dysmenorrhea, PMDD & PMS Flashcards
define Dysmenorrhea
recurrent, cyclic, abdominal pain starting a day or two before and in first 1-3 days of menses
Pathogenesis difference between primary & secondary dysmenorrhea?
w/ primary its caused by increased prostaglandin
w/ secondary its being caused by a different issue
typical onset & course for Primary dysmenorrhea?
few months to 3 years after menarche
increases through 20s and may decrease after
typical onset & course for Secondary dysmenorrhea?
it is more common with older ppl
How is primary vs secondary dysmenorrhea diagnosed?
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
what happens if you suspect secondary dysmenorrhea but the pelvic US came back normal?
get an MRI & laparoscopy
how does dysmenorrhea affect life?
absenteeism
reduces quality of life
Tx for primary dysmenorrhea
1) NSAIDs
2) OCP or progesterone IUD
what happens if tx for primary dysmenorrhea does not work?
start considering that it is actually secondary dysmenorrhea
find underlying illness and tx that.
what are 4 common causes of secondary dysmenorrhea
PID
endometriosis
ovarian cysts
uterine adenomyosis/fibroid
Sx seen with secondary dysmenorrhea
dyspareunia, increased flow, etc.
what role does prostaglandin play in menses?
causes smooth muscle contraction for contents to be emptied
this causes pain in pelvis and diarrhea
when is prostaglandin high in the menstrual cycle?
luteal phase after progesterone levels drop
what is PMS/PMDD
group of physical, mood and behavioral changes that happen in regular, cyclic relationship to luteal phase of menstrual cycle
what is the pattern of PMS/PMDD sx– when do they show up and leave?
show up in last week of luteal phase (before menses)
leave a few days into menses and STAYS GONE through the week after!
what are sx of PMS/PMDD
depression, fatigue, irritability
anxiety/tension, breast tenderness, etc
what hormone is responsible for PMS/PMDD
progesterone– its high!!
it can also be sedative and lower BP
4 General PMS/PMDD tx
CBT
diet–less caffeine & sodium, more complex carbs
exercise for endorphins
supplements like B complex & magnesium glycinate
PMDD specific tx
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
What is PMDD & DSM V criteria
premenstrual dysphoric disorder
severe PMS w/ fx impairment where anger, irritability, internal tension are prominent
are there any tests or imaging for PMS/PMDD?
no
Chronic Pelvic Pain (CPP)
continuous or episodic pain for >6months and affects daily functioning and relationships
CPP vs dysmenorrhea
CPP is not cyclic
dysmenorrhea is tied to menses and stops after period
causes of CPP
endometriosis, CPID
mental health issues
interstitial cystitis
IBS, constipation
pelvic floor myalgia, myofascial pain
neuralgia
important parts of history for CPP workup
prior births, procedures, assaults, abuse, abnormal PAPs
PE findings associated w/ CPP
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!
how is CPP evaluated?
Lab tests
Pelvic US
laparoscopic surgery
how is CPP treated?
treat what ever the cause is
empiric tx of suspected endometriosis before/instead of diagnostic laparoscopy
