Lecture 7: Menstruation, Contraception, and Vaginal Infections Flashcards
Menarche
First period
- starts at age of 12. range is (11-14.5)
- influenced by factors like race, genetics, nutritional status, body mass
Period cycle
- Avg cycle is 28 days
- Range is 24-38 days,
- Generally 3-7 days
Dysmenorrhea
painful menstruation
- prevalence is highest in adolescence, 93% affected
- generally develops within 6-12 months of menarche
Premenstrual Syndrome
physical disorder or physical/emotional/behavioral changes that occur during luteal phase
Amenorrhea
absence of menstruation
Menorrhagia
abnormally heavy or prolonged bleeding
metrorrhagia
abnormal bleeding from uterus
oligomenorrhea
infrequent menstrual flow
Primary dysmenorrhea
- appropriate to use self-care measures to treat
- as soon as 6-12 months after menarche but typically several years after
- no pain during other parts of cycle,
- more likely to be regular with normal blood loss
- NSAIDS help
Prostaglandins
stimulate uterine contractions to expel menstrual fluid and control bleeding as the endometrium sloughs
Leukotreines
cause vasoconstriction and uterine contractions
Dysmenorrhea Risk factors contributing to it
- young age
- nulliparity
- early menarche (prior to age 12)
- heavy menstrual flow
- tobacco smoking
- low fish consumption
- BMI above 30 or below 20
- PMS symptoms
- stress, anxiety, depression
Secondary Dysmenorrhea
- mid to late 20s or older, usually 30s and 40s
- more likely irregular menses, menorrhagia or metrorrhagia is more common
- pattern and duration of pain can vary with cause these changes in pattern or intensity may indicate secondary disease
- There may be pain during other parts of the menstrual cycle
- NSAIDS don’t really help
Primary Dysmenorrhea symptoms
fatigue, headache, nausea, change in appetite, backache, dizziness, irritability, depression
Secondary Dysmenorrhea symptoms
vary according to cause but may include dyspareunia (genital pain) and pelvic tenderness
Ovulation
each month, an egg matures in the ovaries and is released through the fallopian tube into the uterus
Implantation
- if the egg is fertilized by the sperm, it implants on the wall of the uterus
- Leads to pregnancy
Egg is not fertilized
- it then exits the body through the cervix and vagina
- Leads to menstruation
Menstruation
- Hormone levels drop and the endometrium (uterine lining) breaks down
Primary Dysmenorrhea Exclusions for Self-Care
- severe dysmenorrhea and/or menorrhagia
- symptoms inconsistent with primary dysmenorrhea
- history of Pelvic Inflammatory Disease (PID), infertility, irregular menstrual cycles, endometriosis, ovarian cysts
- use of IUD/IUCs
- allergy or intolerance to aspirin or NSAIDs
- use of warfarin, heparin or lithium
- active GI disease
- bleeding disorders
First line treatment for dysmenorrhea
Ibuprofen or Naproxen
- begin therapy at onset of menses and pain
- treatment may be started 1-2 days prior to expected menses to improve relief
- most effective when taken on schedule
Using Acetaminophen for dysmenorrhea
- weak prostaglandin inhibitor
- may be able to treat mild symptoms
Using Aspirin for dysmenorrhea
- may increase menstrual flow
- moderately treats minimal symptoms
Non-pharmacological treatment for dysmenorrhea
- sleep
- hot bath
- heating pad
- exercise
- avoid smoking
- exposure to secondhand smoke
PMS
Premenstrual Syndrome
PMS Pathiophysiology
- fluctuations in estrogen and progesterone caused by normal ovarian function are the cyclic triggers for symptoms
- Serotonin
- allopregnanolone
- GABA receptors
Lower beta- endorphin levels
lower tolerance for discomfort and pain
PMS symptoms
- fatigue
- irritability
- labile mood with alternating sadness and anger
- crying and oversensitivity
- anxiety
- depression
- difficulty concentrating
- abnormal bloating
- breast tenderness
- appetite changes
- headache
- GI upset
- increased energy
- increased libido
- increased sense of control
Typical premenstrual symptoms
Mild physical or mood changes before onset of menses that do not interfere with normal life functions
Normal PMS
- at least one mood or physical symptom during first 5 days prior to menses
- symptoms are virtually absent during cycle days 5-10
- the symptoms have negative effect on social functioning or lifestyle but the severity is mild-moderate
Moderate-severe PMS
at least one mood or physical symptom that results in significant impairment of daily activities or relationships
Premenstrual dysphoric disorder (PMDD)
five or more symptoms, physical or mood, that are present the last week of the luteal phase with at least one symptom being significant depression, anxiety, affective lability or anger. Severity of symptoms interfere with work, school, social activities and social relationships. Symptoms should be absent the week after menses and must not be an exacerbation of another disorder like panic disorder
Premenstrual Exacerbation
a worsening of the symptoms of other, typically psychiatric disorders, there is no symptom free interval
PMS Exclusions to selfcare
- Severe PMS or PMDD
- uncertain pattern of symptoms
- onset of symptoms coincident with use of hormonal contraceptives
- contraindications to specific agents
PMS Treatment goals and approach
- Patient education to better understand PMS and the cyclic nature of the illness
- identify techniques for coping with PMS symptoms and stress
- Lifestyles modification (diet, exercise)
- Non-pharmacologic and Pharmacologic options
PMS Pharmacologic options
- Pyridoxine 80mg once daily (for mood)
- calcium 600mg and vitamin D twice daily (for emotional symptoms, mood)
- magnesium 360mg daily during luteal phase (mood)
- NSAIDs (pain)
- Diuretics- water pills (bloating)
Caffeine
- Dose: 100-200mg every 3-4 hours
- Inhibits renal tubular secretion of sodium and water
- May cause anxiety, restlessness, insomnia or irribility
- May increase GI irritation
Pamabrom
Up to 50mg 4 times daily
- common product in combination PMS products
