Menstrual Syndromes

painful menstrual periods
classified as primary and secondary

**more common**
**pain in a pt with normal pelvic anatomy and no underlying pathology**
**onset before 20 y/o**

**pain is cyclical and crampy
associated sx: HA, nausea, inner thigh pain, LBP**

**underlying pelvic pathology**
**onset after 20**
**pain is progressive with age**

**increased prostaglandin activity in the unterus causes uterine contractions and ischemia**
**smooth muscle contraction is stimulated and a vasodilator inhibits platelet aggregation**
**Primary: usually secrete an increased amt of vasopressin, which causes myometrial hyperactivity and vasoconstriction resulting in ischemia and pain**

**PE pelvic tenderness, cervical motion tenderness, uterosacral nodularity, enlarged ovaries, or fixed urterus**
**Serum Ca 125 may be elevated**
**NSAIDs and OC for pain control**
**surgical ablation possible tx**

**NSAIDs are 80-85% effective**
OC: 50-80% effective**
**More effective in conjunction**

unilocular, <6 mc, and normal CA-125 tx with NSAIDs or OCs

**physical, emotional, and behavioral symptoms that occur during the luteal phase**
**etiology unclear**
**sx during luteal phase**
**sx remit during folicular phase**

severe form of PMS that affects pts ability to fcn

**most common: emotional liability, anger, irritability, anxiety, depression, and "feeling out of control"**
**other common sx: fluid retention, edema, breast tenderness, HA, and dietary cravings**

**Calcium: 1,200 mg/day**
**Pyridoxine (vitamin B6): 50 mg/day for irritability, breast enderness, fatigue, and bloating**
**Magnesium 200-360 mg/day**

**SSRIs-intermittent tx (dosing during luteal phase only); first line**
**Buspirone and Alprazolam for anxiety (luteal phase dosing); 2nd line due to addictive properties**

-Sprionolactone for fluid retention and bloating: 1-- mg daily during luteal phase

**OC to elminate the hormonal fluctuations**
**effect is still unclear**

-Cycle: 21-35 days
-Bleeding days: 4-8 days
-

**Oligomenorrhea-intervals>35 days**
**Polymenorrhea-intervals<24 days**
**Menorrhagia-regular normal intervals with excessive flow or duration**
**Metrorrhagia-irregular intervals with excessive flow or duration**

Menorrhagia occurring in the absence of structural uterine disease

**OC: regulate the menstrual cycle and decrease the amt of blood flow**
**NSAIDs: decrease the amount of blood flow**