menstrual cycle disorders

What is normal menstrual cycle length in adolescents?

21–45 days.

What is secondary dysmenorrhea?

Due to underlying pathology—endometriosis, fibroids, adenomyosis, PID, anomalies, IUD use

Primary dysmenorrhea risk factors?

Early menarche (<12), age <30, heavy/irregular menses, long cycles, nulliparity, low BMI, FHx, sexual abuse, stress

What causes the dysmenorrhea pain?

PG release → inflammation + vasopressin-mediated vasoconstriction → uterine ischemia.

Classic dysmenorrhea symptoms?

Spasmodic cramps starting hours before or at menses; peak 24–48h; may radiate to back/thighs.

When does secondary dysmenorrhea typically begin?

after age 25.

Does primary respond to NSAIDs/OC?

Yes. Secondary usually does NOT.

Symptoms suggesting secondary dysmenorrhea?

Dyspareunia, heavy bleeding, intermenstrual bleeding, infertility, postcoital bleeding

Non-pharm options for dysmenorrhea?

Exercise, topical heat, low-fat vegetarian diet, TENS, behavioural therapy.

When can acetaminophen be used?

If NSAIDs not tolerated. Heat is comparable to NSAIDs.

First-line drug class for dysmenorrhea?

NSAIDs.

NSAID mechanism in dysmenorrhea?

↓ prostaglandins in endometrium/menstrual fluid.

NSAID administration instructions?

Start at onset of pain/menses; continue 72h; trial for 3 cycles. Consider pre-dosing 1–2 days before menses if inadequate relief

How do CHCs reduce dysmenorrhea?

Inhibit ovulation → thinner endometrium → fewer prostaglandins.

Who should receive CHCs for dysmenorrhea?

Those needing contraception OR NSAID failure/contraindication.

When should dysmenorrhea patients be referred?

• Pain onset >2 years post-menarche
• Pain occurs outside first 3 days of menses
• Change in pain pattern
• Change in menstrual fluid characteristics
• Failure of proven treatment

Vitamin D role?

May help only if deficient; evidence insufficient

Current definition of HMB?

Excessive bleeding that interferes with quality of life

What complication may HMB cause?

Iron-deficiency anemia.

examples of causes of HMB?

Pelvic pathology, IUDs, systemic disease, dysfunctional uterine bleeding.

MOA of TXA?

Blocks plasminogen activation → ↓ fibrinolysis → ↓ bleeding.

TXA contraindications?

Thromboembolic disease, hematuria, SAH, hormonal contraceptive use, colour-vision disturbances

Are cyclic progestins effective for HMB?

Poor efficacy (2–30%). Not preferred.

DMPA effect on HMB?

Amenorrhea in >50% after 1 year.

LNG-IUS effectiveness in HMB?

Most effective — reduces blood loss 70–96%

Why is danazol rarely used?

Significant androgenic adverse effects (weight gain, acne, hirsutism). Teratogenic.

GnRH agonist effect?

nduces reversible amenorrhea in 3–4 weeks; highly effective (90%)

When do PMS symptoms occur?

During week before menses; resolve at onset.

What is PMDD?

Severe PMS with functional impairment and mood symptoms. Prevalence 3–8%.

PMS diagnostic requirement?

≥1 moderate/severe somatic or psych symptom in luteal phase for ≥3 months + prospective charting.

PMDD DSM-5 requirement?

≥5 symptoms in luteal phase, including one of: affective lability, irritability, depressed mood, anxiety. Must impair functionin

Non-pharm PMS management?

CBT, sleep hygiene, exercise, ↓ caffeine, ↓ sugar, ↓ salt, small carb meals.

Calcium carbonate role in PMS

May reduce mild PMS symptoms (mood, cravings, water retention).

First-line drug class for severe PMS/PMDD?

SSRIs