Dysmenorrhea Clinical

  1. Primary dysmenorrhea clinical presentation include:
    • Painful menstruation
    • Ovulatory cycles only
    • Not associated pelvic pathology
    • “cramps”
  2. Protective factors for dysmenorrhea:
    • Regular exercise
    • Oral contraceptive use
    • Early childbirth
  3. When does onset of primary dysmenorrhea normally occur?
    First few postmenarchal years (Teenage years)
  4. What are the three pathophysiologic theories of primary dysmenorrhea?
    • Myometrial stimulation and vasoconstriction
    • Neuronal hypothesis -> type C pain fibers
    • Vasopressin contribution
  5. Myometrial inflammation is likely due to _____ influence
    Luteal hormone
  6. What hormone is elevated during luteal phase?
    Progesterone is elevated
  7. What happens when there is elevated progesterone, what happens in terms of the chemical pathway?
    Phospholipase released and cell membrane phospholipids hydrolyze and arachidonic acid and icosatetraenoic acid generated which are precursors for COX and prostaglandins and leukotrienes are produced
  8. Uterine Angina is a form of _______
    Myometrium inflammation
  9. Arachidonic acid turns into _______ and ______
    Prostaglandin and leukotrienes
  10. What are effects of prostaglandin and leukotrienes on the uterus?
    • Prolong uterine contractions
    • Decrease endometrial blood flow
  11. Neuronal hypothesis, type ____ pain fibers, which are the ____ pathway fibers and this signals nociception
    • C
    • Slow
  12. T/F: C fibers are stimulated by aerobic metabolites that are generated from an ischemic endometrium
    False; C fibers are stimulated by anaerobic metabolites generated from an ischemic endometrium
  13. T/F: anterior pituitary hormones increases response to elevated prostaglandin
    False; posterior pituitary hormones- vasopressin, increases response to elevated prostaglandins which results in myometrial hypersensitivity and reduced uterine blood flow and pain
  14. T/F: pelvic exams are necessary for evaluation of primary dysmenorrhea when h/o intercourse
    False; for primary dysmenorrhea, pelvic exams are deferred if there is no history of intercourse
  15. Parasympathetic effect on the uterus is _____, sympathetic effect on the uterus is _____
    • Uterine vasodilation
    • Uterine vasoconstriction
  16. What is the recommended dosing frequency of NSAID for primary dysmenorrhea?
    Taken 1-2 days before the anticipated onset of menses and continue on a fixed schedule for 2-3 days (Wtf, this is so unnecessary)
  17. What are some therapeutic interventions for primary dysmenorrhea?
    • NSAID use – first line treatment
    • Supportive measure – such as heat pack
    • Hormonal contraceptive
    • OMT- sacral
  18. What is secondary dysmenorrhea?
    • Associated with pelvic pathology and not always gynecologic
    • But menses exacerbates the symptoms
    • (vs primary dysmenorrhea does not involve)
  19. What are symptoms of secondary dysmenorrhea?
    • Menorrhagia
    • Intermenstrual bleeding
    • Dyspareunia
    • Postcoital bleeding
    • Infertility
  20. Pathophysiology shared visceral innervation of dysmenorrhea is ____
  21. Onset of secondary dysmenorrhea usually occurs ages _____
    • 30+
    • (vs primary is during teenage years)
  22. Characteristic of secondary dysmenorrhea of a gynecological cause would have pain in ______
    Crampy low anterior pelvic discomfort
  23. T/F: gynecologic cause of secondary dysmenorrhea would be non-cyclic and intensifies with menses
  24. Non-gynecological causes of secondary dysmenorrhea include:
    • IBS IBD
    • Peritoneal inflammation or irritation
    • Urinary cause – ie nephrolithiasis
    • MSK and psychologic
  25. What is adenomyosis?
    • slightly enlarged globular tender uterus within uterine musculature
    • a gynecologic etiology of secondary dysmenorrhea
  26. what is inguinal adenopathy?
    • local infection such as HSV, GC, syphilis
    • a gynecologic etiology of secondary dysmenorrhea
  27. what is leiomyomat?
    • benign, enlarged irregular tumor, nonpainful uterus, may be palpable abdominally
    • a gynecologic etiology of secondary dysmenorrhea
  28. what is endometriosis?
    • presence of endometrial glands and stroma outside endometrial cavity and uterine musculature
    • nodularity, thickening of uterosacral ligaments, cervix fixed displaced laterally
    • a gynecologic etiology of secondary dysmenorrhea
  29. T/F: Pelvic inflammatory disease would have positive chandelier sign on exam
    True; chandelier sign is indicative of cervical motion tenderness
  30. what is chandelier sign?
    Cervical motion tenderness on exam
  31. Mullerian defects can be evaluated using _____ imagining; tubal and uterine cavity patency can be evaluated using _____ imagining
    • MRI
    • HSG
  32. T/F: most common cause of secondary dysmenorrhea is endometriosis
  33. How is endometriosis diagnosed?
    • TVUS (Transvaginal ultrasound)
    • Diagnostic laparoscopy
  34. What is the first line treatment for dysmenorrhea caused by endometriosis?
    OCP use
  35. How is Adenomyosis diagnosed?
    • TVUS
    • MRI
  36. TVUS is used to diagnose which conditions?
    • Endometriosis
    • Adenomyosis
    • Ovarian cyst
    • Ovarian torsion
    • Ectopic pregnany
  37. T/F: leiomyomata is diagnosed with TVUS
    False; it is usually diagnosed with ultrasound, hysteroscopy or MRI
  38. Cysts, endometriomas, neoplasms, torsion, and mittelschmerz are _______ cause of ______ dysmenorrhea
    • Ovarian gynecologic
    • Secondary
  39. T/F: ovarian torsion is a surgical emergency
    True; necessary to preserve function of ovaries
  40. What is Mittelschmerz?
    Recurrent midcycle pain in female with regular ovulatory cycles caused by normal follicular enlargement just prior to ovulation. Unilateral mild pain
  41. Tubal infections can cause secondary dysmenorrhea, and include these conditions:
    • Ectopic pregnancy
    • Pelvic adhesions
    • PID
    • Pelvic congestion
  42. Ectopic pregnancy is present ____ weeks after last menstrual period
  43. Common causes of pelvic inflammatory disease?
    • C trachomatis
    • N honorrhoeae
  44. Which condition would you likely to admit the patient for IV antbiotics?
  45. Venography is used to diagnose_____
    Pelvic congestion syndrome
  46. What is pelvic congestion syndrome?
    damage to valves in ovarian veins results in valvular incompetence leading to reflux and chronic dilation
  47. Cystitis, pyelonephritis, interstitial cystitis, nephrolithiasis are _____ causes of ____ Dysmenorrhea
    • Urinary non-gyn
    • Secondary
  48. Acute Appendicitis/peritonitis, bowel obstruction, diverticulitis, gastroenteritis, IBD, IBS are ____ causes of ____ Dysmenorrhea
    • GI Non-gyn
    • Secondary
  49. Uterus VSR:
    • T10-L2
    • S2-S4
  50. Ovaries VSR:
    • T10-T11
    • S2-S4
  51. Descending, sigmoid colon and rectum VSR:
    • L1-L2
    • S2-S4
Card Set
Dysmenorrhea Clinical
Endo Exam 3