Primary Dysmenorrhoea

Question 1

What causes painful cramps?

Answer 1

overproduction of uterine prostaglandins E2 and F2-alpha. Before menstruation starts progesterone levels decrease allowing prostaglandin production to increase and if over produced cramps occur.

Question 2

how does the contraceptive pill improve symptoms of dysmenorrhoea?

Answer 2

ovulation inhibition lessons the endometrial lining of the uterus reducing menstrual fluid volume and prostaglandin production

Question 3

What clinical features are seen in pts that have PD?

Answer 3

low ab pain, fatigue, back pain, N/V, diarrhoea

Question 4

when should your refer patients with period pain?

Answer 4

1. Heavy or unexplained bleeding
2. Pain experienced days before menses
3. Pain that increases at the onset of menses
4. Women over the age of 30 with new or worsening symptoms
5. Accompanying systemic symptoms, such as fever and malaise
6. Vaginal bleeding in postmenopausal women

Question 5

When to refer pts with primary of dysmenorrhoea taking naproxen?

Answer 5

1. Peptic ulceration and/or GI bleeding
2. hypersensitivity to naproxen and naproxen sodium
3. caution is required if pt is asthmatic or allergic disease
4. HF, kidney or liver disease
5. pregnant or BF
6. Naproxen decreases platelet aggregation and prolongs bleeding time therefore aavoid in pts on anticoagulants
7. pts taking steriods
8. naproxen inhibits cyclooxygenase/prostaglandin synthesis -impairs female fertility and is not recommended in women attempting to conceive

Question 6

What tx is given for pts with period pain?

Dosage for each?

Answer 6

1. ibuprofen - one tablet TDS
2. Naproxen - TWO tablets initially followed 6-8 hours by a second tablet 250mg if needed
   subsequent doses on second and third days if needed. No more than 3 tablets each day. No more than 3 days tx in any one month. Take with food.
3. Hyoscine hydrobromide - TWO tablets QDS

Question 7

What are the likely side effects of naproxen/ibuprofen?

Answer 7

1. GI discomfort; N/V, diarrhoea, flatulence, constipation, dyspepsia, abdominal pain, heartburn, epigastric distress
2. GI bleeding/ucleration
3. Elderly pts have increased frequency of S/E to NSAIDS

Question 8

What are the likely side effects of hyoscine hydrobromide?

Answer 8

Dry mouth, sedation, and constipation

Question 9

What drugs can interact with NSAIDS

Answer 9

lithium, anticoagulants, MTX

Question 10

What drugs can interact with hyoscine hydrobromide?

Answer 10

anticholinergics, TCAs

Question 11

What tx is used for PMS?

Answer 11

1. Calcium
2. Pyridoxine
3. VAC - vitex agnus-castus