dysmenorrhea Flashcards
primary dysmenorrhea
painful menses in women w/ normal anatomy and generally occurring in adolescent women
what is the most likely cause of dysmenorrhea?
prostaglandin, too much E2 secretion in the menstrual fluid
what does P. E2 do?
causes smooth muscle conraction leading to N, V, D
onset- w/in 3-6 mnths of menarche
sx of dysmenorrhea
cramping, heavy flow
tx for primary dysmenorrhea
NSAID , OCP, application of heat, regular exercise
tx for resistant cases
tocolytic agents, CCB, progestogens
secondary dysmenorrea
painful menses in the presence of a dz of the uterus or pelvis
ex of secondary dysm, causes
endometriosis, uterine fibroids, adenomyosis, STI, endometrial polyps, PID, IUD
adenomysosis?
implantation of endometrial tissues in the myometrium that results in a tender, symmetrically enlarged “boggy” uterus
what other sx may be seen w/ secondary dysmen?
bloating, menorrhagia, dyspareunia
tx for secondary?
removed IUD, may need hysterectomy, D&C,
dysfn uterine bleed (DUD)
abnormal uterine bleding in the absence of an anatomic lesion, usually caused by a problem w/ the hypothamlamic-pit-ovarian hormonal axis
when does DUD often occur?
shortly after menarche and during perimenopause bc of increased anovulatory cycles
possible causes of DUD
PCOS, exogenous obesity, adrenal hyperplasia
what is the first thing you want to do when dx DUD?
rule out prego
how to approach DUD?
think of pt in the framework of whehter or not they are ovulating-if so, think problems w/ reporductive system or systemic dz
Ovulatory (structural bleedin) causes?
Coag defects, infx, fibroids, adenomyosis, FB, vasculare anomalies, malignancy
anovulatory bleeding causes?
PCOS, hypothyroidism, hyperprolactinemia, hypothalamic dysfnx
how to asses ovulatory status
1) 10 day variablity btw cycle lengths
2) Basal body temp
3) progesterone level
4) urine LH
basal body temp and ovulation?
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.
progesterone levle and ovulation
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.
urine LH and ovulation
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
other studies for DUB?
CBC, iron studies, PT, PTT, TSH, LFTs, prolctin, serum FSH
papsmear, endometrial bx, pelvic US, removal of shit
tx for DUB
depends on severity of bleed
what is needed for an acute hemorrhage?
IV or PO high dose estrogens
what should be performed on a pt w/ DUB?
Progestin trial- if bleeding stops, then anovulatory
when should oral contraceptives not be used?
women over 35 who smoke, HTN, D, hx, of vascular dz, breast cancerer, liver dz, focal headaches
when can cylic progestins be used?
younger pts
