Dysmenorrhea - AUD lecture

Question 1

What is dysmenorrhea
and what does primary vs secondary mean

Answer 1

Dysmenorrhea is described as pain associated with mensuration
Primary means the person has normal ovulatory cycles and pelvic anatomy
Secondary means there are underlying anatomic or physiologic causes

Question 2

Pathophysiology of dysmenorrhea

Answer 2

the buildup of fatty acids in cell membranes get released and this release causes prostaglandins and leukotrienes to be released in the uterus which causes inflammation and this inflammatory response is the cause of dysmenorrhea symptoms

Question 3

Risk factors

Answer 3

<20 years old
Weight loss attempts
Depression and anxiety
Heavy menses
Menarche before 12 years old
Nulliparity (no previous pregnancy)
Smoking
family history

Question 4

Symptoms

Answer 4

Dizziness
Nausea
vomiting
headaches
diarrhea
crampy pelvic pain
muscle cramps

Question 5

First line of therapy for treatment

Answer 5

NSAIDS
- MOA: decrease the production of prostaglandins by inhibiting COX-1 and -2
- Celecoxib (COX-2 specific), diclofenac, ibuprofen, naproxen
- can take these around the clock 1-2 days before the cycle starts
Oral contraceptives
- MOA: Decrease endometrial production of prostaglandins and leukotrienes by inhibiting endometrial tissue proliferation
- Multiple options - combined hormonal contraceptives
Non-pharmacologic
- heating pad
-exercise
- nutritional supplementation : omega-3, Vitamin B, and ginger
- smoking cessation
- acupuncture

Question 6

Second-line therapy for the treatment

Answer 6

Levonorgestrel IUD
Depot medroxyprogesterone acetate

BOTH MOA- related to amenorrhea side effect
- beneficial in those desiring contraception
- recommended to try levonorgestrel IUD before the shot

Question 7

Monitoring and follow up

Answer 7

Assess patient symptoms improvement
- if symptoms have not lessened in severity or resolved in 3-6 months of tradition therapy REFER