dysmenorrhea & Premenstrual syndrom

Question 1

Dysmenorrhea secondary/primary

Answer 1

• *painful menses: cramping, backache, abdominal ache
• *primary= no evident pathology; diagnosis of exclusion
• *secondary underlying pathology that causes pain with menses

Question 2

Dysmenorrhea define

Answer 2

• *quite common
• *associate with OVULATORY cycles
• *important role for PROSTAGLANDIN

Prostaglandin release –> uterine contractions–> decreased uterine blood flow—> uterine hypoxia –> pain

Question 3

dysmenorrhea hx, pe, dx, & management

Answer 3

hx: pain that usually begin shortly before or at the same time as onset of bleeding; usually diminishes w/in a day and subsides/resolves w/in few days
–> usually suprapubic area that lower back, may radiate to inner thighs
nausea & vomiting & diarrhea

pe: negative findings
Dx: none in primary
management : NSAIDs COC are mainstays of pharmacologic management

Question 4

PMS

Answer 4

symptoms with specific timing that are distressing to the woman

Question 5

PMDD

Answer 5

small subset of women with severe PMS that causes impairment

Question 6

symtom clusters

Answer 6

• *mood –>irritability, mood swings, depression, anxiety
• *behavioral–> tearfulness, social withdrawal
• *cognitive–> feelings of confusion, poor concentration
• *physical–> bloating breast tenderness insomnia headache, fatigue, wt. gain, appetite changes, food cravings.

Question 7

PMS / PMDD timing

Answer 7

symptoms beginning at or soon after ovulation, with escalation in the LUTEAL PHASE
worst symptoms in week preceding menses
symptoms gone or much better at onset of menses and for first two weeks of new cycle.

Question 8

PMS/ PMDD PE & dx testing

Answer 8

**none specific to PMS; only those needed to rule out other causes

Question 9

PMS/PMDD management

Answer 9

Management: involving the woman !!!
Lifestyle approaches : exercise, reduce caffeine, sodium, and alcohol, increase complex CHO

supplements/herbs: calcium magnesium, chasteberry
physical symptom treatment: OCPs, NSAIDs
Mood symptom treatment : SSRIs
LUTEAL phase or beginning with symptoms dosing are often great options
Response often seen in first cycle of use
choose a long-half-life SSRI if using therapy intermittently:
**Fluroxetine (Prozac) –long half life
**sertraline (Zoloft) –long half life because few withdraw side effect