Menstrual Related Disorders Flashcards
what is dysmenorrhea
recurrent, cramping pain associated with menses
what is secondary dysmenorrhea?
painful periods with an identifiable cause like endometriosis, adenomyosis, polyps
what is the pathophysiology of dysmenorrhea?
↓in progesterone lvls = ↑PGF2a and 2 = sensitization of afferent nerves = pain
Vasopressin + ↑PGF2a and 2 = myometrial contraction + constriction of arterioles = uterine ischemia
risk factors for dysmenorrhea
early menarche
heavy and increased duration of menstrual flow
smoking
fewer social supports, stressful close relationships, lower SES
depression
nulliparity
family hx
what are some sx of dysmenorrhea
cramping, suprapubic pain that starts hrs before menstruation- may persist for 2-3d, peak pain with max flow
diarrhea, N/V, lightheadedness, fever
worsened pelvic pain from comorbidities like IBS, IBD, PID
what to assess when diagnosing dysmenorrhea
Menstrual history, age at menarche, length and regularity of cycles, duration of periods, amount of bleeding
Pain: type, location, radiation, timing, severity, duration, progression
Degree of disability
Rule out secondary dysmenorrhea
when trialing therapies for dysmenorrhea, how long should each trial be?
3-6mths
what are some nonpharm measures for dysmenorrhea
Exercise
TENS
Acupuncture
Topical heat therapy
Behavioral interventions- biofeedback, relaxation, hypnotherapy, mindfulness
what are some PHARM measures for dysmenorrhea
NSAIDs
CHC
POP or DMPA
LNG-IUD
what are some CAMs for dysmenorrhea
vit B1
ginger during first 3-4 days of menses
magnesium
fish oils, fenugreek, valerian, zinc sulfate
define abnormal uterine bleeding
any change in menstrual period frequency, duration, or amount of flow- also includes BTB
what is anovulatory AUB
irregular and unpredictable bleedign
anovulatory AUB is due to
inadequate progesterone secretion from lack of ovulation
endometrium experiences continued E stimulation that is unopposed by progesterone
endometrium lining breaks down by irregularly + heavier
what is ovulatory AUB
heavy, but regular menstrual cycles/ periods
may include menorrhagia
what is menorrhagia
menstrual bleeding that lasts >7days
what causes menrorhagia
imbalance between thromboxane and prostacyclin
what is a normal amount of blood loss during a period
<1 maxipad or tampon every 3 hours
what are possible etiologies of AUB
pregnancy or ectopic preg
structural issues
other medical conditions
herbal NHPs
medications
what are some medical conditions that can cause AUB
hyper/hypothyroidism
inherited coagulopathy
renal and liver disease
PCOS
cushing’s
what are some herbals that can cause AUB
ginseng, gingko, phytoestrogens
what are some medications that can cause AUB
hormonal contraceptives./ therapies
IUDs
anticoagulants
tamoxifen
danazol
spironolactone
a dx of AUB is usually done through a process of
exclusion
what are the 4 things that can be used for an AUB dx
pt hx
labs
pelvic ultrasound
endometrial biopsy
what kind of labs do we look for for diagnosing AUB?
progesterone on days 21-23- if they’re low = anovulatory, high = ovulatory
but harder to use if pt is irregular
TSH for thyroid issues
in diagnosing AUB, what is the pelvic ultrasound looking for?
polyps or submucous fibroids that commonly cause AUB
what is an endometrial biopsy for in AUB?
to assess endometrium for premalignant conditions or malignancy
pharm treatments for AUB
NSAIDs
CHC
POP
DMPA
ulipristal
tranexamic acid
how do NSAIDs decrease AUB
decreases endometrial PG and blood loss by 20-40% if taken with menses
how to use NSAIDs for AUB
start on first day and continue reg dosing for 2-3d or until end of period
ulipristal is a ___________ which has ____________ effects on fibroids
selective progesterone receptor modulator
progesterone antagonist effects
uipristal in AUB is indicated for
uterine fibroids
T or F: ulipristal has antagonist activity on some tissues and agonist activity on others
T
why was ulipristal removed from market?
risk of liver disease
when is tranexamic used in AUB
for women who do not want hormonse or heavy bleeding
tranexamic acid MOA
reversible blockade on plasminogen = no conversion to plasmin
SEs of tranexamic acid
N/D, skin rash, colour vision change, theoretical VTE risk
what are some surgical options for AUB
dilation and curettage
endometrial ablation
hysterectomy
what is the first and second line tx of ovulatory AUB
1st: NSAIDs/ CHC
2nd: progesterone oral or DMPA or LNG-IUS
what is the first and second line tx of anovulatory AUB
1st: CHC
2: POP, DMPA, LNG-IUS
how long should treatment for AUB be trialed?
3 months
how to treat severe acute uterine bleed that is nonemergent
CHC given BID-QID until bleeding stops
why do we use high dose CHC for nonemergency severe uterine bleeds
high dose estrogen causes vasoconstriction = decreased blood loss
how to treat severe bleed in a hemodynamically unstable pt
premarin 25mg IV q4h F24h
D/C if no response in 2-4 doses of premarin
what are the 3 first line recs for primary dysmenorrhea
recommended regular exercise
heating pads
NSAIDs
wht to use for primary dysmenorrhea if hormones are contraindicated and 3 first line agents don’t work
CAM- B1 or ginger
