- pain relief in 72% - NSAIDs are equally effective - Ibuprofen - Naproxen sodium - Diclofenac potassium (Cataflam®) - Mefenamic acid (Ponstel ®) - Ketoprofen - use up to 3 days; scheduled, NOT prn

- 20-50% reduction in blood loss in 75% of women

Women's Health Issues Exam 3 Flashcards by Gold Xiong

What population is affected for dysmenorrhea?

women 17-24 y/o

How well did you know this?

Not at all

Perfectly

Pathogenesis of dysmenorrhea

shedding of the uterine lining releases arachidonic acid and stimulates prostaglandin synthesis that causes uterine and GI smooth muscle contraction and ischemia

How well did you know this?

Not at all

Perfectly

Non-Pharmacologic Treatment for Dysmenorrhea

Regular exercise
Smoking cessation
Low-fat, vegetarian diet
Local application of heat

How well did you know this?

Not at all

Perfectly

Pharmacologic Treatment for Dysmenorrhea

NSAIDS
COX-2 inhibitors
Combinational hormonal contraceptives (CHC)
Other contraceptives
try each therapy for 3 months; can switch or combine methods

How well did you know this?

Not at all

Perfectly

Dysmenorrhea: NSAIDs

pain relief in 72%
NSAIDs are equally effective
Ibuprofen
Naproxen sodium
Diclofenac potassium (Cataflam®)
Mefenamic acid (Ponstel ®)
Ketoprofen
use up to 3 days; scheduled, NOT prn

How well did you know this?

Not at all

Perfectly

Dysmenorrhea: NSAID contraindications

Hypersensitivity to aspirin or NSAIDs
Renal disease
History of GI bleeding or ulceration

How well did you know this?

Not at all

Perfectly

Dysmenorrhea: NSAID place in therapy

first line

How well did you know this?

Not at all

Perfectly

Dysmenorrhea: COX-2 Selective Inhibitors

Celecoxib (Celebrex®)

- similar efficacy to NSAIDs

How well did you know this?

Not at all

Perfectly

Dysmenorrhea: COX-2 Selective Inhibitors place in therapy

limited to patients who have significant risk for GI ulceration or who have failed traditional NSAIDs

How well did you know this?

Not at all

Perfectly

Dysmenorrhea: Combinational hormonal contraceptives (CHC) MOA

Suppresses ovulation, decreases menstrual fluid volume, and thereby decreases prostaglandin production and uterine cramping

How well did you know this?

Not at all

Perfectly

Dysmenorrhea: Combinational hormonal contraceptives (CHC) place in therapy

Generally second line.
May be first-line if contraception is also desired.
relieve dysmenorrhea in 50-80% of women

How well did you know this?

Not at all

Perfectly

Dysmenorrhea: Other Contraceptives

can be considered if other therapies ineffective
Extended or continuous cycle CHC
Levonorgestrel IUD
Depo-medroxyprogesterone

How well did you know this?

Not at all

Perfectly

Pharmacologic Treatment for Menorrhagia

NSAIDS
Hormonal contraception
Medroxyprogesterone
Tranexamic acid

How well did you know this?

Not at all

Perfectly

Menorrhagia: NSAIDs

20-50% reduction in blood loss in 75% of women

How well did you know this?

Not at all

Perfectly

Menorrhagia: NSAIDs place in therapy

first line

How well did you know this?

Not at all

Perfectly

Menorrhagia: Hormonal contraception

40-50% reduction in blood loss with cyclic combined oral contraceptives
79-97% reduction in blood loss with levonorgestrel IUD

How well did you know this?

Not at all

Perfectly

Menorrhagia: Hormonal contraception place in therapy

First line option in those desiring contraception

How well did you know this?

Not at all

Perfectly

Menorrhagia: Medroxyprogesterone (MPA, Provera®) MOA

Suppresses FSH and LH and ultimately estrogen and progesterone

How well did you know this?

Not at all

Perfectly

Menorrhagia: Medroxyprogesterone (MPA, Provera®)

32-50% reduction in menstrual blood loss

Menorrhagia: Tranexamic acid MOA

Antifibrinolytic

Menorrhagia: Tranexamic acid

26-60% reduction in menstrual blood loss

Pathogenesis of PMS

results from the interaction of cyclic changes in ovarian steroids and central neurotransmitters

Population affected by PMS

occurs in late 20s through early 40s

Diagnostic Criteria for PMS

Physical

abdominal bloating
acne
backache
breast tenderness
fatigue
headache
weight gain

Psycholoigcal

irritability
depressed mood
forgetfulness and difficulty concentrating
increased appetite
labile mood
tension

Must have one of each for 3 cycles

Treatments for PMS and PMDD

- First line: Nonpharmacologic therapies for mild to moderate PMS - First line: Pharmacologic therapies for severe PMS (i.e. PMDD)

Nonpharmacologic Therapies for PMS

- Decrease salt, caffeine, and refined sugars - eat smaller - more frequent meals - aerobic exercise > 3x/week with an increase in exercise during the premenstrual week

Pharmacologic Therapies for PMS

- Antidepressants - Anxiolytics - Non-prescriptions therapies (calcium, NSAIDS, combination products) - Ovulation suppression

Pharmacologic Therapies for PMS: Antidepressants: SSRIs

- Fluoxetine (Sarafem®) - Paroxetine (Paxil CR®) - Sertraline (Zoloft®) - Improves both psychological and physical symptoms.

Pharmacologic Therapies for PMS: Antidepressants: SSRIs timing and duration

- Onset of efficacy: within first treatment cycle - Initially, use only during the luteal phase (14 days premenstrual) - If response is inadequate, increase to continuous daily regimen - If response remains inadequate, may try switching to another SSRI

Pharmacologic Therapies for PMS: Antidepressants: SSRIs place in therapy

considered first-line

Pharmacologic Therapies for PMS: Alternative Antidepressants

- clomipramine - duloxetine - nefazodone - venlafaxine

Pharmacologic Therapies for PMS: Alternative Antidepressants place in therapy

secondline in patients who fail, cannot tolerate, or have contraindications to SSRI therapy

Pharmacologic Therapies for PMS: Anxiolytics: Benzodiazepines

- Alprazolam | - also useful for acute anxiety and intermittent insomnia

Pharmacologic Therapies for PMS: Anxiolytics: Benzodiazepines timing and duration

TID days 1428 of cycle

Pharmacologic Therapies for PMS: Anxiolytics: Benzodiazepines place in therapy

agent of choice if intent is for short-term use

Pharmacologic Therapies for PMS: Anxiolytics: 5HT1A-Agonist

- Buspirone (BuSpar ®) - does not improve physical symptoms - also useful for anxiety and insomnia

Pharmacologic Therapies for PMS: Anxiolytics: 5HT1A-Agonist place in therapy

can be used in pts with anxiety esp if drug dependence is a concern

Pharmacologic Therapies for PMS: Anxiolytics: 5HT1A-Agonist timing and duration

take days 14-28 of cycle

Pharmacologic Therapies for PMS: Calcium

- Improves mood, bloating, food cravings, and pain. | - May take a few months to see improvement

Pharmacologic Therapies for PMS: Calcium place in therapy

all women with symptoms of PMS

Pharmacologic Therapies for PMS: NSAIDS

improves physical symptoms but not psychosocial

Pharmacologic Therapies for PMS: Ovulation Suppression: Hormonal Contraception (CHC)

- does not work for everyone | - CHC containing drospirenonemay be more beneficial because they reduce fluid retention (i.e. Yaz®, Yasmin®)

Pharmacologic Therapies for PMS: Ovulation Suppression: GnRH Agonists

- downregulates pituitary gonadotropin secretion and suppresses gonadal function - Leuprolide (Lupron Depot®) (IM) - works for both physical and psychological symptoms - can give adjunct estrogen and progestin to counter hypo-hormone

Pharmacologic Therapies for PMS: Ovulation Suppression: GnRH Agonists place in therapy

reserve for those with severe PMDD who do not respond to more conservative measures due to adverse effects

Pharmacologic Therapies for PMS: Surgery

- oophorectomy