Dysmenorrhea and PMS Flashcards
Dysmenorrhea only occurs during ______ cycles
ovulatory (during the follicular phase of the menstrual cycle)
When does dysmenorrhea usually begin?
usually begins with the onset of menses (within the first 6-12 months of menarche)
The onset and severity of dysmenorrhea often mimics what?
menstrual flow
What are the other associated symptoms with dysmenorrhea?
- headache, nausea, vomiting, fatigue and IBS
What is the difference between primary and secondary dysmenorrhea?
Primary: uterine contractions involving increased PGs
Secondary: PID, endometriosis
Primary dysmenorrhea is often thought to be due to what?
to to prostaglandins
- concentration of PGE2 and PGE2-alpha are increased in the endometrium. This increase correlates with pain severity
- results in an increase in uterine activity, strength and frequency of contractions (dysrhythmic)
What is the difference of age of onset between primary and secondary dysmenorrhea
1: typically 6-12 months
2: mid to late 20s through 30s and 40s
What is the difference in menses between primary and secondary dysmenorrhea?
1: more likely to be regular with normal blood loss
2: more likely to be irregular, menorrhagia more common (increased amount of blood loss)
What is the patten and duration of primary and secondary dysmenorrhea?
1: onset just before or coincidental with menses, pain with each or most menses, lasting 2-3 days
2: vary with cause, change in pain pattern or intensity may indicate secondary disease
Will both primary and secondary menorrhea respond to NSAIDs?
1: yes it will
2: no it will not
What are the other symptoms associated with both primary and secondary dysmenorrhea?
1: N/V, fatigue, dizziness, irritability, diarrhea, and headache may occur at same time of dysmenorrhea
2: vary with cause, may include dyspareunia and pelvic tenderness
What are that main risk factors of dysmenorrhea?
- under 30 y/o
- BMI under 20 kg/meter squared
- smoking
- menarche before 12 y/o
- longer menstrual cycles/duration of bleeding
- irregular or heavy menstrual flow
- history of sexual assault
- PMS or pelvic inflammatory disease
- sterilization
What are the red flags for dysmenorrhea?
- onset of pain > 2 years post-menarche
- symptoms occur outside the first 3 days of menses
- change in severity of pattern of pain
- change in characteristics of menstrual fluid
- if trial of OTC treatment fails (because we know that dysmenorrhea is caused by the production of PGs, and NSAIDs block the production of these)
What are the non-pharm options for dysmenorrhea
- heat therapy
- lifestyle modifications
(stop smoking, regular exercise, decreased fat intake) - other non-pharm measures: TENS, CBT, relaxation, etc
- regular aerobic exercise throughout the cycle should decrease how painful periods are
- decrease saturated fat - fish oil supplements can also be beneficial-high in omega 3 polyunsaturated fatty acids. Thought to decrease the severity of pain
What is the first line therapy for treating dysmenorrhea?
- ibuprofen or naproxen (ASA and acetaminophen do not reduce PGs in menstrual fluid)
- first choice to decrease prostaglandin concentrations in endometrial and menstrual fluid
- start at onset of pain or menses and continue on a schedules basis for 72 hours
- – there will be a 3 month trial before referring or if symptoms are not relieved or pain worsens
What are the rx options available for treating primary dysmenorrhea?
- NSAIDs: propionic acids (naproxen, ibuprofen) or fenamates (e.g. mefenamic acid) or acetic acids (indomethacin)
- mefenamic acid is unique because it inhibits PG synthase and blocks the action of PG that have already been formed
- clinical efficacy is similar for all NSAID options
- oral contraceptives are 90% effective, levonorgestrel IUS- modification of the menstrual cycle (blocks ovulation); low dose agents provide lighter, shorter and less painful periods, or no periods at all
When should a patient se improvement in symptoms?
- may take up to 3 cycles for improvement of dysmenorrhea issues/symptoms overall
What is the maximum duration of treatment for self-treatment approaches?
- 3 days each cycle
What is the definition of PMS?
- recurrent physical, psychological and behavioural symptoms which occur during the luteal phase of the cycle (day 14-28) and which are relieved by menstruation with a symptom free week. The symptoms have a negative impact on the quality of life of the woman
When is the typical onset of PMS in a woman?
anytime after puberty, typically in the mid-twenties
When are the symptoms of PMS usually experienced?
- anywhere from 7-14 days before menstruation, symptoms peak just a few days before
- usually improve significantly or disappear just a few days of menstruation
Will a woman get symptoms of PMS during pregnancy or menopause?
no they will not
What ar the three most supported aetiologies of PMS?
- Exaggerated response to normal hormonal changes
- fluctuations in estradiol and progesterone cause an abnormal response - 5HT deficiencies
- women with PMS have been found to have decreased 5HT concentrations and decreased platelet uptake of 5HT during the late luteal phase
- decreased 5HT may lead to depressed mood, irritability, anger, aggression, poor impulse control and appetite disturbances - Abnormalities in catcholaminergic, GABA and opioid NT systems
What are some of the risk factors associated with PMS?
- lower intake of vitamin D
- genetic predisposition
- high BMI
- stress
- traumatic life events
