Menstruation

What is menarche?

the first occurrence of menstruation

When does the average female get her first period? How long dose it last?

12 years

28 days

What menstruation related diseases are able to be self-treated?

dysmenorrhea and PMS

Cannot self-treat PMDD or TSS

What is dysmenorrhea?

painful menstruation, abdominal cramps

most prevalent gynecological problem among young women

prevalence is highest in adolescence

What are some common symptoms of dysmenorrhea?

spasmodic cramping, fatigue, headache, etc.

What are some risk factors for developing dysmenorrhea?

heavy/irregular menstrual cycles

less than 30 y/o

menarche before 12 y/o

low BMI (under 20)

What is the difference between primary and secondary dysmenorrhea?

Primary - SELF TREATABLE, cramps DURING period, starts 6-12 months after menarche, responds to NSAIDs

Secondary - CANNOT SELF TREAT, due to underlying issue, irregular, potentially not aligned with period

FITB: Dysmenorrhea is associated with elevated levels of _____ and _____.

prostaglandins and leukotrienes

What are the goals of treating dysmenorrhea?

improve symptoms, minimize disruptions to daily activities

When is self care of dysmenorrhea appropriate?

healthy young women who have primary dysmenorrhea and are not sexually active

When should we refer a patient with dysmenorrhea?

sexually active patients

characteristics of secondary dysmenorrhea

severe pain or change in pain

non-responsive to NSAIDs

What pharmacologic therapy can we use for dysmenorrhea? (include dosing regimen)

NSAIDs are 1st line

Ibuprofen - 200-400mg every 4-6 hrs (NTE 1200 mg/day)

Naproxen - 220-400mg initially, then 220mg every 8-12 hrs (NTE 660 mg/day)

Acetaminophen - 650-1000mg every 4-6 hrs (NTE 4000 mg/day)

Aspirin - 650-1000mg every 4-6 hrs (NTE 4000 mg/day)

*these are per mconaha, not mcfalls

What is the 1st line pharmacologic therapy for dysmenorrhea?

NSAIDs

Ibuprofen - 200-400mg every 4-6 hrs (NTE 1200 mg/day)

Naproxen - 220-400mg initially, then 220mg every 8-12 hrs (NTE 660 mg/day)

refer is these do not work

most effective when taken on a schedule

if pt does not respond, try a different NSAID

wait 3-6 cycles before considering a treatment a failure

What other pharmacologic therapies can we use for dysmenorrhea?

Acetaminophen - 650-1000mg every 4-6 hrs (NTE 4000 mg/day)

Aspirin - 650-1000mg every 4-6 hrs (NTE 4000 mg/day)

These are both less effective

When recommending NSAIDs to a patient, what patient factors must we keep in mind?

peptic ulcer disease, GI bleeding, GI ulcers

anticoagulation use

3+ alcoholic drinks/day

What pharmacologic options are safe for pregnant/trying for pregnancy women experiencing dysmenorrhea?

pregnant women should not be experiencing dysmenorrhea - REFER

avoid NSAIDs if trying to become pregnant and during pregnancy

What pharmacologic options are safe for lactating women experiencing dysmenorrhea?

acetaminophen and ibuprofen are safe

avoid naproxen due to long half life

avoid aspirin

What nonpharmacologic therapies can be used for dysmenorrhea?

sleep, hot baths, heating pads, exercise, acupuncture, smoking cessation

A 13-year old girl is asking you for recommendations for her cramps. Her symptoms coincide with her period and are most bothersome during the first 2 days. She uses a warm water bottle and sometimes tries aspirin, but this has not been effective. What therapies would you recommend, and which are 1st line?

PHARMACOLOGIC

1st line - NSAIDs taken on a schedule

Ibuprofen - 200-400mg every 4-6 hrs (NTE 1200 mg/day)

Naproxen - 220-400mg initially, then 220mg every 8-12 hrs (NTE 660 mg/day)

2nd line

Acetaminophen - 650-1000mg every 4-6 hrs (NTE 4000 mg/day)

NONPHARMACOLOGIC

sleep, hot baths, heating pads, exercise, acupuncture, smoking cessation

What are premenstrual disorders?

PMS (self treatable) and PMDD (not self treatable)

set of symptoms occurring before menses

likely due to fluctuation of estrogen and progesterone

What symptoms may a patient with PMS/PMDD experience?

mood changes - irritability, crying, anxiety

physical symptoms - bloating, breast tenderness, joint pain

What is the difference between PMS and PMDD?

PMS usually experiences 1-4 symptoms, has a minimal effect on normal daily functions

PMDD usually experiences 5 or more symptoms, interferes with daily functioning

What nonpharmacologic therapies can be used for PMS?

exercise, stress management, CBT, symptom log, dietary mods

What pharmacologic therapies can be used for PMS?

all of these have conflicting data

Calcium and Vit D. - strongest candidate

Pyroxidine

Magnesium

Vit E

NSAIDs - for physical symptoms

Diuretics - unlikely to be effective, but commonly used

What pharmacologic options are safe for pregnant women experiencing PMS?

pregnant women do not experience PMS - REFER

What pharmacologic options are safe for adolescents experiencing PMS?

avoid aspirin

try nonpharm/lifestyle mods first

NSAIDs and acetaminophen ok if needed

What pharmacologic options are safe for breastfeeding women experiencing PMS?

avoid herbals and diuretics

try nonpharm/lifestyle mods first

ibuprofen and acetaminophen ok (not naproxen)

What is TSS?

toxic shock syndrome

severe illness

What symptoms might a patient with TSS be experiencing?

fever, hypotension, diarrhea, confusion

What is TSS caused by?

a staph infection

produces superantigen toxin

Who experiences TSS?

anyone, but most commonly in women 13-19 y/o

linked to tampon use

Is TSS self treatable?

NO, REFER!