Dysmenorrhoea Flashcards Preview

Jason's MD3 Women's > Dysmenorrhoea > Flashcards

Flashcards in Dysmenorrhoea Deck (34):
1

What is dyschezia?

Pain with defecation

2

What is Mittelschmertz?

Mid cycle pain, usu ovulation

3

How many women experience pelvic pain?

1 in 5 women experience chronic pelvic pain

4

Causes of primary dysmenorrhoea?

2ndary to prostaglandin release

5

Causes of secondary dysmenorrhoea?

Endometriosis
Adenomyosis
Intracavity mass
Isolated endometrial pocket

6

What causes superficial dyspareunia? (Introitis)

Thrush
Atrophic vaginitis
Dermatitis
Vestibulodynia

7

vEstibulodynia?

Nerves near hymen are sensitized(eg.thrush), get hyperalgesia/allodynia

8

Deep dypareunia causes?

And extrinsic
Adenomyosis
Adhesions
Ovarian cysts

9

Midway dypareunia causes?

Pelvic floor
-spasm
Trigger points

10

dypareunia examination?

Cotton bud prodding
-painful?
-does it reproduce the same pain as dypareunia

11

dypareunia examination bimanual?

Check all walls of vagina, the walls of bowel, ovaries
Cervix, uterus balloting

Pouch of Douglas

12

When is mid cycle pain?

D10-14

13

Ask what for nonmenstrual pelvic pain?

Ask Cyclical Pattern!
Beware of drugs

14

Who gets endometriosis?

10-15% of women reproductive
60-70% with cyclical pelvic pain
30-40% women with infertility

15

Does dysmenorrhoea correlate with endometriosis?

Not necessarily

16

Theories of endometriosis cause?

Retrograde menses
-risk factors for implantation
Coelom if metaplasia
CongeniTal
Iatrogenic
Metastatic spread
Direct spread

17

Coelomic metaplasia

Menstrual fluid, not endometrial cells, causes changes in peritoneum to change

18

Presentation of endometriosis?

-Asymptomatic: incidental finding
-cyclical pain
-provoked pain: dyspareunia
-infertility

19

endometriosis beware?

Symptom severity and disease severity does NOT correlate

20

Signs of endometriosis?

Lower Abdo pain
PV pain, lateral fornices
Uterus is 'fixed'
Palpable adenexa L mass
Palpable nodule

21

endometriosis diagnosis ultrasound?

Better at picking up cysts
Now can see on bowel.

22

What is gold standard for endometriosis?

Laparoscopy

23

Where do you see endometriosis usually?

Pouch of Douglas
near ovaries

24

Classic endometriosis looks?

Black spots, could be white, or red

25

endometriosis Rx options?

What has been done?
Do you plan to become pregnant?
Do nothing
Analgesics (not narcotics)
Suppress hormones: OCP, Progestins

26

What to tell patients with endometriosis?

It's not fatal

27

What to tell patient re: endometriosis Rx?

May not fix the pain

28

Surgery options for endometriosis?

Ablate or excise (80%) improved symptoms
Radical: remove organs

MAY not fix pain.

29

Treating endometriosis infertility?

Check other causes
NO DRUGS
Surgery: remove Cysts if >3cm
REmove hydrosalpinges
IVF - early move it need be
-Plan preg sooner rather than later

30

Classic signs of Adenomyosis

Bulky uterus
Uterus tender on bimanual palpation

31

adenomyosis gold standard Dx?

Histology, hysterectomy sample

32

Risk factors for adenomyosis?

Age Older
More gravidarum/parity

33

adenomyosis Rx?

-Do nothing
-Benign condition
-Drugs: NSAIDS, OCP, progestin
-Mirena
-hysterectomy

34

Primary dysmenorrhoea classic history

Gets better as increase:
Age
Parity
OCP