Disorders Related to Menstruation

What is Menarche?

the first occurance of menstruation

What is the Menstruation Cycle?

time between onset of one period of menstruation and the onset of the next

What is the Median Menstrual Cycle Length?

28 days

What Menstruation Disorders are Self-Treatable?

• dysmenorrhea

• PMS

What Menstruation Disorders are not Self-Treatable?

• PMDD

• toxic shock syndrome

What is Dysmenorrhea?

painful menstruation, typically involving abdominal cramps

Who is Dysmenorrhea Most Prevelant In?

adolescents

What are the Most Common Symptoms of Dysmenorrhea?

• spasmodic (intermittent) cramping

• fatigue

• headache

What are the Risk Factors for Dysmenorrhea?

• heavy menstrual loss

• irregular menstrual cycle

• age below 30 years old

• pelvic inflammatory disease (PID)

• sexual abuse

• menarche before 12 years old

• BMI less than 20 kg/m²

Which Form of Dysmenorrhea Needs Referral?

secondary (caused by something else like endometriosis, adenomyosis, or ectopic pregnancy)

How Do Uterine Contractions Differ in Dysmenorrhea?

they are more frequent and at a greater pressure (180mmHg compared to normally 120mmHg)

What are the Treatment Goals When Treating Dysmenorrhea?

• resolve or provide significant improvement in pain symptoms

• minimize disruptions of usual activities

What Drug Class is the First Line Treatment for Dysmenorrhea?

NSAIDs (ibuprofen and naproxen)

What is the Max Daily Dose for Acetaminophen?

4000mg per day

What is the Max Daily Dose for Asprin?

4000mg per day

What is the Max Daily Dose for Ibuprofen?

1200mg per day

What is the Max Daily Dose for Naproxen?

660mg per day

How Should NSAIDs be Used to Treat Dysmenorrhea?

• start at onset of menses or 1-2 days prior

• optimal pain relief when taken on a schedule (not PRN)

• switch to a different NSAID if different one doesn’t work after 3-6 cycles

What are Some Precautions/Contraindications for NSAID Use?

• peptic ulcer disease

• risk for GI bleeding

• history of GI ulcers

• anticoagulation use

• 3+ alcoholic drinks per day

• trying to get pregnant

Special Considerations for Treating Dysmenorrhea in Breastfeeding Individuals?

• acetaminophen and ibuprofen are safe

• avoid high-dose aspirin

• naproxen is less optimal due to long half-life

What are the Nonpharmacological Treatment Options for Dysmenorrhea?

• sleep

• hot baths

• heating pad

• exercise

• acupuncture*

• smoking cessation

What are the Mood Symptoms of PMS?

• irriability/anger

• anxiety

• oversensitivity

• difficulty concentrating

• crying spells

• depression

• labile mood

• fatigue

What are the Physical Symptoms of PMS?

• abdominal bloating

• breast tenderness

• appetite changes

• joint/muscle pain

• headache

• insomnia/hypersomnia

How Does PMDD Differ from PMS?

• PMDD has more symptoms with at least 1 significant mood symptom that interferes with normal daily functioning

• PMDD is present the last week of the luteal phase and absent the week after menses while PMS is during the 5 days prior to menses

When is Treatment of PMS Considered Effective?

if it alleviates symptoms by more than 50%

What are the Nonpharmacological Treatment Options for PMS?

• physical exercise

• stress management

• cognitive behavioral therapy (CBT)

• symptom log/calendar

• dietary modifications

What are the Pharmacological Treatments for PMS?

1. NSAIDs

   • reduce physical symptoms

2. Diuretics

   • unlikely to be helpful since PMS causes fluid redistribution not retention

   • ex: ammonium chloride, caffeine, pamabrom

How is PMS Treatment Different in Adolescents?

• avoid combinations with aspirin (risk of Reye Syndrome)

• manage symptoms with lifestyle changes and calcium supplementation

How is PMS Treatment Different in Breastfeeding Individuals?

• avoid herbal products

• vitamins and minerals are generally fine

• avoid diuretics

  • caffeine appears in breast milk about 1 hours after ingestion

What are the Symptoms of Menstrual Toxic Shock Syndrome (TSS)?

• high fever

• profound hypotension

• severe diarrhea

• mental confusion

• renal failure

• erythroderma

• skin desquamation

How Can TSS be Prevented?

avoiding use of tampons or following guidelines on tampon use

What is the Recurrence Rate for TSS?

28-64%