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Dysmenorrhea

Gynecology

QuestionAnswer
PMS course 1-2 weeks before menses (during luteal phase) to 1-2 days post onset; symptom-free during follicular phase
DUB causes usually increased anovulatory cycles; also PCOS, obesity, adrenal hyperplasia
endometriosis pathophysiology endometrial glands & stroma outside endometrium, usually pelvis or on ovary (90%) or distant
Amenorrhea: pathophysiology (if low/normal FSH): HPA tumor, Cushing, hypothyroid, high testosterone, uterine malformation.
Dysmenorrhea: tx Heat, thiamine; vitamin E; NSAIDs, celebrex; OCPs. Laparoscopy if tx failure (to rule out causes of secondary dysmenorrhea)
Cervicitis: etiology often CT/NG; or idiopathic
Amenorrhea: dx tests LH, FSH, prolactin, testosterone, TSH, FT4, hCG, DHEA-S, estradiol
secondary dysmenorrhea etiology endometriosis, adenomyosis, uterine leiomyomata, chronic PID. Onset usually after age 25
primary dysmenorrhea etiology frequent/ prolonged uterine contractions mediated by prostaglandins -> decreased blood flow to myometrium -> ischemia (uterine "angina"). Onset 1-2 yrs post-menarche
Chronic pelvic pain sx Intermittent, cyclical, dull, nonspecific, diffuse. Generally afebrile
Endometriosis sx Dysmenorrhea; dyspaurenia; low back pain. Adhesive dz possible. Improved with suppression of ovulation
Osteitis pubis Symphysis pain; Pelvic joint instability following childbirth
Vulvodynia Vulvar pain; Painful urination; Dyspaurenia; Vaginal and Pelvic floor symptoms
Primary dysmenorrhea: onset within: 1-2 years of menarche
Musculoskeletal pelvic pain includes: Myofascial pain; Muscle spasm; Round ligament; Spinal nerve innervation
Painful bladder syndrome = Dysuria; Negative UA; Urinary Frequency; Dyspareunia ; Dx of exclusion/ autoimmune component
Overweight, irregular menstrual cycles or amenorrhea, infertility, elevated blood sugar, hirsutism = PCOS (Stein-Leventhal syndrome)
Adolescent female with midcycle pain alternating from left to right side. Relieved w/ NSAIDs Mittelschmerz
Dysmenorrhea, dyspareunia, dyschezia. Uterus is fixed, retroflexed. Cyclic pelvic pain. May have palpable pelvic mass = Endometriosis
Palpable pelvic mass (chocolate cyst) = Endometriosis
primary amenorrhea = absence of menses by 13 yo (in pt w/o secondary sexual characteristics) or by 15 yo (in pts having secondary sexual characteristics)
secondary amenorrhea = cessation of menses after onset of menarche, lasting 3+ months
secondary amenorrhea: pt w/o secondary sex characteristics = 2/2 gonad agenesis, pubertal delay, ovarian resistance syndrome, galactosemia, GnRH def, CNS mass lesion
secondary amenorrhea: pt w/ breast devt but no pubic hair = androgen insensitivity
secondary amenorrhea: normal 2nd sex characteristics = imperforate hymen, transverse vaginal septum, mullerian dysgenesis
secondary amenorrhea: incomplete 2nd sex characteristics = HPA tumor, hypothyroid, hyperprolactinemia, premature ovar failure
secondary amenorrhea, not PG: Asherman syndrome (uterine synechiae) or PCOS
primary dysmenorrhea = painful menses 2/2 xs prostaglandin E2 secretion; onset near menarche, peaks in late teens
secondary dysmenorrhea = 2/2 other condition (endometriosis, adenomyosis, fibroids); usu >25 yo
Ectopic PG sx Missed menses/unusual menses; Lower abdominal/pelvic pain; Vaginal bleeding; Positive PG test
Ovarian cyst sx Unilateral/diffuse; Sharp; Spontaneous resolution common; Uncommon on OCPs
Ovarian torsion sx severe pain, down legs/back
average uterine length = 6-8 cm
uterine (apical) prolapse grading 0 (no descent) to 4 (thru hymen)
anterior vaginal wall prolapse includes: cystocele or cystourethrocele
apical vaginal prolapse includes: uretovaginal or vaginal vault prolapse
posterior vaginal prolapse includes: enterocele or rectocele
Atrophic vaginitis often masquerades as: Infection
atrophic vaginitis S/S Pruritis/burning, vaginal dryness, dyspareunia, possibly spotting, pale/thin vaginal mucosa, loss of vaginal rugation; women w/o menses (decreased estrogen)
PCOS pathology Abnormal gonadotropin secretion with excessive androgen production with pituitary suppression
Amenorrhea: pathophysiology (if high FSH): Ovarian, Turner, autoimmune. High LH: pseudohermaphroditism
Menstrual cycle definitions Normal: Q24-38 days. Oligo: interval >36 days. Polymenorrhea: interval <21 days
Primary amenorrhea causes developmental/absence of repro organs, ovarian failure, hypogonadotrophic hypogonadism, androgen insensitivity, chronic anovulation
Secondary amenorrhea causes CNS, pituitary/thyroid/adrenal/ovarian/uterine dysfn, strenuous exercise
endometritis sx/sx usually post C-section or if membrane rupture >24 hours pre-delivery. sx/sx 2-3 days post partum; fever >101F, uterine tenderness
Created by: Abarnard
 

 



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