Flashcards in Dysmenorrhoea Deck (34):
What is dyschezia?
Pain with defecation
What is Mittelschmertz?
Mid cycle pain, usu ovulation
How many women experience pelvic pain?
1 in 5 women experience chronic pelvic pain
Causes of primary dysmenorrhoea?
2ndary to prostaglandin release
Causes of secondary dysmenorrhoea?
Isolated endometrial pocket
What causes superficial dyspareunia? (Introitis)
Nerves near hymen are sensitized(eg.thrush), get hyperalgesia/allodynia
Deep dypareunia causes?
Midway dypareunia causes?
Cotton bud prodding
-does it reproduce the same pain as dypareunia
dypareunia examination bimanual?
Check all walls of vagina, the walls of bowel, ovaries
Cervix, uterus balloting
Pouch of Douglas
When is mid cycle pain?
Ask what for nonmenstrual pelvic pain?
Ask Cyclical Pattern!
Beware of drugs
Who gets endometriosis?
10-15% of women reproductive
60-70% with cyclical pelvic pain
30-40% women with infertility
Does dysmenorrhoea correlate with endometriosis?
Theories of endometriosis cause?
-risk factors for implantation
Coelom if metaplasia
Menstrual fluid, not endometrial cells, causes changes in peritoneum to change
Presentation of endometriosis?
-Asymptomatic: incidental finding
-provoked pain: dyspareunia
Symptom severity and disease severity does NOT correlate
Signs of endometriosis?
Lower Abdo pain
PV pain, lateral fornices
Uterus is 'fixed'
Palpable adenexa L mass
endometriosis diagnosis ultrasound?
Better at picking up cysts
Now can see on bowel.
What is gold standard for endometriosis?
Where do you see endometriosis usually?
Pouch of Douglas
Classic endometriosis looks?
Black spots, could be white, or red
endometriosis Rx options?
What has been done?
Do you plan to become pregnant?
Analgesics (not narcotics)
Suppress hormones: OCP, Progestins
What to tell patients with endometriosis?
It's not fatal
What to tell patient re: endometriosis Rx?
May not fix the pain
Surgery options for endometriosis?
Ablate or excise (80%) improved symptoms
Radical: remove organs
MAY not fix pain.
Treating endometriosis infertility?
Check other causes
Surgery: remove Cysts if >3cm
IVF - early move it need be
-Plan preg sooner rather than later
Classic signs of Adenomyosis
Uterus tender on bimanual palpation
adenomyosis gold standard Dx?
Histology, hysterectomy sample
Risk factors for adenomyosis?
-Drugs: NSAIDS, OCP, progestin