Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

IPT 1 Lectures > Primary dysmenorrhea and premenstrual syndrome (3.6) > Flashcards

Primary dysmenorrhea and premenstrual syndrome (3.6) Flashcards

1
Q

Define the following terms:

A) Menerache

B) Dysmenorrhoea

C) Amenorrhoea

D) Primary amenorrhoea

E) Secondary amenorrhoea

F) Dyspareunia

A

A) Menarche: occurrence of first menstrual period

B) Dysmenorrhoea: painful menstruation

C) Amenorrhoea: absence of menstruation

D) Primary amenorrhoea: failure of menses to occur by age 16 years, in the presence of normal growth and secondary sexual characteristics

E) Cessation of menses for at least 3 months

F) Painful intercourse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Outline the stages in the menstrual cycle?

A

See attached image

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Outline the menstrual cycle starting from the hypothalamus (e.g. what hormones are involved)

A
  1. Hypothalamus releases GnRH
  2. GnRH stimulates anterior pituitary gland to release gonadotrophic hormones (FSH and LH)
  3. FSH and LH act on the ovaries: to stimulate follicle development in the ovary

GnRH: gonadotrophin-releasing hormone

FSH: follicle-stimulating hormone

LH: luetinising hormone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What happens in the ovary under FSH influence

A

20 follicles continue to grow

  • Each follicle has an ovum
  • one follicle develops faster than the others to become dominant follicle which secretes oestrogens
  • Oestrogens secreted by the dominant follicle will decrease FSH secretion via negative feeback to stop growth of other follicles
  • The rest of the follicles will degenerate
  • Dominant follicle becomes the mature graafian follicle (GF)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What does FSH do?

A

Follicle stimulating hormone –> main hormone stimulating oestrogen release

  • oestrogen controls the proliferative phase of endometrium, which causes endometrium to regnerate (thickens + increase vascularity)

> occurs from day 5 or 6 until mid-cycle

  • High estrogen level in mid cycle leads to surge of LH secretion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What does LH do?

A

LH: main hormone controlling subsequent progesterone secretion from the corpus luteum

  • stimulates ovulation in mid cycle
  • Graafian follicle swells and ruptures –> release of ovum

fertilisation possible

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Provide a summary of the 28 day menstrual cycle

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is dysmenorrhoea? What are the types?

A

Recurrent, cramping pain associated with menstruation

  • Primary dysmenorrhoea (no pathology)
  • Secondary dysmenorrhoea

Most common gynaecological symptoms reported by women:

  • 70% of adolescent or young woman, 40 % of adult women
  • decreases with age
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What causes secondary dysmenorrhoea? What is the pathophysiology of secondary dysmenorrhoea?

A

Causes:

  • Endometriosis
  • Endometrial polyps
  • Fibroids
  • Uterine myomas
  • Cervical stenosis
  • PID
  • IUD use
  • Obstructive malformations of the genital tract

Pathophysiology: see attached image

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are some risk factors for dysmenorrhoea?

A
  • Early menarche
  • Heavy and increased duration of menstrual flow
  • Family history
  • Smoking
  • Obesity
  • Social environment: fewer social support, stressful close relationships
  • Lower socioeconomic status
  • Depression
  • Nulliparity
  • Usually improves symptoms after childbirth and/or 3rd decade of reproductive life
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are some symptoms that a patient would experience?

A

Cramping, suprapubic pain

  • Across the lower abdomen (stomach)
  • May extend to lower back, thighs

> Starts several hours or about 1 day before start of menstruation, may persist upto 2-3 days

> peak pain is with maximum blood flow

> pain slowly settles after bleeding starts

other symptoms: diarrhoea, nausea and vomiting, lightheadedness, diziness and fever

other causes of pelvic pain (i.e IBS, IBDM chronic PID etc) may worsen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How to diagnose (patient assessment)?

A
  1. Menstrual history
  • age of patient
  • age at menerache
  • start of dysmenorrhoea
  • length and regularity of cycles
  • dates of law few periods
  • duration of periods
  • amount of bleeding
  1. Pain nature:
  • type, location, radiation
  • timing in relation to menstruation
  • severity, duration, progression
  • associated symptoms (i.e. diarrhoea etc)
  • degree of disability (effect on QOL) –> work/school days missed
  1. Rule out secondary dysmenorrhoea –> see next slide
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How to differentiate primary from secondary dysmenorrhoea?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What’s the 1st line, 2nd line and other agents used for the treatment of dysmenorrhea

A

See attached image (NSAIDs purposely left out cos its on the table)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are some therapeutic approaches (non-pharmacological) to dysmenorrhoea?

A
  • High frequency transcutaneous electrical nerve stimulation (TENS) –> good evidence
  • Exercise
  • Acupuncture
  • Topical heat therapy –> as effective as ibrupofen 400mg TID
  • Biofeedback, relaxation, hypnotherapy (behavioral interventions)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is premenstrual syndrome (PMS)

PMS is caused by fluctuations in hormone levels five to ten days before the start of menstruation

A
  • Wide range of symptoms –> both physical and psychological

Cyclic recurrence of symptoms during the luteal phase of menstrual cycle

>often symptoms dissipate with onset of menses

>mixture of mood, physical and cognitive symptoms

  • Symptoms usually begin 25-35 years of age
  • 85% report one or more symptoms of PMS
  • Genetics: family history
  • Precise pathology unclear, some suggest complex interaction between ovarian steroids and serotonin and GABA neurotransmitters
  • Severe PMS = Pre-menstrual dysphoric disorder (PMDD)
17
Q

What are some common symptoms of PMS

A

See attached image

18
Q

How to diagnose PMS? what do symptoms have to be?

A

Symptoms must be:

  • limited to luteal phase (often worse few days before menses)
  • impacting daily life
  • symptoms present for at least 2 previous cycles
  • Not explained by some other diagnosis

> Ask about previous cycles (Diary over 3 cycles)

Symptoms - patient assessment

Onset of symptoms

  • Experienced 7-14 days before menses
  • Disappear a few hours after onset of menses

Patient age

  • Most common in 30s and 40s

Presenting complaints

  • Symptoms suggestive of mental health disorders e.g. low mood, irritability, insomnia
  • Cyclical in nature, in conjunction with other symtpoms e.g. breast tenderness, bloating, fluid, retention
19
Q

What are the affective and somatic symptoms that are in the 5 days before menses in each of the three prior menstrual cycles?

A

Affective

  • Depression
  • Angry outbursts
  • Irritability
  • Anxiety
  • Confusion
  • Social withdrawal

Somatic

  • Breast tenderness
  • Abdominal bloating
  • Headache
  • Swelling of extremities

Symptoms are relieved within 4 days of the onset of menses, without recurrence until at least cycle day 13

20
Q

What are some non-pharmacological options for PMS?

A

Patient education

  • Biologic basis of PMS –> may help give patient sense of control and relief of symptoms
  • Education to establish patient expectations

Daily charting of symptoms –> symptom diary

  • Greater awareness of symptoms by patient

Exercise

  • Regular, aerobic
  • Reduces severity of smyptoms

Adequate rest and relaxation (relaxation courses)

Stress reduction

Dietary

  • (sodium restriction –> if fluid retention, bloating, breast swelling)
  • (caffeine restriction–> if irritability or insomnia)
21
Q

What are some pharmacological options for PMS?

A

NSAIDS

  • Most studied for PMS - naproxen, mefenamic acid, however any NSAID could be used
  • May help with the physical symptoms of PMS
  • Can start a few days before expected menses
22
Q

What are some complementary medicines for PMS?

A
23
Q

What is the therapeutic approach for PMS? When to follow up?

A
  • Individual therapy to target most troublesome symptoms
  • Non-pharmacological and symptom diaries should be considered
  • Try one agent for 2-4 cycles before switching to the next therapy

What/when to follow up?

  • Symptoms - mood, physical symptoms
  • How are they in comparison to the start of therapy
  • Symptom diary
  • Side effects: individualized to the drug therapy
  • Additional therapies since the last visit –> consider non-pharmacological, herbals etc
24
Q

Alarming symptoms –> when to refer?

A
  • If only physiological symptoms are present –> could be mental health condition
  • Severe or disabling symptoms –> could indicate more severe form such as PMDD
  • Symptoms that worsen or stay the same after onset of menses –> could be secondary causes as PMS symptoms should abate once menstruation starts
25
Q

Self care for menstrual problems

A
  • Healthy diet, limit high fat, sugar or salt diet
  • Limit caffeine intake
  • Limit alcohol –> no more than one standard drink per day
  • Exercise: moderate level for at least 150 minutes each week
  • Do pelvic floor exercises daily
  • Plenty of rest and sleep
  • Avoid smoking
  • Lean and use relaxation techniques to help alleviate stress and pain
  • For period pain –> apply heat on your stomach or lower back, massage lower back and buttocks
  • For PMS/mood symptoms –> talk to family, friends or doctor and explain how you are feeling so they can help, engage in something you enjoy

IPT 1 Lectures (24 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions