Term
| Premenstrual Syndrome (PMS) |
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Definition
cyclic recurrence of a combination of psychological, behavioral, and physical symptoms that occur during luteal phase of menstrual cycle & resolves after start of menses;
Sx: affects woman's mood, behavior, & physical function;
Most common in females 20-30 yrs old; |
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Term
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Definition
females ages 20-30;
overweight;
unbalanced diet;
nutrient deficiencies - Ca, Mg, B vitamins, vitamin E;
stressful lifestyle;
HIGH DOSE OCs |
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Term
| Clinical Presentation of PMS |
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Definition
Occur late in luteal phase, relieved around onset of menses, without recurrence until at least day 13;
Occur in cyclic pattern;
Menstrual magnification exacerbates other conditions (epilepsy, depression, asthma, migraines);
Emotional/Mood: depression, sadness, irritability, tension, anxiety, tearfulness, restlessness, anger, hostility, loneliness, food cravings, change in libido;
Behavioral: mood swings, difficulty concentrating, confusion, forgetfulness, being accident prone, social avoidance, overeating, angry outbursts, change in EtOH tolerance;
Physical: mastalgia (breast tenderness), abdominal bloating, fatigue, dizziness, N/V, acne, hot flashes, muscle aches, pelvic pressure/heaviness, appetite changes, constipation or diarrhea, menstrual migraines |
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Term
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Definition
Rule out other causes, psychiatric conditions;
Sx confined to luteal phase, peak shortly before menses, and cease shortly during or shortly after menses;
Pt charts out Sx over min of 2-3 months;
Increase in basal body temperature; |
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Term
| Goals of Treatment for PMS |
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Definition
Minimize symptoms;
Improve functioning & well-being;
Avoid adverse effects; |
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Term
| Treatment Strategies for PMS |
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Definition
lifestyle modifications;
physical/behavioral symptom relief;
modification of neurotransmitter/hormonal imbalance;
suppress ovulation;
remove ovaries; |
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Term
| Non-pharm Tx/Lifestyle Modifications for PMS |
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Definition
Education;
Daily charting of Sx;
Exercise 20-30 min 3-4x/wk;
Adequate rest/regulate sleep cycle;
Stress management techniques;
Cognitive therapy;
Smoking cessation;
Dietary modifications: low-fat, high-fiber; smaller, more frequent meals; avoidance of foods & beverages that can worsen S/Sx (Na-rich foods, simple sugars, red meats, processed foods, EtOH, nicotine, caffeine) |
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Term
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Definition
1200 mg PO daily (600 mg BID);
Efficacy for reducing depression, water retention, pain, food cravings, fatigue, insomnia;
Added benefit of osteoporosis prevention; |
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Term
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Definition
100-400 mg daily;
May decrease fluid retention, breast tenderness, & bloating;
ADR: diarrhea; |
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Term
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Definition
400 IU daily during luteal phase;
Effective for breast pain & tenderness, reducing mood symptoms |
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Term
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Definition
50-100 mg/day;
Effective for mood symptoms |
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Term
| acetaminophen (APAP, Tylenol) |
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Definition
For PMS pain;
Dose: 500-1000 mg q4-6 hrs prn, Max = 4 g/day;
Caution: liver dx, heavy EtOH users |
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Term
| NSAIDs - ibuprofen (Advil, Motrin), naproxen (Aleve), ketaprofen |
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Definition
Used to tx pain in PMS;
Inhibits PG synthesis, very effective in cramping/dysmenorrhea;
May cause GI upset --> TAKE WITH FOOD;
Avoid in pts w/ GI ulcers, bleeding disorders, ASA allergy, PUD;
CVD risk if taken long-term; |
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Term
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Definition
| use to treat water gain, bloating, and swelling before using diuretics; |
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Term
| Tx of Water weight gain, bloating, & swelling |
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Definition
Sodium restriction before diuretics;
OTC diuretics: pamabrom, caffeine;
RX diuretics: spironolactone |
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Term
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Definition
may reduce painful cramps, depression, irritability, menstrual migraines;
Used for tx of endometriosis;
Use biphasic or triphasic combo pills;
Trial period of 3-6 months;
Use combo pills cyclically (3 wks active, 1 wk placebo - period monthly) or continuously (3 months active, 1 wk placebo - period every 3 months) |
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Term
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Definition
100-200 mg daily;
For SEVERE cases of PMS;
2nd line for tx of endometriosis - effective for pain;
androgenic agent, with anti-estrogenic effects - INDUCES amenorrhea;
ADR: hirsutism, voice deepening, mood changes, acne, menopausal effects;
Teratogenic |
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Term
| GnRH agonists - leuprolide acetate (Lupron), goserelin acetate (Zoladex), naferelin (Synarel) |
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Definition
for SEVERE cases of PMS;
3rd line for tx of endometriosis;
Induces a "menopausal" state (amenorrhea, anovulation);
MoA: causes pituitary desensitization to GnRH --> down-regulation of GnRH receptors, decreases LH, FSH, suppresses progesterone & estrogen, suppresses ovulation;
reduces physical & behavioral Sx but can WORSEN mood/depressive Sx;
Do NOT use >6 months;
ADRs: menopausal symptoms, weight gain;
Use estrogen-progestin as back therapy to prevent loss of BMD |
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Term
| Premenstrual Dysphoric Disorder (PMDD) |
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Definition
severe form of PMS marked by severe mood changes that affects approx. 3-5% of women w/ PMS;
Seratonin-mediated; |
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Term
| DSM-IV Diagnostic Criteria for PMDD |
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Definition
At least 5 Sx must occur premenstrually;
Sx for at least 1 yr;
At least 1 of Sx must be a marked dysphoric mood change (depressed mood, hopelessness, sudden mood changes, anxiety, tension, anger or irritability);
Sx occur during last week of luteal phase;
Sx are serious enough to interfere w/ a woman's work, school, social activities, & interpersonal relationships; |
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Term
| Oral Contraceptives - Yaz (drosperinone, ethinyl estradiol) |
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Definition
RX tx for management of PMDD symptoms;
given daily for 24 days w/ 4 placebo pills;
effective for physical & mood-related symptoms; |
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Term
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Definition
pain or discomfort occurring during menstruation, begins on 1st day of menses;
Sx: ABDOMINAL CRAMPING, migraines, pain starts on day 1 of menses, peaks on highest day of menstrual flow, & resolves within 3-5 days;
Pain restricted to pelvic region & lower abdomen; |
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Term
| Risk Factors for Primary Dysmenorrhea |
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Definition
earlier age at menarche;
long menstrual periods;
obesity;
EtOH consumption;
heavy menstrual periods;
smoking |
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Term
| NSAIDs - ibuprofen (Advil, Motrin), ketoprofen, naproxen (Aleve), celcoxib (Celebrex), diclofenac (Voltaren), meclofenamate (Meclomen) |
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Definition
| inhibits prostaglandin synthesis, effective for cramping/dysmenorrhea, pelvic pain; |
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Term
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Definition
caused by an underlying process or disease;
MUST refer to physician!!!
Sx: long duration of time w/ painful menstrual periods, heavier bleeding than normal, poor response to NSAIDs, abnormal vaginal discharge, pelvic tenderness; |
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Term
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Definition
Characterized by presence of endometrial tissue outside of uterus & in other areas of body;
growth of small lesions that appear on any pelvic organs & may progress to large cysts that can adhere to bowel, bladder, or ureter;
Chronic condition;
Sx: chronic pelvic pain, dysmenorrhea, dyspareunia, infertility, obstruction of menstrual flow, frequent/heavy menstruation, genital tract abnormalities, high estrogen levels, high peripheral body fat |
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Term
| Risk Factors for Endometriosis |
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Definition
nullparity;
genetics;
prolonged estrogen exposure |
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Term
| Goals of Tx for Endometriosis |
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Definition
minimize or remove endometrial deposits;
prevent dx progression;
relieve pain;
prevent or correct infertility; |
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Term
| NonPharm Treatment for Endometriosis |
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Definition
Conservative Surgery: mild-moderate dx, laparoscopic removal, decreases pain, recommended if infertility is an issue, drug therapy recommended to decrease recurrence;
Definitive Surgery: severe dx, intractable pain, removal of uterus or ovaries, eliminates recurrence, only if pts do not desire to become pregnant; |
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Term
| Pharmacological Tx for Endometriosis |
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Definition
1st line: NSAIDs, Oral Contraceptives;
2nd line: progestins (medroxyprogesterone acetate, norethindrone, levonorgestrel IUD), danazol;
3rd line: GnRH agonists (goserelin acetate [Zoladex], leuprolide [Lupron], naferelin [Synarel]) |
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Term
| Progestins - medroxyprogesterone acetate, depot medroxyprogesterone, norethindrone, levonorgestrel releasing IUD |
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Definition
Used in tx of endometreosis - 2nd line;
suppresses LH & FSH which inhibits follicular maturation & ovulation, leading to atrophy of endometrium;
ADRs: breakthrough bleeding, weight gain, fluid retention, mood swings, decreased bone mineral density; |
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