Menstrual Disorders Flashcards
What is dysmenorrhea, when do they start to occur
Painful menstrual crams, a few years after the first period
What is primary dysmenorrhea, secondary dysmenorrhea
pain induced by uterine contractions during ovaulatory cycles, pain induced by an underlying etiology
What is the onset of primary dymenorrhea, symptoms, duration
during or just before menstrual bleeding, lower abdominal pain/backache, 2-3 days
What is the onset secondary dysmenorrhea, symptoms, duration
typically two years after menses onset, pain throughout menses and non-menstual days, specific to individual with no relationship to menstrual flow
What are non-pharmacological therapy for primary dymenorrhea
heat, Regular aerobic exercise/ smoking cessation, powedered ginger/acupuncture
What is the first line pharmacological therapy for primary dysmenorrhea, other options
NSAIDS for 2-3 days (start right before menses), Contraceptions (CHCs, Depo, IUD)
T/F: If a patient wants to stop their dysmenorhea try no pharmacological options first before moving to pharmacological options
True
What is endometriosis, how is it diagnosed
Presence of endometrial tissue outside of the uterine cavity, biopsy of direct surgical visulaization
T/F: Endometriosis is like primary dysmenorrhea in that it causes pain throughout a women’s cycle
False: Endometriosis can cause acyclic menstrual pain cramps with progression of disease pain possibly being more frequent
What are the first line pharmcotherapy options for endometriosis 2nd, 3rd
NSAIDS, CHCs, Progestin only Contraceptives/ Gn-RH agonist and Gn-RH antagonist/ Aromatase inhibitors and Danazol
What pharmacotherapy option is only for endometriosis, what is the dosing
GnRH-antagonist (Orlissa), 150 mg every day for 24 months OR 200 mg every day for 12 months
T/F: Patients taking Orlissa should also take CHCs if pregnancy would like to be avoided
True
What are the two surgical options for endometriosis
Conservative surgery: removal of tissue implants (high rate of recurrence), Definitive surgery: Total removal of uterus and ovaries
T/F: For premenstrual disorders patients have symptoms during the luteal phase and must have symptoms free period during follicular phase
True
What is the two types of premenstrual disorders
Premenstrual syndrome (PMS) or Premenstrual Dysphoric Disorder (PMDD)
What is the diagnostic criteria for PMS
At least 1 affective symptom and 1 somatic symptom that occurs greater than 5 days before menses in each of 3 prior cycle, symptoms relieved by day 4 of menses
What type of affective symptom must a patient have to be described as having PMDD
Lability, irritability, markedly depressed mood, or anxiety
What are first line therapy for PMS, PMDD
Lifestyle modifications and/or supplements, sertonergic agents and CHCs
What nutritional supplements have been shown to possibly decrease symptoms of PMS
Calcium 1000 mg/day, Vitamin B6 50-100 mg/day, Magnesium 200- 360 mg/day
What are the 1st line serotonergic antidepressants that can be used for PMDD, what other class can be used
Fluoxetine, Sertraline, Paroxetine/ velafaxine and duloxetine or nefazodone, TCAs
How can the dosing be done with serotonergic antidepressants
Low dose luteal phase dosing or symptoms onset OR daily dosing throughout cycle
What is the only CHC that is approved for PMDD, what is the main caution with this CHC
Yaz and Beyaz (ethinyl estradiol plus drospirenone), increased risk of Thrombosis
If a patient has anxiety during periods what are the two anxiolytics that have been studied
Alprazolam and Buspirone
If a patient has fluid retention what could be given
Spironolactone
What are first line therapy agents for Mastalgia (breast pain), alternatives
Vitamin E therapy, NSAIDS/ Danazol
T/F: For patients with PMDD if given a low dose Gn-RH agonist they should also be given a low dose estrogen and progestin CHC to lessen side effects
True
