Dysmenorrhoea

Question 1

What is dyschezia?

Answer 1

Pain with defecation

Question 2

What is Mittelschmertz?

Answer 2

Mid cycle pain, usu ovulation

Question 3

How many women experience pelvic pain?

Answer 3

1 in 5 women experience chronic pelvic pain

Question 4

Causes of primary dysmenorrhoea?

Answer 4

2ndary to prostaglandin release

Question 5

Causes of secondary dysmenorrhoea?

Answer 5

Endometriosis
Adenomyosis
Intracavity mass
Isolated endometrial pocket

Question 6

What causes superficial dyspareunia? (Introitis)

Answer 6

Thrush
Atrophic vaginitis
Dermatitis
Vestibulodynia

Question 7

vEstibulodynia?

Answer 7

Nerves near hymen are sensitized(eg.thrush), get hyperalgesia/allodynia

Question 8

Deep dypareunia causes?

Answer 8

And extrinsic
Adenomyosis
Adhesions
Ovarian cysts

Question 9

Midway dypareunia causes?

Answer 9

Pelvic floor
-spasm
Trigger points

Question 10

dypareunia examination?

Answer 10

Cotton bud prodding

• painful?
• does it reproduce the same pain as dypareunia

Question 11

dypareunia examination bimanual?

Answer 11

Check all walls of vagina, the walls of bowel, ovaries
Cervix, uterus balloting

Pouch of Douglas

Question 12

When is mid cycle pain?

Answer 12

D10-14

Question 13

Ask what for nonmenstrual pelvic pain?

Answer 13

Ask Cyclical Pattern!

Beware of drugs

Question 14

Who gets endometriosis?

Answer 14

10-15% of women reproductive
60-70% with cyclical pelvic pain
30-40% women with infertility

Question 15

Does dysmenorrhoea correlate with endometriosis?

Answer 15

Not necessarily

Question 16

Theories of endometriosis cause?

Answer 16

Retrograde menses
-risk factors for implantation
Coelom if metaplasia
CongeniTal
Iatrogenic
Metastatic spread
Direct spread

Question 17

Coelomic metaplasia

Answer 17

Menstrual fluid, not endometrial cells, causes changes in peritoneum to change

Question 18

Presentation of endometriosis?

Answer 18

• Asymptomatic: incidental finding
• cyclical pain
• provoked pain: dyspareunia
• infertility

Question 19

endometriosis beware?

Answer 19

Symptom severity and disease severity does NOT correlate

Question 20

Signs of endometriosis?

Answer 20

Lower Abdo pain
PV pain, lateral fornices 
Uterus is 'fixed'
Palpable adenexa L mass
Palpable nodule

Question 21

endometriosis diagnosis ultrasound?

Answer 21

Better at picking up cysts

Now can see on bowel.

Question 22

What is gold standard for endometriosis?

Answer 22

Laparoscopy

Question 23

Where do you see endometriosis usually?

Answer 23

Pouch of Douglas

near ovaries

Question 24

Classic endometriosis looks?

Answer 24

Black spots, could be white, or red

Question 25

endometriosis Rx options?

Answer 25

``` What has been done? Do you plan to become pregnant? Do nothing Analgesics (not narcotics) Suppress hormones: OCP, Progestins ```

Question 26

What to tell patients with endometriosis?

Answer 26

It's not fatal

Question 27

What to tell patient re: endometriosis Rx?

Answer 27

May not fix the pain

Question 28

Surgery options for endometriosis?

Answer 28

Ablate or excise (80%) improved symptoms Radical: remove organs MAY not fix pain.

Question 29

Treating endometriosis infertility?

Answer 29

``` Check other causes NO DRUGS Surgery: remove Cysts if >3cm REmove hydrosalpinges IVF - early move it need be -Plan preg sooner rather than later ```

Question 30

Classic signs of Adenomyosis

Answer 30

Bulky uterus | Uterus tender on bimanual palpation

Question 31

adenomyosis gold standard Dx?

Answer 31

Histology, hysterectomy sample

Question 32

Risk factors for adenomyosis?

Answer 32

Age Older | More gravidarum/parity

Question 33

adenomyosis Rx?

Answer 33

- Do nothing - Benign condition - Drugs: NSAIDS, OCP, progestin - Mirena - hysterectomy

Question 34

Primary dysmenorrhoea classic history

Answer 34

Gets better as increase: Age Parity OCP