Dysmenorrhea, Chronic Pelvic Pain and MCIDs -Gambone Flashcards
What is the definition of dysmenorrhea?
chronic cyclic uterine pain (doesn’t occur unless ovulation occurs)
What are some symptoms of primary dysmenorrhea?
occurs during ovulatory cycles (symptoms begin just before the onset of menses)
presents within 6-12 months of menarche
increased uterine activity and painful contractions –> pain in the lower and
associated GI and urinary tract symptoms, fatigue, dizziness and headache
affects teens
What is the treatment for primary dysmenorrhea? What is NOT effective?
NSAIDS are very effective
OCs also effective because block ovulation
Aspirin is NOT effective*
What age group is affected by secondary dysmenorrhea? What are some underlying causes?
“older” women in their 20s-30s –> pain not limited to menses
causes:
- adenomyosis
- endometrial glands and stroma infiltrating the myometrium
- early endometriosis
What is the pathophysiology of primary dysmenorrhea?
progesterone causes increase in prostaglandins, endoperoxidase and metabolites that leads to increased contractility of myometrium and reduced blood flow and increased pain
What are the treatment options for secondary dysmenorrhea?
- NSAIDS initially or with OCs
- 2nd line: GnRH agonist or high dose progestins
- resistant cases caused by adenomyosis or endometriosis may need hysterectomy (not common)
What are some differences in acute vs chronic pain?
both pains are modulated in the first synapse of the dorsal horn or other areas (inhibition or facilitation)
in acute pain, the response if more likely appropriate and adaptive
in chronic pain, the response may be affected by learning –> can be exaggerated and persistent = “secondary gain”
What is the pain sensitivity of various the genital tissues?
External genitals – very tender
Cervix—variable, usually less sensitive to minor trauma
Uterus—very sensitive
Ovaries—insensitive to many stimuli, but very sensitive to rapid distension and compression during pelvic exams
When is PMS seen?
during the luteal phase of the menstrual cycle
*ONLY in ovulating women
largely due to progesterone and prostaglandin production
What are some symptoms of PMS and PMDD? Are these thought to be hormonal or psychological?
*seen in the Luteal phase and resolve after menses start
Physical symptoms include breast swelling and tenderness, bloating, weight gain, edema, and headache
Severe cases have depressed mood, anxiety, irritability, decreased interest in life-activities, sleep disturbances and feeling of being overwhelmed
*hormonal –> allopregnanolone interacts with GABA and 5HT neurons –> influence emotion and perception centers in the brain
What should be tested for in pts with PMDD? How can this be treated?
Major depressive disorder
low dose SSRI (like Prozac)
Why is it believed that migraines are have a menstrual hormonal component?
- occur 2-3x more in females than males
- resolve after menopause and during pregnancy
What is Catamenial Epilepsy? What is the treatment?
14% of women who ONLY have seizures during the premenstrual phase of the cycle
(70% of epileptic women have increased seizures premenstrually)
Treatment: progestin-only OCs and GnRH agonist
(don’t want to give estrogens that increase coagulation to headaches)
What other disorders are thought to be affected by the menstrual cycle?
asthma
DM type I
acne (flair-ups do not occur in PCOS and hyperandrogen disorders –> due to lack of ovulation?)
What is used to treat mild PCOS?
low dose OCs block LH and increase sex hormone binding globulin which binds free testosterone
spironolactone==> anti-androgen
