Dysmenorrhea (Final) Flashcards
true or false: pharmacists can prescribe for dysmenorrhea
true
this is known as pain associated with menses. patient has normal pelvic anatomy and physiology. majority of cases are associated with ovulation
primary dysmenorrhea
here there is an underlying pathological process. the underlying cause needs to be addressed first, could be:
- endometriosis
- pelvic inflammatory disease
- uterine fibroids
- interstitial cystitis
this requires extensive medical workup
secondary dysmenorrhea
what are some risk factors for primary dysmenorrhea
- age (more common in age < 25)
- nulliparity (never given birth)
- family hx of dysmenorrhea
- increased duration.amount of menstrual flow
- smoking
- presence of mood disorder
- frequent life changes/fewer social supports
clinical presentation of this type of dymenorrhea includes:
- onset shortly after ovulatoin and predictable with each cycle thereafter
- usually occurs 6-12 months post-menarche
- bilateral/midline lower pelvic or abdominal pain at onset of menstrual flow
- may experience back pain, thigh pain, h/a, diarrhea, n/v
- normal pelvic examination
primary dysmenorrhea
clinical presentation of this type of dysmenorrhea includes:
- onset can occur anytime after menarche (typically after age 25)
- variable time of pain onset during menstrual cycle
- variable pain intensity from cycle to cycle
- presence of other gynecological sxs such as dyspareunia, menorrhagia, spotting
- abnormality upon pelvic exam
secondary dysmenorrhea
what are some red flags for dysmenorrhea
- age < 12 y/o requiring an Rx product
- first episode (within 6 months of menarche or more than 2 years post menarche - esp if > 25 y/o)
- symptoms outside the first 3 days of menses
- changes in the severity or pattern of pain
- changes in the characteristics of menstrual fluid (degree of flow, odour, colour)
- IUD insertion in last year
- secondary dysmenorrhea suspected
describe the patho of primary dysmenorrhea
- regression of the corpus luteum occurs (which happens in the absence of fertilization)
- this causes a decrease in progesterone
- which leads to PG release from menstrual flow
- myometrial contractions occur
- which causes a decreased blood flow
- and therefore PAIN
what are the three main treatment options for dysmenorrhea
- reduce muscle tension/improve circulation (local heat application, regular exercise)
- decrease PG synthesis (NSAIDs)
- suppress ovulation (hormonal contraceptives)
true or false: if there is inadequate relief with one NSAID after 3 months, another one should be tried
true
true or false: all NSAIDs are ~80% effective in treating dysmenorrhea
false - except ASA
true or false: acetaminophen is inferior to NSAIDs for dysmenorrhea
true - acetaminophen doesnt have the same effect on PG synthesis
true or false: NSAIDs should be taken STAT at the first onset of symptoms/menses and continue PRN for 2-3 days
false - taken at a regular schedule for 2-3 days (NOT PRN)
what is the onset of action for NSAIDs
30-60 minutes
what is an adequate trial for NSAIDs
3 cycles
