Pharm Wk 4 - Dysmenorrhea, Endometriosis, and Heavy Menstrual Bleeding Flashcards
What is dysmenorrhea?
abdominal and pelvic pain associated with menses
what percentage of menstruating Canadians are affected by dysmenorrhea?
more than 50% experience some degree of pain; 15% are incapacitated for 1-3 days per month
How does the prevalence of dysmenorrhea change with age?
it decreases with age
what is the difference between primary and secondary dysmenorrhea?
primary: no organic pathology
secondary: due to underlying causes (e.g endometriosis, adenomyosis, obstructed uterine outflow)
what role do prostaglandins play in dysmenorrhea?
They induce myometrial contractions, causing pain.
What are nonpharmacologic treatments for dysmenorrhea?
Exercise, heat therapy, smoking cessation.
What is the first-line pharmacologic treatment for dysmenorrhea?
NSAIDs (e.g., ibuprofen, naproxen).
Why are NSAIDs effective in treating dysmenorrhea?
They inhibit prostaglandin synthesis.
What are common side effects of NSAIDs?
Dyspepsia, nausea/vomiting, rash, dizziness, headache.
Why are combined hormonal contraceptives (CHCs) used for dysmenorrhea?
They inhibit ovulation, reduce endometrial growth, and decrease prostaglandin production.
what is endometriosis?
a condition where endometrial-like tissue grows outside the uterus
what are common symptoms of endometriosis?
Chronic pelvic pain, dysmenorrhea, infertility.
What percentage of reproductive-age women are affected by endometriosis?
10-15%
What are the treatment goals for endometriosis?
Relieve pain, treat infertility, prevent recurrence.
What is the first-line treatment for mild endometriosis-associated pain?
NSAIDs
How do CHCs help manage endometriosis?
Reduce menstrual blood flow, suppress ovulation, and relieve symptoms.
What are the advantages of progestin-only contraceptives for endometriosis?
Inhibit ovulation, suppress gonadotropin secretion, and reduce endometrial activity.
What is the role of androgen agonists (Danazol) in endometriosis?
Inhibits ovarian estrogen production and causes atrophy of endometrial deposits.
Why is the use of Danazol limited?
Androgenic side effects (e.g., voice deepening, hirsutism, weight gain).
What are the adverse effects of GnRH agonists (e.g., leuprolide, goserelin)?
Bone density loss, hot flashes, vaginal dryness, mood changes.
How does “Add-Back” therapy help patients on GnRH agonists?
Mitigates bone density loss and perimenopausal symptoms.
What is the role of Letrozole in endometriosis-associated infertility?
Stimulates ovarian follicle recruitment by reducing estrogen levels.
what is abnormal uterine bleeding (AUB)
any change in menstrual frequency duration, or volume
What is heavy menstrual bleeding (HMB)?
Excessive menstrual bleeding that interferes with quality of life and may cause anemia.
What are the treatment goals for AUB?
Improve quality of life, identify and treat underlying causes, manage anemia.
What are common pharmacologic treatments for AUB?
CHCs, progestin-only contraceptives, NSAIDs, antifibrinolytics.
How does tranexamic acid help in AUB?
Inhibits fibrinolytic activity in the endometrium, reducing blood loss.
