Menstrual Disorder Flashcards
What is the average age of menarche?
Menarche = first period
average age = 12
Early and late menarche
-early menarche: associated with breast cancer
-late menarche: associated with osteoporosis and increased fracture risk
What influences the onset of menarche?
-race
-genetics
-nutritional status
-body mass (gymnast with delayed menarche due to muscles)
What is the median cycle length of menses?
28 days
-more variability in adolescents bc their hormones are not balanced out yet (may have longer, irregular cycles)
How long does the average menses last?
-3 to 7 days
The average amount lost during the cycle
30 ml
-most blood is lost on days 1 and 2
What does Menorrhagia mean?
-Loss of >80mL of blood per cycle or bleeding lasting longer than 7 days
-associated with severe anemia and impairments in
daily functioning
What is Dysmenorrhea?
-Painful menstruation
Primary dysmenorrhea
Secondary dysmenorrhea
Premenstrual Disorders
-Cyclic and composed of a combination of physical, mood,
and behavioral symptoms that occur during the luteal phase (after ovulation - the egg travels to the uterus)
What are Menstrual Disorders eligible for OTC Treatment?
-Primary Dysmenorrhea
-Premenstrual Syndrome (PMS)
Complaints: Abdominal pain and cramping
Irritability, Fluid retention
What differentiates primary from secondary Dysmenorrhea?
Both with Cramp-like lower abdominal pain during or before menstruation
-The symptoms: in primary: N/V, diarrhea, bloating, fatigue, headache
-Secondary Dysmenorrhea is caused by pelvic disease (infection of the uterus)
Which patient population is mostly affected by Primary Dysmenorrhea?
-Teens and early 20s
-Increases in early and older adolescents and decreases after the age of 24 (hormones balanced, and they may use contraceptives which may help)
-up to 93% of adolescents affected
When does Primary Dysmenorrhea happen?
Only during the ovulatory cycle
What is the timing of Pain associated with Primary Dysmenorrhea?
-Starts with the onset of menstruation
-subsides in day 2-3
-N/V, fatigue, dizziness, bloating, diarrhea, headache
Characteristics of Secondary Dysmenorrhea
-later after menarche (at least 2 years after menarche - mid to late 20’s)
-pelvic pathology
-may cause irregular menses
-pain outside of the ovulation cycle
Nonpharmacologic Approach for Primary Dysmenorrhea
-Sleep
Hot bath/heating pad (vasodilation -> relaxes smooth muscles that cause abdominal cramping)
Light exercise (yoga, swimming)
Smoking cessation
What are some OTC products that may help in pain reduction (no strong evidence)
-Omega-3-fatty acid (Fishoil): decreases the production of proinflammatory cytokines
-Vitamin D3: reduces production of prostaglandin
Pharmacologic Approach for Primary Dysmenorrhea
Target is PAIN
-NSAIDs - Ibuprofen, Naproxen (BEST recommendation)
-Aspirin (high doses may increase bleeding)
-Tylenol (used when the woman is trying to get pregnant)
-Start 1-2 days before the menstrual cycle
-regular periods during the cycle
Best pain medication if the woman tries to get pregnant
Tylenol
Which of the Pain medications have DDI with Warfarin?
-NSAIDs
-Aspirin
When to Refer
-Pain persists
-New symptoms occur
-> because there might be other things causing the pain
-Secondary dysmenorrhea and/or menorrhagia !!!!
-History of PID, infertility, irregular
menstrual cycles, endometriosis, or ovarian
cysts
-use of warfarin, heparin, or lithium
-Active GI disease (PUD, GERD, ulcerative
colitis)
-Diagnosis of bleeding disorder
Premenstrual Syndrome (PMS)
-Symptoms usually begin in the teenage
years up to the early 20s
-only during the ovulary cycle
-disappears during pregnancy, breastfeeding and menopause
60-80%: mild symptoms
20-30%: clinically
significant symptoms
6-8%: severe symptoms
Symptoms of PMS
-Fatigue, lack of energy
-mood changes
-breast tenderness (physical symptom)
-appetite and sleep change
-joint/muscle pain, headache
Positive: increased libido, sense of control, or energy
The presence and severity of symptoms differentiate PMS from regular premenstrual symptoms and PMDD
Key differences in Menstrual Conditions
!!!
Typical premenstrual symptoms: mild, do not interfere with daily life
PMS: at least one mood or physical symptom during the 5 days before menses - negative effect on daily life
PMDD (PM dysphoric disorder): five or more symptoms (mood or physical) -should go away in the week after menses -> if NOT it might be Premenstrual exacerbation of other disorders
Premenstrual exacerbation of other disorders:
worsening of other disorders (often psychiatric, depression, anxiety) - there is no symptom-free interval
When is a therapy considered effective?
When the symptoms are reduced by 50%
-may need multiple agents to address all symptoms (behavioral, physical symptoms)
-treat the most bothersome symptoms first
Which supplements can be helpful for mood symptoms?
-Vitamin B6 (Pyridoxine) 100 mg (at high doses peripheral neuropathy)
-Vitamin D 600 IU daily
-Calcium 1200 mg in divided dose
Which supplements can be helpful for bloating or fluid retention?
-Diuretics
-Ammonium chloride (Dont: use for more than 6 days and in renal/liver impairment)
-Caffeine
-Pamabrom (my cause gold urine)
Why might diuretics not be helpful?
during menses the fluid is actually not retained but shifted to the abdomen, diuretics will just shift somewhere else
What to look out for in caffeine
-Tolerance
-may worsen other PMS symptoms
-DDI with MAOI
-worsen insomnia and anxiety
Why should combination products be not recommended?
-we want to treat the most severe symptoms first and go from there
-it contains Tylenol and NSAIDs -> pain is often not the chief complaint
-it contains antihistamines -> no evidence to be helpful in emotional symptoms of PMS
Refer when:
-Severe PMS or PMDD
-uncertain, inconsistent patterns of symptoms
-symptoms started with taking oral contraceptives
-contraindications with specific agents
