Menstruation Disorders Lecture

Question 1

Define menstruation

Answer 1

Monthly cycling of female reproductive hormones
- Time between onset of one to onset of the next period
Usually 28 days
Usually last 4 days
Blood loss of 30-80 mL

Question 2

Complex interplay between the hormones of the?

Answer 2

Hypothalamus
Pituitary gland
Ovaries

Question 3

Major events per menstrual cycle?

Answer 3

Proliferative (follicular) phase: maturation and release of an ovum from the ovaries
Secretory (luteal) phase: prep of endometrial lining for implantation of egg

Question 4

Define dysmenorrhea

Answer 4

Difficult or painful menstruation
90% experience
Primary: only if ovulatory cycle
Secondary

Question 5

Primary dysmenorrhea?

Answer 5

13-17
Normal flow
Last 1-3 days
No other pain
Responds to NSAIDS and OCs
Cramping, fatigue, aches, nausea, irritability change in appetite

Question 6

Secondary dysmenorrhea?

Answer 6

Mid to late 20s
Irregular with heavy and prolonged flow
Pattern/intensity vary
Pain other times
Doesn't respond to NSAIDS or OCs
Dyspareunia, pelvic tenderness

Question 7

Primary is self treatable if?

Answer 7

Directly related to period
Not sexually active
Previously diagnosed

Question 8

Secondary cannot be self treated because?

Answer 8

Can have: endometriosis

PID, ovarian cysts, unterine tumors

Question 9

Exclusions for self care of dysmenorrhea

Answer 9

Severe
Inconsistent with primary
History of PID, infertility, cysts, IUD, etc
Allergy to Aspiring or NSAIDS
History of bleeding disorder

Question 10

Nonpharmacologic treatment of primary dysmenorrhea?

Answer 10

Hot baths
Heating pads
Regular exercise
Adequate sleep
Complementary: B1, magnesium, vitamin E

Question 11

Pharmacologic treatment of primary dysmenorrhea?

Answer 11

Acetaminophen
Aspiring
Ibuprofen
Naproxen sodium

Question 12

Acetaminophen as a treatment?

Answer 12

Mild symptoms

Weak inhibitor of PG synthesis

Question 13

Aspirin as a treatment?

Answer 13

Mild symptoms
Minimal effect on PG synthesis
May increase flow
Less than 19 precaution

Question 14

Nonsalicylate NSAIDs as a treatment?

Answer 14

60-90% effective

Avoid if trying to get pregnant

Question 15

Counseling for NSAIDS

Answer 15

Being at onset
Use a schedule
Switch between drugs
Talk to PCP

Question 16

Define PMS

Answer 16

Cyclic disorder: occurs during luteal phase (1 week prior to menses) and is triggered by hormonal fluctuations
Combo of physical, emotional/mood, and behavioral symptoms
Disappear by end of period

Question 17

Physical symptoms?

Answer 17

Breast tenderness
Bloat
Lower backache
Food cravings

Question 18

Changes in mood?

Answer 18

Irritability
Emotional lability
Lowered mood
Depression, anxiety, anger

Question 19

Define Premenstrual dysphoric disorder

Answer 19

Five or more physical/mood symptoms
One sx significant: depression, anxiety, anger
Interferes with work, school, relationships
No underlying disorder

Question 20

Exclusion to self-care for PMS

Answer 20

Severe PMS or PMDD
Uncertain patterns of symptoms
Onset of symptoms starts with hormone therapy
Contraindication for OTCs

Question 21

Nonpharmacologic treatment of PMS

Answer 21

Aerobic exercises (increase endorphins)
Dietary changes (balanced diet, decrease salt, sugar, alcohol, increase carbs)
Cognitive-behavioral therapy (reduce stress)

Question 22

Pharmacologic treatment of PMS?

Answer 22

Pyridozine (B6) –> improve mood
Calcium and Vitamin D –> reduce emotional symptoms, food craving, physical symptoms
NSAIDS –> reduce pain
Diuretics –> reduce bloating

Question 23

Define diuretics

Answer 23

Relieve water retention, bloating, swelling, weight gain

- Caffeine, pamabrom

Question 24

Caffeine does what?

Answer 24

Inhibits reabsorption of sodium and water
Tolerance may develop
ADR: irritability, anxiety, insomnia

Question 25

Pamabrom?

Answer 25

Most common

Question 26

Define toxic shock syndrome

Answer 26

Caused by toxin=producing straings of S. aureus or pyogenes
13-19
Linked to tampon use, IUDs, cervical caps or diaphragms

Question 27

Symptoms of toxic shock syndrome?

Answer 27

Malaise, chills, GI symptoms

High fever, vomiting and diarrhea, rash, decrease urine output, hypotension, shock

Question 28

Counseling for TSS?

Answer 28

Risk is ZERO if not using tampons
Use lowest absorbency tampons
Wast hands
Do not leave in longer than recommended