dysmenorrhea, PMDD & PMS

Question 1

define Dysmenorrhea

Answer 1

recurrent, cyclic, abdominal pain starting a day or two before and in first 1-3 days of menses

Question 2

Pathogenesis difference between primary & secondary dysmenorrhea?

Answer 2

w/ primary its caused by increased prostaglandin
w/ secondary its being caused by a different issue

Question 3

typical onset & course for Primary dysmenorrhea?

Answer 3

few months to 3 years after menarche
increases through 20s and may decrease after

Question 4

typical onset & course for Secondary dysmenorrhea?

Answer 4

it is more common with older ppl

Question 5

How is primary vs secondary dysmenorrhea diagnosed?

Answer 5

W/ primary it is a diagnosis of exclusion & PE is normal
W/ secondary PE may or may not be normal and you need pelvic US

Question 6

what happens if you suspect secondary dysmenorrhea but the pelvic US came back normal?

Answer 6

get an MRI & laparoscopy

Question 7

how does dysmenorrhea affect life?

Answer 7

absenteeism
reduces quality of life

Question 8

Tx for primary dysmenorrhea

Answer 8

1) NSAIDs
2) OCP or progesterone IUD

Question 9

what happens if tx for primary dysmenorrhea does not work?

Answer 9

start considering that it is actually secondary dysmenorrhea
find underlying illness and tx that.

Question 10

what are 4 common causes of secondary dysmenorrhea

Answer 10

PID
endometriosis
ovarian cysts
uterine adenomyosis/fibroid

Question 11

Sx seen with secondary dysmenorrhea

Answer 11

dyspareunia, increased flow, etc.

Question 12

what role does prostaglandin play in menses?

Answer 12

causes smooth muscle contraction for contents to be emptied
this causes pain in pelvis and diarrhea

Question 13

when is prostaglandin high in the menstrual cycle?

Answer 13

luteal phase after progesterone levels drop

Question 14

what is PMS/PMDD

Answer 14

group of physical, mood and behavioral changes that happen in regular, cyclic relationship to luteal phase of menstrual cycle

Question 15

what is the pattern of PMS/PMDD sx– when do they show up and leave?

Answer 15

show up in last week of luteal phase (before menses)
leave a few days into menses and STAYS GONE through the week after!

Question 16

what are sx of PMS/PMDD

Answer 16

depression, fatigue, irritability
anxiety/tension, breast tenderness, etc

Question 17

what hormone is responsible for PMS/PMDD

Answer 17

progesterone– its high!!
it can also be sedative and lower BP

Question 18

4 General PMS/PMDD tx

Answer 18

CBT
diet–less caffeine & sodium, more complex carbs
exercise for endorphins
supplements like B complex & magnesium glycinate

Question 19

PMDD specific tx

Answer 19

SSRI first line for emotional sx w/ dysfx
Anxiolytics like Buspirone for anxiety
GnRH agonist + low dose combined OCP “add back” if no response to SSRI or OCP (rare)
Diuretics (spironolactone) for bloating or acne

Question 20

What is PMDD & DSM V criteria

Answer 20

premenstrual dysphoric disorder
severe PMS w/ fx impairment where anger, irritability, internal tension are prominent

Question 21

are there any tests or imaging for PMS/PMDD?

Answer 21

no

Question 22

Chronic Pelvic Pain (CPP)

Answer 22

continuous or episodic pain for >6months and affects daily functioning and relationships

Question 23

CPP vs dysmenorrhea

Answer 23

CPP is not cyclic
dysmenorrhea is tied to menses and stops after period

Question 24

causes of CPP

Answer 24

endometriosis, CPID
mental health issues
interstitial cystitis
IBS, constipation
pelvic floor myalgia, myofascial pain
neuralgia

Question 25

important parts of history for CPP workup

Answer 25

prior births, procedures, assaults, abuse, abnormal PAPs

Question 26

PE findings associated w/ CPP

Answer 26

endometriosis
fibroids/leiomyoma- enlarged/irregular uterus
PID- cervical motion tenderness
surgery adhesions– pain w/ movement of viscera
neuropathy– saddle sx
adnexal mass– ovarian neoplasm, adnexal tenderness, ascites
prolapsed uterus
vulvar or vestibular pain
etc!

Question 27

how is CPP evaluated?

Answer 27

Lab tests
Pelvic US
laparoscopic surgery

Question 28

how is CPP treated?

Answer 28

treat what ever the cause is
empiric tx of suspected endometriosis before/instead of diagnostic laparoscopy