 3

causes smooth muscle conraction leading to N, V, D

onset- w/in 3-6 mnths of menarche

Question 4

sx of dysmenorrhea

Answer 4

cramping, heavy flow

Question 5

tx for primary dysmenorrhea

Answer 5

NSAID , OCP, application of heat, regular exercise

Question 6

tx for resistant cases

Answer 6

tocolytic agents, CCB, progestogens

Question 7

secondary dysmenorrea

Answer 7

painful menses in the presence of a dz of the uterus or pelvis

Question 8

ex of secondary dysm, causes

Answer 8

endometriosis, uterine fibroids, adenomyosis, STI, endometrial polyps, PID, IUD

Question 9

adenomysosis?

Answer 9

implantation of endometrial tissues in the myometrium that results in a tender, symmetrically enlarged “boggy” uterus

Question 10

what other sx may be seen w/ secondary dysmen?

Answer 10

bloating, menorrhagia, dyspareunia

Question 11

tx for secondary?

Answer 11

removed IUD, may need hysterectomy, D&C,

Question 12

dysfn uterine bleed (DUD)

Answer 12

abnormal uterine bleding in the absence of an anatomic lesion, usually caused by a problem w/ the hypothamlamic-pit-ovarian hormonal axis

Question 13

when does DUD often occur?

Answer 13

shortly after menarche and during perimenopause bc of increased anovulatory cycles

Question 14

possible causes of DUD

Answer 14

PCOS, exogenous obesity, adrenal hyperplasia

Question 15

what is the first thing you want to do when dx DUD?

Answer 15

rule out prego

Question 16

how to approach DUD?

Answer 16

think of pt in the framework of whehter or not they are ovulating-if so, think problems w/ reporductive system or systemic dz

Question 17

Ovulatory (structural bleedin) causes?

Answer 17

Coag defects, infx, fibroids, adenomyosis, FB, vasculare anomalies, malignancy

Question 18

anovulatory bleeding causes?

Answer 18

PCOS, hypothyroidism, hyperprolactinemia, hypothalamic dysfnx

Question 19

how to asses ovulatory status

Answer 19

1) 10 day variablity btw cycle lengths
2) Basal body temp
3) progesterone level
4) urine LH

Question 20

basal body temp and ovulation?

Answer 20

Progesterone causes BBT to increase 0.5°F. Need to check temp first thing in the morning, before getting out of bed, eating, or drinking.

Question 21

progesterone levle and ovulation

Answer 21

Day 18-24 it should be between 6-25 ng/mL, but there is variability as it is affected by cyclical LH production. A high progesterone level is helpful to indicate ovulation, but a low test may mean either tested at a low phase, or no ovulation.

Question 22

urine LH and ovulation

Answer 22

Urine LH increase occurs 12 hours after serum LH surge. However keep in minds that tests to measure urine LH will be falsely positive in conditions where baseline LH is high (PCOS, premature ovarian failure, and menopause

Question 23

other studies for DUB?

Answer 23

CBC, iron studies, PT, PTT, TSH, LFTs, prolctin, serum FSH

papsmear, endometrial bx, pelvic US, removal of shit

Question 24

tx for DUB

Answer 24

depends on severity of bleed

Question 25

what is needed for an acute hemorrhage?

Answer 25

IV or PO high dose estrogens

Question 26

what should be performed on a pt w/ DUB?

Answer 26

Progestin trial- if bleeding stops, then anovulatory

Question 27

when should oral contraceptives not be used?

Answer 27

women over 35 who smoke, HTN, D, hx, of vascular dz, breast cancerer, liver dz, focal headaches

Question 28

when can cylic progestins be used?

Answer 28

younger pts