Ex. 5 L5 -Abnormal Bleeding (47) Flashcards
Normal Bleeding
35mL of blood per day
Cycle length of 22-35 days
Menstruation lasting 3-7 days
Median age of mearche: 12.4 years (starting period)
Types of abnormal bleeding
Dysmenorrhea
Amenorrhea
Oligomenorrhea
Polymenorrhea
Heavy Menstrual Bleeding (HMB)
Metrorrhagia
Dysmenorrhea
Pain associated with menstruation
Primary:
-Normal ovulatory cycles and pelvic anatomy
Secondary:
-Underlying anatomic or physiologic cause
Occurring in 17-90% of women
About 6-12 months after cycle - more immediate
One of the key symptoms of endometriosis is
Dysmenorrhea
Pathophysiology of Dysmenorrhea
-Buildup of fatty acids in cell membranes, then released
-Prostaglandins and leukotrienes released in uterus
-Inflammatory response causes symptoms
Risk Factors - Dysmenorrhea
< 20 years old
Weight loss attempts
Depression/anxiety
Heavy Menses
Menarche before <12YO
Nulliparity
Smoking
Family History
Symptoms of Dysmenorrhea
Diarrhea
Vomiting
Nausea
Crampy Pelvic Pain
Dizziness
Muscle Cramps
Headache
Goals of therapy for patients with Dysmenorrhea
Provide symptomatic relief
Reduce lost school/work productivity
Improve QOL/ADLs
Dysmenorrhea - Treatment Overview
First-Line
-Non-steroidal anti-inflammatory (NSAID), +/-
Oral Contraceptives +/-
Non-pharmacologic
Second-Line
-Depot Medroxyprogesterone acetate (DMPA)
-Levnorgestrel-releasing IUD
Treatment for Dysmenorrhea - Non-Pharmacologic
-Heating Pad
-Exercise
-Nutritional Supplementation: Omega-3-fatty acids, vitamin B, Ginger
-Smoking Cessation
-Acupuncture
NSAID Therapy: Dysmenorrhea
MOA: Inhibits COX enzyme (1 and 2), leading to decrease in prostaglandin production
-Dosing can be taken around the clock 1-2 days before cycle start
-Intended for short-term use
No NSAID found to be more efficacious than another
Dysmenorrhea NSAID drugs and dosing
Celecoxib
(COX2 specific)
-Rx only
-400mg x 1, then 200mg PO Q12h
Diclofenac
-Rx only
-100mg x 1, then 50 mg PO q8h
Ibuprofen
-Rx and OTC
-800mg x 1, then 400-800mg PO Q8h
Naproxen
-Rx and OTC
-500mg x 1, then 220-550mg PO Q12h
Pros and Cons of NSAID therapy
Pros:
-Good option for those wanting to conceive
-Short term use
-Pain relief within hours
-Cheap, non-Rx
Cons:
-SE can be intolerable
-Not a great option for those with CV history
NSAIDs SE and precautions & counseling
SE and Precautions
-GI bleeding/ulcers and upset
-Renal injury
-Onset of CV events, exacerbate HTN
Counseling and Education:
-Take w/food or milk to minimize GI upset
-Monitor for abnormal bleeding
-Scheduled dosing vs. PRN
NOT RECOMMENDED FOR PATIENTS WITH CV HISTORY
Oral contraceptive therapy
MOA: Inhibition of endometrial tissue proliferation, leading to decreased endometrial production of prostaglandins and leukotrienes
Multiple options:
-Combined hormonal contraceptives (CHCs)
Can use ethinyl estradiol component up to 35 mcg (or 50 mcg)
Dosing: efficacy noted with cyclic and continuous regimens
-No regimen found to be more efficacious than another