Dysmenorrhea Flashcards
Dysmenorrhea is the leading cause of what?
recurrent short-term
absence in adolescent girls & common
problem in women of reproductive age
What is primary dysmenorrhea?
- Pain with menses without underlying pelvic pathology: diagnosis of exclusion
- Onset within a year or two after menarche.
- Pain tends to decrease as a woman ages and often resolves after childbirth.
What is secondary dysmenorrhea
Menstrual pain due to underlying pathology
What are symptoms of primary dysmenorrhea?
- Lower abdominal/pelvic pain begins with onset of menses and lasts 8-72 hours — Typically 24-48 h6 - Low back pain - Medial/anterior thigh pain - Headache - Diarrhea - Nausea/vomiting
What decrease prevalence or severity of primary dysmenorrhea?
- age
- parity
- education
- healthy lifestyle
What increase the prevalence or severity of primary dysmenorrhea?
- smoking
- nulliparity
- depression
- menorrhagia
- cold environment
- stress
What are possible etiologies of secondary dysmenorrhea?
- Ovarian disorders
— Endometrioma
— Cysts, neoplasm
Uterine disorders
- Fibroids
- Adenomyosis
- Endometriosis
- PID
- IUD
What are symptoms of secondary dysmenorrhea?
- Onset in 20s or 30s, after relatively painless
menstrual cycles in the past - Infertility
- Heavy menstrual flow or irregular bleeding
- Dyspareunia
- Vaginal discharge
- Lower abdominal or pelvic pain during times other than menses
- Pain oftentimes unrelieved by nonsteroidal anti- inflammatory drugs (NSAIDs)
What are labs for dysmenorrhea?
- cervical culture
- B-hCG
- CBC
- UA
- ESR
What are diagnostic procedures for dysmenorrhea?
- pelvic ultrasound
- sonohystogram
- hysteroscopy
- D & C
- laparoscopy
- endometrial biopsy
What is the prostaglandin theory and how does it explain painful menses?
LH &Progesterone increases the release of local Pgs
then progesterone withdraw causes the endometrium
to increase prostaglandin production
Prostaglandins
- increase myometrial contractions
- constrict small endometrial blood vessels, with consequent tissue ischemia
- endometrial disintegration
- bleeding and pain
- Follicular - luteal has __x PG increase
- Luteal - menses has __x PG increase
- Most of the production & release of PG occurs
- Dysmenorrhic women make __-___x more PG than controls
3x
2-7x
in the first 48 hrs of menstrual flow
8-13x
Excess prostaglandins enter bloodstream
affecting other smooth muscles causing what (4)?
- Headaches
- Dizziness
- Hot and cold flashes
- Diarrhea and nausea
What is the conventional management of primary dysmenorrhea?
NSAIDS (block cyclooxygenase pathway) (75% effective)
- Ibuprofen(advil) 400-600mg q 4-6hrs
- Naproxen sodium (alleve) 220ii q 12hr
- ASA 650mg q tid-qid
- MOA: inhibits arachodonic acid conversion to PG & leukotrienes
Hormones
- OCs (90% effective6) hormonal birth control
- Mirena IUD (progesterone)
- Depo Provera (progesterone)
What foods should be decreased/avoided for dysmenorrhea?
foods high in arachidonic acid, saturated fats, caffeine, allergens/intolerances
What are therapeutic foods for dysmenorrhea?
- foods high in omega 3 oils (linolenic acid - flax)
- foods and nuts that are sources of omega 6 (linoleic acid – EPO borage)
- foods high in magnesium and calcium
Increase foods that are excellent sources of bioflavonoids and vitamin C
What is the best lifestyle change for dysmenorrhea?
Exercise
- 89.3% - 92% symptom reduction
- Moderate aerobic exercise~ frequency and consistency
- 45-60 m tiwk (3x/week)+ regardless of intensity reduction on VAS pain scale by 25 mm
What are nutritional supplements for dysmenorrhea?
Vitamin B3 100mg bid, q 2-3hrs during pain
Vitamin B6 100mg q 2hr during menses
Vitamin C /Bioflav 500-1000mg/ 60mg
Vitamin E 400iu
Beta carotenes 10,000iu
EFA’s (borage/flax, EPO/flax, hemp, black currant, fish)
Melatonin 2.5mg 3-4d before menses
Calcium 800-1000mg qd
Magnesium 400mg x 7days before + 3days during @ 100mg q 2-3 hrs
What are botanicals for dysmenorrhea?
- Valerian: spasmolytic, 1tsp q 3-4 hrs, 1-2 caps q3-4hr
- Crampbark: uterine relaxant, antispasmodic 40mg q 2-3hr
- Black Cohosh: antispasmodic and congestive menstrual cramps
- Chamomile, Hops
- Curcumin , bromelian, quercetin (Natural COX-2 inhibitors decrease prostagladins)
- Ginger*** Anti-inflammatory
- Pycnogenol2 (Antiinflammatory)
- Cannabis*** (Pain perception, Antiinflammatory, Affects volt-gated Na channels)
What cream is thought to help with dysmenorrhea?
Progesterone cream > 400mg/ounce Apply 1/4 - 1/2 tsp bid for 3-12 days prior to menses onset
What alternative medicine can help with dysmenorrhea?
Acupuncture*
- Reduction in Pain, Duration of pain, NSAIDs use
- Improvement in Mood related sxs
Acupressure*
- Reduction in Pain
Chiropractic***
- Studies to date use spinal manipulation vs HVLA showing no difference between the 2
What is a long term plan for dysmenorrhea?
Diet - cold water fish, fruits, veggies, legumes - dec. sat fats, sugar, salt, caffeine Supplements - Borage/flax oil 2caps bid - Magnesium 500-1000mg qd - Crampbark 2-4 caps qd Exercise (aerobic) DC: Spinal evaluation and techniques Stress management Acupuncture
What is an acute pain plan for dysmenorrhea
Supplements - Calcium carb 1000-1500mg qd Botanical - Valerian - Crampbark/ formulation Relaxation techniques Heat TENS Acupuncture Chiropractic evaluation/treatment
