Dysmenorrhea Flashcards
What is primary dysmenorrhea?
no pelvic abN
What are causes of secondary (acquired) dysmenorrhea?
Infections, Endometriosis, Adnexal AbN
How do you manage Grade 3 (mod severe pain) dysmenorrhea?
NSAIDs, OCP (second line except when contraception is desired)
How do you manage Grade 1/2 dysmenorrhea
counselling
What are non gyne causes of pelvic pain?
IBD, IBS, uteropelvic junction obstruction, psychogenic disorders, abuse
What is the classic triad of endometriosis?
dysmenorrhea, Dyspareunia, Dyschezia
What is a sharp, firm, exquisitely tender “barb” on the uterosacral ligament a classic feature of?
endometriosis
What are the RF for endometriosis?
Family Hx, Nulliparity, Age >25yo, obstructive anomalies of the genital tract
Where does endometriosis occur?
Ovaries (60%), broad ligament, vesicoperitoneal fold, peritoneal surface, rectosignmoid colon, appendix, rare may occur outside abdo/pelvis (lungs; pleura)
A 30 yo nulliparous woman comes to clinic with a complaint of dyspareunia and dysmenorrhea for 2 yrs. Menses occur at regular 28-day intervals. Pelvic exam shows nodularity over the uterosacral area and the uterus is retroverted. Both adnexa are normal-sized but tender. Which of the following is the appropriate next step in diagnosis?
a) CT scan of the abdomen
b) Measurement of serum α-fetoprotein concentration
c) MRI of the pelvis
d) Laparoscopy
e) Measurement of serum CA 125 concentration
Laparoscopy
Dysmenorrhea:
a) Is synonymous with premenstrual syndrome
b) Is pelvic pain that occurs before or during menstruation
c) Is usually associated with ovulatory menstrual cycles
d) Is usually associated with anovulatory menstrual cycles
e) Both B and C
Borth B and C
Carol has been your patient for eight years. She is a nulliparous 29 year old and complains of worsening dysmenorrhea that is unresponsive to anti-inflammatory drugs and oral contraceptives.
What is the most likely dx?
endometriosis
Which findings are likely on physical examination for endometriosis? select up to three.
1) Painful pelvic examination
2) Uterosacral thickening or nodules
3) Fixed, retroverted uterus
4) Tender adnexal mass
5) Colored vaginal or vulvar mass
1) Painful pelvic examination
2) Uterosacral thickening or nodules
3) Fixed, retroverted uterus
4) Tender adnexal mass
5) Colored vaginal or vulvar mass
How do you manage endometriosis?
a) Oral contraceptives (monophasic combine.
b) Medroxyprogesterone
c) Danazol
d) Gonadotropin-releasing hormone (GnRH) agonists (leuprolide, nagarelin, goserelin, buserelin)
A healthy 17 yo nulliparous female comes to clinic for a routine health maintenance exam. She states that she typically has pelvic pain during days 13 and 14 of her menstrual cycle. She describes the pain as brief and sharp. Menarche was at age of 13 yrs, and menses occur at regular 28-day intervals with moderate flow for the first two days. She has never been sexually active. Physical and pelvic exams show no abnormalities.
dysmenorrhea (mittleschmertz)
