Dysmenorrhea Flashcards
Define dysmenorrhea
Painful menstruation
When does dysmenorhhea occur?
Occurs before and/or during the beginning of menstruation
What is the most common gynaecological sx reported by people who menstruate?
Dysmenorhhea
Describe the prevalence of dysmenorrhea
The most common gynaecological sx reported by people who menstruate
Affects 50–90%
Highest incidence in late adolescence and early 20’s
1/3 to ½ report moderate to severe sx’s
10 –15% are incapacitated for 1-3 days/month
Describe the impact on life of dysmenorhhea
Leading cause of absenteeism from school and work for young women yet still largely goes untreated
Describe the impact of dysmenorhhea on academics
The severity of menstrual pain correlated with academic performance (concentration, absenteeism, performance, and lower grades during dysmenorhhea)
Describe the basic etiology of dysmenorhhea
Primary Dysmenorhhea
Secondary Dysmenorhhea
Describe primary dysmenorhhea
Painful menstruation with normal pelvic anatomy
– > Absence of pathology
Associated with normal ovulatory cycles
Typically begins in adolescence once ovulatory cycles established (within first few years after menarche; on average 6-12 months later)
Describe secondary dysmenorrhea
Painful menstruation associated with underlying anatomic or pathologic pelvic abnormalities
More likely to experience other symptoms like:
Irregular uterine bleeding
Chronic pelvic pain
Mid-cycle pain
Dyspareunia
Describe the differences between primary and secondary dysmenorhhea
Describe the underlying pathophysiology
Although the exact cause is unknown, prostaglandins (PG) are known to have a significant role
People with dysmenorrhea have increased production of endometrial PGs prior to menstruation
PG’s results in stronger, more frequent uterine contractions (and vasoconstriction)
Increased vasopressin and leukotriene levels
End result: Increased myometrial contractions, reduced uterine blood flow, which leads to PAIN
Risk factors for primary dysmenorhhea
Early menarche (<12yo)
Age <30yo
Family history of dysmenorrhea
Heavy menses / longer menstrual periods
Smoking
Weight (BMI <20)
Nulliparity (never have birthed a baby)
Describe the symptoms of dysmenorhhea
Spasmodic (cramping) pain in lower abdominal region
May radiate to lower back or thighs
May also experience:
Headache
N/V/D
Fatigue or trouble sleeping
Dizziness
Bloating
Describe the timeline of symptoms of dysmenorhhea
Few hours before menstruation –> peaks –> lasts 2-3 days
Pain comes and goes in cycles – Not constant
Describe the diagnosis of primary dysmenorhhea
Primary dysmenorrhea:
Based upon:
1) symptoms
2) response to therapy
3) clinical history
4) physical exam
Requires a thorough medical history evauluating:
Pain: onset, severity, type, location, duration
Associated sx’s
Family hx of endometriosis
Sexual activity
Menstrual history: age at menarche, cycle regularity, time since menarche, estimated menstrual flow
Describe why a thorough medical history is required for diagnosis of primary dysmenorhhea
Requires a thorough medical history to rule out 2 dysmenorhhea
Symptoms of secondary dysmenorhhea overlap with other conditions so a thorough history necessary
When should secondary dysmenorhhea be considered in the diagnosis of dysmenorhhea?
Menstrual pain after several years of painless periods
Sudden occurrence when normally have mild to no pain
Complaints of heavy bleeding
Dyspareunia
Rectal pain
Pain at times other than during menstruation
Pain persists beyond first couple days of menstruation
Little to no response to drug therapy
Goals of therapy for dysmenorhhea
Relive symptoms
Minimize time lost from work, school, etc
Identify patients with possible secondary dysmenorrhea for further assessment
Describe the treatment of dysmenorhhea? What type of diagnosis is it?
If history does not suggest a secondary cause, a presumptive diagnosis of primary dysmenorrhea may be made and confirmed with a 3 month trial of pharmacotherapy (empiric therapy is initiated – generally NSAIDs)
A history suggestive of 2o dysmenorrhea requires referral to a physician
Describe the treatment duration of NSAIDs and pharmacist prescribing
Can prescribe 6 months of therapy but must follow up at 3 months
No improvement at 3 months – referral to phsycian for assessment
What are some non pharmacological strategies for dysmenorhhea? Describe them.
What are some of the OTC agents that can be used for dysmenorhhea?
Acetaminophen
Pamabrom
Pyrilamine
NSAIDS
Describe acet usage in dysmenorhhea
Analgesic effect may be effective for mild cramping pain
Acetaminophen sometimes combined with caffeine/pamabrom/pyrilamine
Describe pamabrom usage in dysmenorhhea
Mild, short-acting diuretic
Is found combined with acetaminophen/pyrilamine (PMS Midol® Complete, Pamprin® Extra Strength)
