Menstrual Disorders

Question 1

What is dysmenorrhea, when do they start to occur

Answer 1

Painful menstrual crams, a few years after the first period

Question 2

What is primary dysmenorrhea, secondary dysmenorrhea

Answer 2

pain induced by uterine contractions during ovaulatory cycles, pain induced by an underlying etiology

Question 3

What is the onset of primary dymenorrhea, symptoms, duration

Answer 3

during or just before menstrual bleeding, lower abdominal pain/backache, 2-3 days

Question 4

What is the onset secondary dysmenorrhea, symptoms, duration

Answer 4

typically two years after menses onset, pain throughout menses and non-menstual days, specific to individual with no relationship to menstrual flow

Question 5

What are non-pharmacological therapy for primary dymenorrhea

Answer 5

heat, Regular aerobic exercise/ smoking cessation, powedered ginger/acupuncture

Question 6

What is the first line pharmacological therapy for primary dysmenorrhea, other options

Answer 6

NSAIDS for 2-3 days (start right before menses), Contraceptions (CHCs, Depo, IUD)

Question 7

T/F: If a patient wants to stop their dysmenorhea try no pharmacological options first before moving to pharmacological options

Answer 7

True

Question 8

What is endometriosis, how is it diagnosed

Answer 8

Presence of endometrial tissue outside of the uterine cavity, biopsy of direct surgical visulaization

Question 9

T/F: Endometriosis is like primary dysmenorrhea in that it causes pain throughout a women’s cycle

Answer 9

False: Endometriosis can cause acyclic menstrual pain cramps with progression of disease pain possibly being more frequent

Question 10

What are the first line pharmcotherapy options for endometriosis 2nd, 3rd

Answer 10

NSAIDS, CHCs, Progestin only Contraceptives/ Gn-RH agonist and Gn-RH antagonist/ Aromatase inhibitors and Danazol

Question 11

What pharmacotherapy option is only for endometriosis, what is the dosing

Answer 11

GnRH-antagonist (Orlissa), 150 mg every day for 24 months OR 200 mg every day for 12 months

Question 12

T/F: Patients taking Orlissa should also take CHCs if pregnancy would like to be avoided

Answer 12

True

Question 13

What are the two surgical options for endometriosis

Answer 13

Conservative surgery: removal of tissue implants (high rate of recurrence), Definitive surgery: Total removal of uterus and ovaries

Question 14

T/F: For premenstrual disorders patients have symptoms during the luteal phase and must have symptoms free period during follicular phase

Answer 14

True

Question 15

What is the two types of premenstrual disorders

Answer 15

Premenstrual syndrome (PMS) or Premenstrual Dysphoric Disorder (PMDD)

Question 16

What is the diagnostic criteria for PMS

Answer 16

At least 1 affective symptom and 1 somatic symptom that occurs greater than 5 days before menses in each of 3 prior cycle, symptoms relieved by day 4 of menses

Question 17

What type of affective symptom must a patient have to be described as having PMDD

Answer 17

Lability, irritability, markedly depressed mood, or anxiety

Question 18

What are first line therapy for PMS, PMDD

Answer 18

Lifestyle modifications and/or supplements, sertonergic agents and CHCs

Question 19

What nutritional supplements have been shown to possibly decrease symptoms of PMS

Answer 19

Calcium 1000 mg/day, Vitamin B6 50-100 mg/day, Magnesium 200- 360 mg/day

Question 20

What are the 1st line serotonergic antidepressants that can be used for PMDD, what other class can be used

Answer 20

Fluoxetine, Sertraline, Paroxetine/ velafaxine and duloxetine or nefazodone, TCAs

Question 21

How can the dosing be done with serotonergic antidepressants

Answer 21

Low dose luteal phase dosing or symptoms onset OR daily dosing throughout cycle

Question 22

What is the only CHC that is approved for PMDD, what is the main caution with this CHC

Answer 22

Yaz and Beyaz (ethinyl estradiol plus drospirenone), increased risk of Thrombosis

Question 23

If a patient has anxiety during periods what are the two anxiolytics that have been studied

Answer 23

Alprazolam and Buspirone

Question 24

If a patient has fluid retention what could be given

Answer 24

Spironolactone

Question 25

What are first line therapy agents for Mastalgia (breast pain), alternatives

Answer 25

Vitamin E therapy, NSAIDS/ Danazol

Question 26

T/F: For patients with PMDD if given a low dose Gn-RH agonist they should also be given a low dose estrogen and progestin CHC to lessen side effects

Answer 26

True