What is dysmenorrhea?
Crampy pelvic pain starting shortly before or at onset of menses typically lasting 1-3d
What sets PMDD apart from PMS?
- At least 5 of the following must be present:
- markedly depressed mood
- marked anxiety
- marked affective lability
- marked anger or irritability
- decreased interest in activities
- difficulty concentrating
- changes in appetite
- sleep disturbance
- feelings of being overwhelmed
- breast tenderness
- One of the symptoms must be markedly depressed mood, anxiety, irritability, or affective lability
- Sx interfere significantly with work and/or social relationships
What is the tx for PMDD?
- SSRI continual or luteal dosing (DOC)
- Venlafaxine continual or luteal dosing
What is the tx for dysmenorrhea?
- NSAIDs (DOC, esp Naproxen and Ibuprofen)
- MPA depot or Levonorgestrel IUD
What are the sx of endometriosis?
- chronic pelvic pain (cyclic or acyclic)
- premenstrual spotting
- GI or urinary disturbances
- low back pain
- painful defecation
- cul-de-sac or uterosacral ligament tenderness
- adnexal enlargement or tenderness
- pelvic mass (lesions or cysts)
What is the tx for endometriosis?
- Combination OCs
- GnRH agonists (leuprolide)
What are the monitoring parameters for clomiphene?
- Basal body temp
- Serum progesterone
- Urinary LH
- Follicular growth and endometrial thickness
- Pregnancy test
What are the SE of clomiphene?
- Hot flashes
- Mood swings
- Visual disturbances
- Breast tenderness
- Pelvic discomfort
- Multiple gestations
- Ovarian Hyperstimulation Syndrome (OHSS)
When should clomiphene be started for infertility?
Day 5 of the cycle