Term
| What is the cycle of the menstrual phase that differs from patient to patient? |
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Definition
- Follicular phase
- Can be anywhere from 6-16 days
- Luteal phase is always 14 days |
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Term
| What is the definition of dysmenorrhea? |
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Definition
- Difficult or painful menstruation
- Increased prevalence with age
- Occurs in 60% of adolescent girls
- There is both primary and secondary |
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Term
| What is the difference between primary and secondary dysmenorrhea? |
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Definition
Primary: Onset shortly after menarche (menstruation?) begins. Lower pelvic/abdominal pain. No underlying pelvic disease. Could include HA, back pain, nausea
Secondary: Onset at anytime after Menarche. Changes in the timing or intensity of pain. Other gynecologic sx may be present. Pelvic abnormality |
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Term
What are the causes of secondary dysmenorrhea?
*Note: This means that the dysmenorrhea sx are secondary to another disorder |
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Definition
- Endometriosis
- Benign uterine tumors
- PID
- Ovarian cysts
- Adhesions
Leading cause of short term absenteeism |
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Term
| What are some lab value signs that dysmenorrhea is present? |
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Definition
- Elevated prostaglandin levels
- Role of leukotrienes
- Possibly vasopressin |
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Term
| What is the clinical presentation of dysmenorrhea? |
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Definition
- Mid-abdominal pain or cramping
- N/V
- Dizziness
- Diarrhea
- Headache |
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Term
| What are the risk factors of dysmenorrhea? |
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Definition
- Age < 20
- Diet
- Lack of exercise
- Stress
- Alcohol use
- Tobacco use (increases sx) |
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Term
| When do you refer dysmenorrhea patients to their doctor? |
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Definition
- Secondary dysmenorrhea has NOT been ruled out
- Amenorrhea
- Menorrhagia (heavy)
- Dysfunctional/irregular bleeding
- No improvements with initial treatments |
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Term
| What are the non-pharmacological treatments of dysmenorrhea? |
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Definition
- Lifestyle modifications ( diet, exercise, stress reduction)
- Heat therapy (use of heating pad)
- Tobacco cessation |
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Term
| What are the pharmacological treatments of dysmenorrhea? |
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Definition
- APAP - For mild cases 650mg-1000mg a4-6h
-ASA - " "
- NSAIDS - Drug of choice. Motrin 200mg q4-6h. Ketoprofen 12.5mg q4-8h. Naproxen 220mg q8-12h
- OC's - Only after trying NSAID's for 3 months. Inhibits ovulation so decreases flow. Give for 3 months
*Give NSAIDS for 3 months, benefit should be seen in 1 month. Pt's can take up to Rx doses |
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Term
| What is the definition of premenstrual syndrome (PMS)? |
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Definition
- Changes that primarily occur during the luteal phase of the menstrual cycle
- May affect 80% of women
- Could lead to PMDD |
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Term
| What is the cause of PMS? |
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Definition
- Normal shifts in the estrogen and progesterone levels
- Reduced levels of serotonin |
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Term
| What is the clinical presentation of PMS? |
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Definition
- Weight gain/bloating
- Headache
- Appetite changes
- Breast tenderness
- Fatigue
- Anxiety
- Irritability
- Difficulty concentrating
- Sleep pattern changes |
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Term
| How is PMDD different from PMS? |
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Definition
- Must have 5 of the following sx, including 1 mood sx
- Sadness
- Irritability
- Anxious
- Mood Swings
- Losing interest in daily activities
- Fatigue
- Feeling overwhelmed
- Sleeping too much or not enough
- inability to concentrate
- changes in appetite
- Cyclic physical changes |
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Term
| What is the clinical presentation that differentiates between PMS and PMDD? |
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Definition
Normal menstrual sx - Occurs a few days prior to onset of menses, does not affect daily activities
PMS sx - Begins during luteal phase and ends with menses onset. 1 or more of PMS sx. May affect daily activities
PMDD sx - Begins during luteal phase and ends with menses onset. Sx must have 5 of 11 sx present in DSM-IV criteria w/ 1 mood sx. Significant interruptions of daily activites |
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Term
| What are the risk factors of PMS? |
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Definition
| Same as dysmenorrhea, except age is between 20 and 30, and there is psychological factors |
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Term
| What tool is key in the diagnosis of someone who has PMS? |
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Definition
- Symptom diary
- Rate on 0-4. 0 is not present, 4 is severe |
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Term
| When do you refer patients to their doctor? |
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Definition
- Lack of symptom free interval
- Possible psychiatric disorder
- Severe sx or or interruption of daily functioning. Could possibly be PMDD |
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Term
| What are the non-pharmacological options in PMS? |
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Definition
- Dietary modifications (salt, caffeine, alcohol intake)
- Exercise
- Cognitive/behavioral therapy |
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Term
| What are alternative, or second line agents in the treatment of PMS? |
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Definition
Pyridoxine (B6) - 100mg qd. For Bloating and Breast Tenderness, caution with peripheral neuropathy
Vitamin E - 400iu daily, for breast tenderness
Calcium - 600mg bid with vitamin D. helps bloating and cramps
Magnesium - 100-360mg daily. May decrease irritability and bloating |
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Term
| What are the pharmacological treatments for PMS? |
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Definition
NSAIDS - same dose as dysmenorrhea
APAP
ASA
SSRI's - Onset is 1 month, more rapid than traditional indications. Use SSRI and do continuous or luteal dosing. L. dosing ends with the first full day of menses
Diuretics - Caffeine 100-200mg q 3-4 hours. Pamabrom 50mg up to QID. Helps with fluid retention and bloating. The Dosperidone in Yaz can be used as a diuretic |
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Term
| What are some alternative treatments for dysmenorrhea? |
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Definition
Magnesium - 360mg qd
Calcium - 600mg BID with vitamin D.
Vitamin B complex - B1 or thiamine 100mg daily. B12 or cyanobalmin 2mcg daily
Fish Oils - 2g daily. Decrease pain sx
Acupuncture - Inconsistent studies
Black Cohosh? - 20mg BID. Data is lacking, don't use beyond 6 months, no safety data |
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