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Flashcards in dysmenorrhea Deck (28)
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1

primary dysmenorrhea

painful menses in women w/ normal anatomy and generally occurring in adolescent women

2

what is the most likely cause of dysmenorrhea?

prostaglandin, too much E2 secretion in the menstrual fluid

3

what does P. E2 do?

causes smooth muscle conraction leading to N, V, D

onset- w/in 3-6 mnths of menarche

4

sx of dysmenorrhea

cramping, heavy flow

5

tx for primary dysmenorrhea

NSAID , OCP, application of heat, regular exercise

6

tx for resistant cases

tocolytic agents, CCB, progestogens

7

secondary dysmenorrea

painful menses in the presence of a dz of the uterus or pelvis

8

ex of secondary dysm, causes

endometriosis, uterine fibroids, adenomyosis, STI, endometrial polyps, PID, IUD

9

adenomysosis?

implantation of endometrial tissues in the myometrium that results in a tender, symmetrically enlarged "boggy" uterus

10

what other sx may be seen w/ secondary dysmen?

bloating, menorrhagia, dyspareunia

11

tx for secondary?

removed IUD, may need hysterectomy, D&C,

12

dysfn uterine bleed (DUD)

abnormal uterine bleding in the absence of an anatomic lesion, usually caused by a problem w/ the hypothamlamic-pit-ovarian hormonal axis

13

when does DUD often occur?

shortly after menarche and during perimenopause bc of increased anovulatory cycles

14

possible causes of DUD

PCOS, exogenous obesity, adrenal hyperplasia

15

what is the first thing you want to do when dx DUD?

rule out prego

16

how to approach DUD?

think of pt in the framework of whehter or not they are ovulating-if so, think problems w/ reporductive system or systemic dz

17

Ovulatory (structural bleedin) causes?

Coag defects, infx, fibroids, adenomyosis, FB, vasculare anomalies, malignancy

18

anovulatory bleeding causes?

PCOS, hypothyroidism, hyperprolactinemia, hypothalamic dysfnx

19

how to asses ovulatory status

1) 10 day variablity btw cycle lengths

2) Basal body temp

3)progesterone level

4) urine LH

20

basal body temp and ovulation?

Progesterone causes BBT to increase 0.5°F. Need to check temp first thing in the morning, before getting out of bed, eating, or drinking.

21

progesterone levle and ovulation

Day 18-24 it should be between 6-25 ng/mL, but there is variability as it is affected by cyclical LH production. A high progesterone level is helpful to indicate ovulation, but a low test may mean either tested at a low phase, or no ovulation.

22

urine LH and ovulation

Urine LH increase occurs 12 hours after serum LH surge. However keep in minds that tests to measure urine LH will be falsely positive in conditions where baseline LH is high (PCOS, premature ovarian failure, and menopause

23

other studies for DUB?

CBC, iron studies, PT, PTT, TSH, LFTs, prolctin, serum FSH

papsmear, endometrial bx, pelvic US, removal of shit

24

tx for DUB

depends on severity of bleed

25

what is needed for an acute hemorrhage?

IV or PO high dose estrogens

26

what should be performed on a pt w/ DUB?

Progestin trial- if bleeding stops, then anovulatory

27

when should oral contraceptives not be used?

women over 35 who smoke, HTN, D, hx, of vascular dz, breast cancerer, liver dz, focal headaches

28

when can cylic progestins be used?

younger pts