Menstrual Disorder Flashcards
(31 cards)
What is the average age of menarche?
Menarche = first period
average age = 12
Early and late menarche
-early menarche: associated with breast cancer
-late menarche: associated with osteoporosis and increased fracture risk
What influences the onset of menarche?
-race
-genetics
-nutritional status
-body mass (gymnast with delayed menarche due to muscles)
What is the median cycle length of menses?
28 days
-more variability in adolescents bc their hormones are not balanced out yet (may have longer, irregular cycles)
How long does the average menses last?
-3 to 7 days
The average amount lost during the cycle
30 ml
-most blood is lost on days 1 and 2
What does Menorrhagia mean?
-Loss of >80mL of blood per cycle or bleeding lasting longer than 7 days
-associated with severe anemia and impairments in
daily functioning
What is Dysmenorrhea?
-Painful menstruation
Primary dysmenorrhea
Secondary dysmenorrhea
Premenstrual Disorders
-Cyclic and composed of a combination of physical, mood,
and behavioral symptoms that occur during the luteal phase (after ovulation - the egg travels to the uterus)
What are Menstrual Disorders eligible for OTC Treatment?
-Primary Dysmenorrhea
-Premenstrual Syndrome (PMS)
Complaints: Abdominal pain and cramping
Irritability, Fluid retention
What differentiates primary from secondary Dysmenorrhea?
Both with Cramp-like lower abdominal pain during or before menstruation
-The symptoms: in primary: N/V, diarrhea, bloating, fatigue, headache
-Secondary Dysmenorrhea is caused by pelvic disease (infection of the uterus)
Which patient population is mostly affected by Primary Dysmenorrhea?
-Teens and early 20s
-Increases in early and older adolescents and decreases after the age of 24 (hormones balanced, and they may use contraceptives which may help)
-up to 93% of adolescents affected
When does Primary Dysmenorrhea happen?
Only during the ovulatory cycle
What is the timing of Pain associated with Primary Dysmenorrhea?
-Starts with the onset of menstruation
-subsides in day 2-3
-N/V, fatigue, dizziness, bloating, diarrhea, headache
Characteristics of Secondary Dysmenorrhea
-later after menarche (at least 2 years after menarche - mid to late 20’s)
-pelvic pathology
-may cause irregular menses
-pain outside of the ovulation cycle
Nonpharmacologic Approach for Primary Dysmenorrhea
-Sleep
Hot bath/heating pad (vasodilation -> relaxes smooth muscles that cause abdominal cramping)
Light exercise (yoga, swimming)
Smoking cessation
What are some OTC products that may help in pain reduction (no strong evidence)
-Omega-3-fatty acid (Fishoil): decreases the production of proinflammatory cytokines
-Vitamin D3: reduces production of prostaglandin
Pharmacologic Approach for Primary Dysmenorrhea
Target is PAIN
-NSAIDs - Ibuprofen, Naproxen (BEST recommendation)
-Aspirin (high doses may increase bleeding)
-Tylenol (used when the woman is trying to get pregnant)
-Start 1-2 days before the menstrual cycle
-regular periods during the cycle
Best pain medication if the woman tries to get pregnant
Tylenol
Which of the Pain medications have DDI with Warfarin?
-NSAIDs
-Aspirin
When to Refer
-Pain persists
-New symptoms occur
-> because there might be other things causing the pain
-Secondary dysmenorrhea and/or menorrhagia !!!!
-History of PID, infertility, irregular
menstrual cycles, endometriosis, or ovarian
cysts
-use of warfarin, heparin, or lithium
-Active GI disease (PUD, GERD, ulcerative
colitis)
-Diagnosis of bleeding disorder
Premenstrual Syndrome (PMS)
-Symptoms usually begin in the teenage
years up to the early 20s
-only during the ovulary cycle
-disappears during pregnancy, breastfeeding and menopause
60-80%: mild symptoms
20-30%: clinically
significant symptoms
6-8%: severe symptoms
Symptoms of PMS
-Fatigue, lack of energy
-mood changes
-breast tenderness (physical symptom)
-appetite and sleep change
-joint/muscle pain, headache
Positive: increased libido, sense of control, or energy
The presence and severity of symptoms differentiate PMS from regular premenstrual symptoms and PMDD
Key differences in Menstrual Conditions
!!!
Typical premenstrual symptoms: mild, do not interfere with daily life
PMS: at least one mood or physical symptom during the 5 days before menses - negative effect on daily life
PMDD (PM dysphoric disorder): five or more symptoms (mood or physical) -should go away in the week after menses -> if NOT it might be Premenstrual exacerbation of other disorders
Premenstrual exacerbation of other disorders:
worsening of other disorders (often psychiatric, depression, anxiety) - there is no symptom-free interval
