Menstrual Disorders

Question 1

Describe the characteristics of primary dysmenorrhea

Answer 1

It is your typical cramping. It generally occurs within 6 months of first period. It resolves within 48 to 72 hours

Question 2

Describe the characteristics of secondary dysmenorrhea

Answer 2

Onset is 20 and 30’s. Accompanied by heavy bleeding, irregular menses, vaginal discharge, infertility, and painful sex(dyspareunia). It is usually not responsive to NSAIDs or oral contraceptives

Question 3

What are the non pharmacological treatment for Dysmenorrhea

Answer 3

Acupuncture. Heat pad. Omega 3 fatty acids and vitamin D. Aerobic exercise Smoking cessation

Question 4

Is mefenamic acid an NSAID used to treat dysmenorrhea yes or no

Answer 4

Yes it is at high doses

Question 5

List the pharmacological treatments for dysmenorrhea

Answer 5

NSAIDS, leuprolide acetate, Danazol, oral contraceptives

Question 6

What are the characteristics of primary amenorrhea

Answer 6

No menses by age 14 with absence of sings of puberty and no menses by age 16 with other signs of puberty

Question 7

What are the characteristics of secondary amenorrhea

Answer 7

No menses for 3 months with previously regular period and no menses for 6 months with previously irregular periods

Question 8

What is menorrhagia

Answer 8

Heavy bleeding when the bleeding is more than 80 ml a day

Question 9

What is polymenorrhea

Answer 9

When the menstrual cycle is too short like less than 21 days

Question 10

What is oligomenorrhea

Answer 10

When the cycle is too long. When it is more than 35 days

Question 11

What is amenorrhea

Answer 11

Not having periods for 6 months it more

Question 12

What is dysmenorrhea

Answer 12

Painful periods or cramping

Question 13

What are the treatment options for acute menorrhagia

Answer 13

Tranexamic acid, medroxyprgesterone, and high dose estrogen

Question 14

What is metrorrhagia

Answer 14

Bleeding between periods

Question 15

Mention the two selective progesterone modulators used for fibroids

Answer 15

Ullipristal acetate and mifepristone

Question 16

What are the criteria to diagnose a person with PMS

Answer 16

Must have at least 1 or more symptoms. It must be affecting their work life balance, must occur within 5 days before menses, must occur in 3 consecutive cycles

Question 17

What are the criteria to diagnose PMDD

Answer 17

Must have 5 or more symptoms, must be significantly distressed with daily life, must occur 7 days before menses and resolve within a few days after starting menses, must occur in at least 2 symptomatic cycles

Question 18

How long can you take ullipristal acetate for before fibroid surgery

Answer 18

Up to a year and it has less hypo androgenic problems

Question 19

How long can you take GNRH agonists for

Answer 19

6 months before surgery

Question 20

What is the first line treatment for PMS, PMDD

Answer 20

SSRI, NSAIDs, and spironolactone

Question 21

What are the SSRI approved for PMDD

Answer 21

Sertraline, paroxetine, and fluoxetine

Question 22

What is the black box warning for SSRI

Answer 22

Increased suicidal thinking in children and young adults with depression and other psychiatric disorders

Question 23

What are the medications for sexual interest/arousal disorders

Answer 23

Addyi(finanserin) and vyleesi(bremalanotide)

Question 24

What are the counter indications for Addyi

Answer 24

Wait 2 hours if you have taken 1 or 2 drinks of EtOH. Skip dose if more than 3 drinks. Should not be used by people with hepatic impairment or used with strong CYP3A4 inhibitors

Question 25

What are the counter indications for VYLEESI(brelanotide)

Answer 25

Given at least 45 minutes before sex. Counter indicated in people with uncontrolled hypertension

Question 26

What are the drugs for dyspareunia

Answer 26

Ospemifene

Question 27

What are the counter indications for ospemifene

Answer 27

Previous venous thromboembolism and estrogen sensitive cancer like breast cancer or endometrial cancer