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443-SRH and MSK > Menstrual Related Disorders > Flashcards

Menstrual Related Disorders Flashcards

1
Q

what is dysmenorrhea

A

recurrent, cramping pain associated with menses

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2
Q

what is secondary dysmenorrhea?

A

painful periods with an identifiable cause like endometriosis, adenomyosis, polyps

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3
Q

what is the pathophysiology of dysmenorrhea?

A

↓in progesterone lvls = ↑PGF2a and 2 = sensitization of afferent nerves = pain
Vasopressin + ↑PGF2a and 2 = myometrial contraction + constriction of arterioles = uterine ischemia

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4
Q

risk factors for dysmenorrhea

A

early menarche
heavy and increased duration of menstrual flow
smoking
fewer social supports, stressful close relationships, lower SES
depression
nulliparity
family hx

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5
Q

what are some sx of dysmenorrhea

A

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

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6
Q

what to assess when diagnosing dysmenorrhea

A

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

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7
Q

when trialing therapies for dysmenorrhea, how long should each trial be?

A

3-6mths

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8
Q

what are some nonpharm measures for dysmenorrhea

A

Exercise
TENS
Acupuncture
Topical heat therapy
Behavioral interventions- biofeedback, relaxation, hypnotherapy, mindfulness

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9
Q

what are some PHARM measures for dysmenorrhea

A

NSAIDs
CHC
POP or DMPA
LNG-IUD

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10
Q

what are some CAMs for dysmenorrhea

A

vit B1
ginger during first 3-4 days of menses
magnesium
fish oils, fenugreek, valerian, zinc sulfate

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11
Q

define abnormal uterine bleeding

A

any change in menstrual period frequency, duration, or amount of flow- also includes BTB

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12
Q

what is anovulatory AUB

A

irregular and unpredictable bleedign

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13
Q

anovulatory AUB is due to

A

inadequate progesterone secretion from lack of ovulation
endometrium experiences continued E stimulation that is unopposed by progesterone
endometrium lining breaks down by irregularly + heavier

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14
Q

what is ovulatory AUB

A

heavy, but regular menstrual cycles/ periods
may include menorrhagia

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15
Q

what is menorrhagia

A

menstrual bleeding that lasts >7days

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16
Q

what causes menrorhagia

A

imbalance between thromboxane and prostacyclin

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17
Q

what is a normal amount of blood loss during a period

A

<1 maxipad or tampon every 3 hours

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18
Q

what are possible etiologies of AUB

A

pregnancy or ectopic preg
structural issues
other medical conditions
herbal NHPs
medications

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19
Q

what are some medical conditions that can cause AUB

A

hyper/hypothyroidism
inherited coagulopathy
renal and liver disease
PCOS
cushing’s

20
Q

what are some herbals that can cause AUB

A

ginseng, gingko, phytoestrogens

21
Q

what are some medications that can cause AUB

A

hormonal contraceptives./ therapies
IUDs
anticoagulants
tamoxifen
danazol
spironolactone

22
Q

a dx of AUB is usually done through a process of

A

exclusion

23
Q

what are the 4 things that can be used for an AUB dx

A

pt hx
labs
pelvic ultrasound
endometrial biopsy

24
Q

what kind of labs do we look for for diagnosing AUB?

A

progesterone on days 21-23- if they’re low = anovulatory, high = ovulatory
but harder to use if pt is irregular
TSH for thyroid issues

25
Q

in diagnosing AUB, what is the pelvic ultrasound looking for?

A

polyps or submucous fibroids that commonly cause AUB

26
Q

what is an endometrial biopsy for in AUB?

A

to assess endometrium for premalignant conditions or malignancy

27
Q

pharm treatments for AUB

A

NSAIDs
CHC
POP
DMPA
ulipristal
tranexamic acid

28
Q

how do NSAIDs decrease AUB

A

decreases endometrial PG and blood loss by 20-40% if taken with menses

29
Q

how to use NSAIDs for AUB

A

start on first day and continue reg dosing for 2-3d or until end of period

30
Q

ulipristal is a ___________ which has ____________ effects on fibroids

A

selective progesterone receptor modulator
progesterone antagonist effects

31
Q

uipristal in AUB is indicated for

A

uterine fibroids

32
Q

T or F: ulipristal has antagonist activity on some tissues and agonist activity on others

A

T

33
Q

why was ulipristal removed from market?

A

risk of liver disease

34
Q

when is tranexamic used in AUB

A

for women who do not want hormonse or heavy bleeding

35
Q

tranexamic acid MOA

A

reversible blockade on plasminogen = no conversion to plasmin

36
Q

SEs of tranexamic acid

A

N/D, skin rash, colour vision change, theoretical VTE risk

37
Q

what are some surgical options for AUB

A

dilation and curettage
endometrial ablation
hysterectomy

38
Q

what is the first and second line tx of ovulatory AUB

A

1st: NSAIDs/ CHC
2nd: progesterone oral or DMPA or LNG-IUS

39
Q

what is the first and second line tx of anovulatory AUB

A

1st: CHC
2: POP, DMPA, LNG-IUS

40
Q

how long should treatment for AUB be trialed?

A

3 months

41
Q

how to treat severe acute uterine bleed that is nonemergent

A

CHC given BID-QID until bleeding stops

42
Q

why do we use high dose CHC for nonemergency severe uterine bleeds

A

high dose estrogen causes vasoconstriction = decreased blood loss

43
Q

how to treat severe bleed in a hemodynamically unstable pt

A

premarin 25mg IV q4h F24h
D/C if no response in 2-4 doses of premarin

44
Q

what are the 3 first line recs for primary dysmenorrhea

A

recommended regular exercise
heating pads
NSAIDs

45
Q

wht to use for primary dysmenorrhea if hormones are contraindicated and 3 first line agents don’t work

A

CAM- B1 or ginger

443-SRH and MSK (24 decks)

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