Exam 3 - Menstruation, Vaginal, and Vulvovaginal Disorders Flashcards
3 menstruation disorders
Primary dysmenorrhea
Premenstrual syndrome (PMS)
Toxic shock syndrome
What are the best OTC medications for prevention of strong uterine contractions (cramping)
Ibuprofen
Naproxen
3 vaginal and vulvovaginal infections
Bacterial vaginosis (BV)
Trichomoniasis
Vulvovaginal candidiasis (VVC)
Non-drug measures for menstrual pain
Heating pad
Stop smoking
Eat more fish/fish oil supplement
Regular exercise
What is the key to reducing pain when NSAIDs are taken?
Start taking NSAID when menstrual period begins
Take medication and regular intervals
Menstrual cycle
Time between onset of menstrual flow and the start of the next flow (menses to menses)
Menstruation
Monthly cycling of the female reproductive system
Why is aspirin NOT a recommended OTC medication for menstruation
It causes more bleeding
4 causes of painful periods
Prostaglandins
Endometriosis
Fibereosis
Adenomyosis
At what age does a girl’s first period (menarche) begin?
11-14.5 years
What is the mean blood loss during menses?
30 mL
What is the average cycle length
28 days
How long does menses usually last?
3-7 days
When is the most blood lost?
Days 1 and 2
Anemia can result from periods lasting longer than ____ or if blood loss is > ____
7 days
80 mL
Proliferative (follicular) phase
First flow to ovulation
Luteal (secretory) phase
From ovulation to next flow
What are the 2 principle reproductive events that occur during each menstrual cycle
Maturation & release of an ovum from ovaries
Preparation of endometrial lining of the uterus for the implantation of a fertilized ovum
In primary dysmenorrhea, increased levels of prostaglandins and leukotrienes cause _____
Strong contractions like labor
WITHOUT dysmenorrhea, contractions are ____ and pressure is up to ______
Rhythmic
120 mmHg
In primary dysmenorrhea, contractions are ____ and pressure is up to _____
NOT rhythmic
180 mmHg
In primary dysmenorrhea, more ____ and _____ cause _____
Ischemia
Tissue hypoxia
More pain
Primary dysmenorrhea
Cramp-like lower abdominal pain at menstruation
Pain related to onset of menstruation
Cyclic in nature
Described as continuous dull ache w/ spasmodic cramping in lower mid-abdominal region
What causes prostaglandins and leukotrienes to be released
Low progesterone levels at the end of the luteal phase
______ levels are twice as high in women w/ dysmenorrhea
Prostaglandin
What do leukotrienes cause
Vasoconstriction and uterine contractions, which cause pain
(T/F): dysmenorrhea may be worse after childbirth
False
Risk factors for dysmenorrhea
- Heavy menstrual flow/early menarche
- Tobacco use
- Low fish/vegetable/milk/dairy consumption
- History of sexual assault
- Stress/anxiety/depression
- BMI < 20 mg/kg2
(Having To Leave Has Some Benefits)
Primary dysmenorrhea responds to ____ or _____
NSAIDs
Combined oral contraceptives
At what age does primary dysmenorrhea occur?
6-12 months after menarche
Usually ages 13-17
At what age does secondary dysmenorrhea occur?
At least 2 years after menarche
Mid-late 20s or older
What is the cause of secondary dysmenorrhea
Associated with:
- endometriosis
- fibroids
- IUD
- pelvic pathology
Who is an exclusion for self treatment of menstrual disorders?
Pts experiencing severe dysmenorrhea
Symptoms not consistent w/ primary dysmenorrhea
Pts using warfarin, heparin, lithium, or have an allergy to NSAIDs
People w/ bleeding disorders
People w/ history of infertility, irregular menstrual cycles, endometriosis
What are the 1st line pharmacological options for treatment of primary dysmenorrhea
NSAIDs
Hormonal contraceptives
(NOT aspirin though)
What are the treatment goals of primary dysmenorrhea
Provide relief or significant improvement in symptoms
Minimize the disruption of usual daily activities
Dietary supplementations for menstruation disorders
Fish oil
Vitamin D
What NSAID may increase flow, so it is not generally recommended
Aspirin
If APAP is used for primary dysmenorrhea, how should it be dosed?
650-100 mg q6h