Menstrual Disorders Flashcards
1
Q
Define Dysmenorrhea
A
- Painful menstruation that disrupts normal activity & requires medication
- Most commonmenstrual disorder
2
Q
What is the timing of dysmenorrhea?
A
- 1° type starts w/in a year of menarche
- Pain often improves w/age or following 1st childbirth
- Less common w/regular exercise & childbirth early in life
3
Q
What are the sxs of dysmenorrhea?
A
- Pain w/or preceding menses by 1-3 days
- Typically peaks 24 hr after onset of menses, subsides in 2-3 days
- Sharp, dull, cramps, constant ache, may radiate to lower back or legs
- H/A, nausea, urinary frequency, diarrhea or constipation common
- Fatigue
- +/- vomiting
- +/- clots
- +/- syncope
4
Q
What is the pathophys of dysmenorrhea?
A
- Prostaglandin E2 released due to destruction of endometrial cells (lining shed prep)
- Prostaglandin E2causes uterus to contract
- Uterine muscles contract → constrict blood supplyto endometrium → tissue breaks down & dies (menses)
- Contractions & temporary oxygen deprivation cause pain or “cramps”
5
Q
What is primary dysmenorrhea?
A
- Usually begins in adolescence
- Excess prostaglandin E2 secretion in menstrual fluid
A. Prostaglandin E2 (dinoprostone) → uterine muscle contraction & cervix softening during labor
6
Q
What is secondary dysmenorrhea?
A
- Usually occurs in women > 25 yr
- Identifiable conditions
A. Endometriosis
B. Adenomyosis
C. Fibroids
D. Narrowed cervical os due to cryosurgery, cone bx, LEEP (Loop Electrosurgical Excision Procedure)
E. IUD
7
Q
What is the most common cause of dysmenorrhea?
A
- Endometriosis
A. Endometrial tissue grows outside uterus (ovaries, bowel or pelvic lining)
B. Most common cause:
≈ 70% of adolescents w/dysmenorrhea
8
Q
What is adenomyosis?
A
Endometrial tissue grows into muscle wall of uterus
9
Q
What are fibroids?
A
- leiomyoma
A. Benign growths
10
Q
What is the PE for dysmenorrhea?
A
- Physical exam usually normal
2. +/- Pelvic exam
11
Q
What are the ddx for dysmenorrhea?
A
- PID
- Ectopic pregnancy
- Spontaneous abortion
- Endometriosis/adenomyosis
- Ovarian Cyst
- Interstitial cystitis
- Leiomyoma
- Pelvic congestion
12
Q
How is dysmenorrhea dxed?
A
- Clinical Dx typically based on Hx
13
Q
Why would a pelvic US be used in dysmenorrhea?
A
1. Pelvic USN to R/O 2° cause/other pathology: A. Ovarian cyst B. Ectopic pregnancy C. Spontaneous abortion D. Fibroid tumor E. PID F. Pelvic congestion
14
Q
Why would a pelvic laparscopy be used in dysmenorrhea?
A
- Endometriosis
2. Adenomyosis
15
Q
What are the management strategies for primary dysmenorrhea?
A
1. NSAID’s A. Start 24-48hrs before menses begins or at 1st onset of discomfort & cont. 1-2days 2. Low dose combination OCP 3. IUD w/progestogen 4. DepoProvera 5. Vit. BorMgmay help 6. Adequate rest/sleep 7. Regular exercise 8. Heat 9. Reassurance A. 1° dysmenorrhea not associated w/structural abnormalities
16
Q
What are the management strategies for secondary dysmenorrhea?
A
1. Treat underlying cause A. Hormone Tx -OCP -Lupron B. D & C C. Antibx D. Surgery
17
Q
What are the general characteristics of PMS?
A
- Psychoneuroendocrine disorder occurring in relation to luteal phase of menstrual cycle
- Highest incidence in 20’s-30’s
- Sx’s last hours up to 10 days & typically resolve w/menses
18
Q
What is the pathophys of PMS?
A
- Physiologic ovarian function thought to be trigger
2. Mood sx’s likely due to serotonin dysfunction affected by estrogen & progesterone
19
Q
What are the neuro/endocrine sxs of PMS?
A
- H/A
- Breast tenderness
- Pelvic pain
- Bloating
- Premenstrual tension
- Back pain
- Fluid retention
A. Edema
B. Wt gain
20
Q
What are the mood/psych sxs of PMS?
A
- Anxiety
- Depression
- Insomnia
- Appetite changes
- Irritability
21
Q
What are the ddx for PMS?
A
1. Premenstrual dysphoric disorder (PMDD) A. Severe PMS/mood sx’s dominate 2. Hypothyroidism 3. Anemia 4. Major depressive disorder
22
Q
How is PMS diagnosed?
A
- Clinical Dx
A. Hx
B. Labs if indicated: CBC, TSH
23
Q
How is PMS treated?
A
1. Calcium carbonate 1000-1200 mg/day A. Bloating, food cravings & pain 2. Mg 200-360 mg/day A. Water retention 3. NSAID’s 4. Vit B6 100 mg qd A. Acts as cofactor in production of dopamine & serotonin 5. SSRI’s A. 14 days prior & cont. thru menses 6. Anxiolytics if indicated 7. Spironolactone for cyclic edema
24
Q
How can PMS be prevented?
A
- Improved eating habits
A. Limit caffeine, alcohol, tobacco & chocolate - Eat small frequent meals high in complex carbohydrates & protein
- Decrease sodium intake for edema
- Stress management
- Aerobic exercise
25
What is PMDD?
1. Premenstrual Dysphoric Disorder (PMDD)
2. Mood symptoms are dominant
3. Affects 3–8% of women
4. Listed in the DSM-IV
26
What is the timing of PMDD?
1. Sx’s begin in late luteal phase & end shortly after menses begins
2. Avg last six days, w/ the most intense 2 days before to start of menses
27
What are the sxs of PMDD?
1. Feelings of sadness or despair, thoughts of suicide
2. Feelings of tension or anxiety
3. Panic attacks
4. Mood swings or frequent crying
5. Lasting irritability or anger that affects other people
6. Lack of interest in daily activities & relationships
7. Trouble thinking or focusing
8. Tiredness or low energy
9. Food cravings or binge eating
10. Trouble sleeping
11. Feeling out of control
12. Physical symptoms:
A. Bloating, breast tenderness, headaches, joint or muscle pain
28
What are the ddx for PMDD?
1. More common Dx w/PMDD than w/out:
A. Bipolar depression
B. Anxiety disorders
29
What is the treatment for PMDD?
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1. SSRIs – 1st line Tx
A. Take in luteal phase or for duration of sx’s
B. Fluoxetine (Prozac/Sarafem)
C. Sertraline (Zoloft)
D. Paroxetine (Paxil)
E. Escitalopram oxalate (Lexapro)
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2. OCP containing drospirenone & low estrogen
A. Yasmin, Yaz, Ocella
3. Vit B6 qd
