Dysmenorrhea Flashcards
(41 cards)
Dysmenorrhea is defined as…
Painful menstruation, occurring before and/or during the beginning of menstruation
Primary dysmenorrhea is different from secondary dysmenorrhea in these ways…
Painful menstruation with normal pelvic anatomy - associated with normal ovulatory cycles + typically begins in adolescence
Secondary dysmenorrhea is different from primary dysmenorrhea in these ways…
Painful menstruation associated with underlying anatomic/pathologic pelvic abnormalities
Ex: endometriosis
Individuals with secondary dysmenorrhea are more likely to experience additional symptoms such as…
Irregular uterine bleeding
Chronic pelvic pain
Mid-cycle pain
Dyspareunia (painful intercourse)
Pathophysiology of primary dysmenorrhea involves…
Prostaglandins
People with dysmenorrhea have ____ production of ____ prior to…
Increased production of endometrial prostaglandins, prior to menstruation
Prostaglandins result in…
Stronger, more frequent uterine contractions + vasoconstriction; increased vasopressin and leukotriene levels
Resulting in increased myometrial contractions, reduced uterine blood flow, leading to pain
Risk factors for primary dysmenorrhea
Early menarche (<12 yo)
Under 30 years old
Family hx of dysmenorrhea
Heavy menses, longer menstrual periods
Smoking
BMI under 20
Nulliparity
Symptoms of dysmenorrhea include…
Cramping pain in lower abdominal region
Headache, N/V/D, fatigue, dizziness, bloating
Often comes and goes in cycles
Symptom timeframe for dysmenorrhea is usually…
Few hours before menstruation - peaks, lasts 2-3 days
Diagnosis of primary dysmenorrhea is based upon…
Symptoms + response to therapy, as well as clinical history and physical exam
A thorough medical history to diagnosis primary dysmenorrhea involves…
History of…
Pain (onset, severity, type, location, duration)
Associated symptoms
Family hx of endometriosis
Sexual activity
Menstrual history
Secondary dysmenorrhea should be considered if…
Menstrual pain after years of painless periods that lasts beyond first couple days, or pain at times other than during menstruation
Little to no response to drug therapy
Complaints of heavy bleeding, pain during intercourse, rectal pain
Symptoms often overlap with other conditions, so thorough history necessary
Goals of therapy for dysmenorrhea include…
Relieve symptoms
Minimize time lost from work, school, etc.
Identify patients with possible secondary dysmenorrhea for further assessment
If history does not suggest a secondary cause of dysmenorrhea, we can…
Make a presumptive diagnosis of primary dysmenorrhea, and confirm with 3 month trial of pharmacotherapy
Initiate empiric therapy
A history suggestive of secondary dysmenorrhea requires…
Referral to a physician
Exercise for dysmenorrhea…
Has no strong evidence, but may help + is reasonable to suggest
Regular, low intensity exercise; NOT during dysmenorrhea episode
TENS for dysmenorrhea…
Is found to be more effective than placebo, but has low quality evidence
Alternative for those wanting non-drug options
AE’s for TENS include…
Headache, muscle tightness, redness, burning
Acupuncture and spinal manipulation for dysmenorrhea…
May be beneficial, but likely no evidence to support
Topical heat for dysmenorrhea…
Some evidence to show its comparable to ibuprofen. Combination may be beneficial
Acetaminophen for dysmenorrhea…
May be effective for mild cramping pain (but is inferior to NSAID’s, does not decrease inflammation)
Pamabrom for dysmenorrhea…
May help with bloating (is a mild, short-acting diuretic) - found in Midol
Pyrilamine for dysmenorrhea…
Has not been proven to be effective for menstrual symptoms - often found in combination products
