Term
| What is primary dysmenorrhea? |
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Definition
“Primary dysmenorrhea (PD) refers to the presence of recurrent, crampy, lower abdominal pain that occurs during menses in the absence of demonstrable pelvic disease”
Primary dysmenorrhea occurs in 60-93% of adolescents
Incidence decreases with age |
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Term
| What is the typical presentation of primary dysmenorrhea? |
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Definition
| Typical presentation: Intense lower abdominal cramping, strongest midline, possibly with radiation to the back & thigh. Nausea, diarrhea, fatigue, headache, and a general sense of malaise are also associated. |
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Term
| What is secondary dysmenorrhea? |
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Definition
| “Secondary dysmenorrhea is the occurrence of painful menstruation in the presence of a pelvic pathology, such as endometriosis, adenomyosis, uterine leiomyomata, or chronic pelvic inflammatory disease” |
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Term
| What is the typical presentation of endometriosis? |
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Definition
| D/t endometriosis: “pain is becoming progressively more severe, occurs at mid-cycle and during the week before menstruation, and may be associated with deep dyspareunia and dyschezia (difficulty with defecation)” |
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Term
| What is the typical presentation of fibroids? |
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Definition
| D/t uterine fibroids: “increasing dysmenorrhea is characteristically accompanied by increasing menstrual flow (menorrhagia)” |
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Term
| What is the typical presentation of adenomyosis? |
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Definition
| D/t adenomyosis: “pain is limited to menses, but such women may also experience noncyclic chronic pelvic pain. Women with adenomyosis typically present with dysmenorrhea after 35 years of age while women with primary dysmenorrhea typically develop symptoms before 25 years of age” |
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Term
| What are the two main pharmacologic treatments of primary dysmenorrhea? |
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Definition
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Term
| Dosing/recommendations for NSAIDs for primary dysmenorrhea |
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Definition
NSAIDs
Onset 2-3 days, depending on symptoms
Phenylproprionic acid derivatives (ibuprofen, naproxen)
Ibuprofen 400-800mg PO q 6 hours
Fenamates (mefenamic acid, tolfenamic acid, flufenamic acid, meclofenamate, bromfenac) may be more effective
Mefenamic acid 500 mg loading dose, 250 mg PO q 6 hours
COX-2 inhibitors
If fail above, or are at high risk for GI toxicity
ACOG recommends NSAIDs for moderate pain associated with dysmenorrhea (2004, 2008). This includes COX-2 inhibitors. |
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Term
| Which COCs for primary dysmenorrhea? |
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Definition
Hormonal Contraceptives
Recommended by ACOG for treatment of PD (2004, 2008)
Synthetic progestins cause endometrium to thin over time, decreasing the overall production of arachidonic acid. (Decreased contractions & decreased menstrual flow)
No comparisons have been done to compare monthly, extended cycle, or continuous use, although extended cycle appears to be associated with less pain
Any estrogen dose appears to be effective
With limited data, OrthoEvra appears to be less effective than OCPs
With limited data, NuvaRing appears to be similarly effective to OCPs |
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Term
| What is the diagnostic test for evaluation of secondary dysmenorrhea? |
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Definition
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