NR 602: MIDTERM STUDY GUIDE
QUIZ
Etiology, diagnosis, and treatment of dysmenorrhea (primary vs. secondary)
Dysmenorrhea—defined as painful cramps that occur with menstruation—is the most commonly report
menstrual disorder, affecting as many as 81% of women
• Etiology-- The pain of dysmenorrhea originates from intense uterine contractions
during the menstrual phase of the cycle, triggering endometrial prostaglandin
production and release.
o The excessive amount of prostaglandins causes the uterus to contract further,
reducing uterine blood flow and causing ischemia and pain.
o While the etiology of dysmenorrhea is not completely understood, studies
support the hypothesis that uterine inflammation with menstrual cycles may
also promote cross- organ pain sensitization, a mechanism by which
dysfunction in one organ elicits neurogenic inflammation in another organ
o The uterus lies in close proximity to the bladder, the bowel, and the
peritoneum, and its contraction may elicit pain in those structures during the
menstrual cycle.
o This theory, along with the current knowledge about prostaglandins’ major
role in dysmenorrhea, may help explain the chronicity of pain that may occur
throughout the pelvic area during the menstrual cycle.
• Primary (absence of pelvic pathology)
o more common than secondary dysmenorrhea,
o often begins 6 to 12 months after menarche.
, NR 602: MIDTERM STUDY GUIDE
QUIZ
o Typically symptoms are experienced with the onset of bleeding and continue
for 8 to 72 hours into the menstrual cycle.
o Increased endometrial prostaglandin production is believed to be the
cause of the associated pain
o It is associated with multiple symptoms, including abdominal cramps,
headache, backache, general body aches, continuous abdominal pain,
and other somatic discomforts.
o The difference between primary dysmenorrhea and normal somatic and
psychological changes prior to menses is that primary dysmenorrhea is
perceived as more severe, with chronic, sometimes debilitating symptoms.
o There is no evidence of organic pathology in the uterus, fallopian tubes, or
ovaries with primary dysmenorrhea.
o Women usually report repeated symptomology with each cycle.
o When charting their cycles, it is evident that that pain, bleeding, and
disruption of lifestyle occur at regular times in the cycle.
o There is a higher prevalence of depression and anxiety in women who
experience pelvic pain or dysmenorrhea
• Secondary (occurring from identifiable organic pathology).
o Diagnosis of secondary dysmenorrhea includes pelvic pathology such as
adenomyosis, leiomyomata, irritable bowel syndrome, interstitial cystitis, and
endometriosis
o Almost any process that can affect the pelvic viscera and cause acute or
intermittent recurring pain might be a source of cyclic premenstrual pain,
including urinary tract infection, pelvic inflammatory disease, hernia, and
pelvic relaxation or prolapse
o Clinical findings may differ from primary dysmenorrhea in that they may include
reports of dyspareunia (pain with intercourse), postcoital bleeding, and
abnormal uterine bleeding.
o The pelvic pain associated with secondary dysmenorrhea may occur before,
, NR 602: MIDTERM STUDY GUIDE
QUIZ
during, or after menses.
o The most common cause of secondary dysmenorrhea is endometriosis—a
chronic condition in which the endometrial lining is implanted outside the
uterus.
o Another cause of secondary dysmenorrhea is uterine fibroids (leiomyomas, myomas).
• The pain associated with either primary or secondary dysmenorrhea may be similar,
although pain that has increased over time is more often associated with secondary
dysmenorrhea.
• Treatment
o Nonpharmacologic Treatments
• Heat
• Lifestyle changes
• Vitamins and herbal supplements
• Acupuncture
o Pharmacologic Treatments
• NSAIDS: start taking 2-3 days before the start of menses; more likely to
be effective for primary dysmenorrhea than for secondary
dysmenorrhea because of the associated underlying pathology that
often accompanies the latter
• Oral contraceptives
, NR 602: MIDTERM STUDY GUIDE
QUIZ
• Progestin implants
• Progestin IUD
• Depo Medroxyprogesterone Acetate
• Surgical intervention—extreme measure
Differentiate between PMS & PMDD
• Premenstrual syndrome (PMS) describes the cyclical recurrence of symptoms that
impair a woman’s health, relationships, and occupational functioning.
o PMS can be defined as a cluster of mild to moderate physical and psychological
symptoms that occur during the late luteal phase of menses and resolve with
menstruation
• Premenstrual dysphoric disorder (PMDD) is a diagnostic label that applies to a much smaller
number of menstruating women experiencing severe PMS with predominantly negative
affective symptoms.
o PMDD encompasses cognitive, behavioral, emotional, and negative
symptomatic changes that severely impair daily functioning, relationships,
parenting, and ability to work in the late luteal menstrual phase
The diagnostic criteria for PMDD are as follows:
o In the majority of cycles, five or more symptoms, including affective and
physical symptoms, are present during the week before menses and are
absent in the follicular phase.
o One (or more) of the following symptoms is present: irritability,
depressed mood, marked anxiety, tension, or affective lability.
o One or more of the following symptoms must additionally be present (the
combination of symptoms in I and II must total five): decreased interest in
usual activities, difficulty concentrating, fatigue, appetite change (decreased or
increased), changes in sleep patterns (hypersomnia or insomnia), sense of
feeling overwhelmed, physical symptoms such as breast tenderness, joint or
muscle pain, bloating, or weight gain.
o The symptoms markedly interfere with occupational or social functioning.
QUIZ
Etiology, diagnosis, and treatment of dysmenorrhea (primary vs. secondary)
Dysmenorrhea—defined as painful cramps that occur with menstruation—is the most commonly report
menstrual disorder, affecting as many as 81% of women
• Etiology-- The pain of dysmenorrhea originates from intense uterine contractions
during the menstrual phase of the cycle, triggering endometrial prostaglandin
production and release.
o The excessive amount of prostaglandins causes the uterus to contract further,
reducing uterine blood flow and causing ischemia and pain.
o While the etiology of dysmenorrhea is not completely understood, studies
support the hypothesis that uterine inflammation with menstrual cycles may
also promote cross- organ pain sensitization, a mechanism by which
dysfunction in one organ elicits neurogenic inflammation in another organ
o The uterus lies in close proximity to the bladder, the bowel, and the
peritoneum, and its contraction may elicit pain in those structures during the
menstrual cycle.
o This theory, along with the current knowledge about prostaglandins’ major
role in dysmenorrhea, may help explain the chronicity of pain that may occur
throughout the pelvic area during the menstrual cycle.
• Primary (absence of pelvic pathology)
o more common than secondary dysmenorrhea,
o often begins 6 to 12 months after menarche.
, NR 602: MIDTERM STUDY GUIDE
QUIZ
o Typically symptoms are experienced with the onset of bleeding and continue
for 8 to 72 hours into the menstrual cycle.
o Increased endometrial prostaglandin production is believed to be the
cause of the associated pain
o It is associated with multiple symptoms, including abdominal cramps,
headache, backache, general body aches, continuous abdominal pain,
and other somatic discomforts.
o The difference between primary dysmenorrhea and normal somatic and
psychological changes prior to menses is that primary dysmenorrhea is
perceived as more severe, with chronic, sometimes debilitating symptoms.
o There is no evidence of organic pathology in the uterus, fallopian tubes, or
ovaries with primary dysmenorrhea.
o Women usually report repeated symptomology with each cycle.
o When charting their cycles, it is evident that that pain, bleeding, and
disruption of lifestyle occur at regular times in the cycle.
o There is a higher prevalence of depression and anxiety in women who
experience pelvic pain or dysmenorrhea
• Secondary (occurring from identifiable organic pathology).
o Diagnosis of secondary dysmenorrhea includes pelvic pathology such as
adenomyosis, leiomyomata, irritable bowel syndrome, interstitial cystitis, and
endometriosis
o Almost any process that can affect the pelvic viscera and cause acute or
intermittent recurring pain might be a source of cyclic premenstrual pain,
including urinary tract infection, pelvic inflammatory disease, hernia, and
pelvic relaxation or prolapse
o Clinical findings may differ from primary dysmenorrhea in that they may include
reports of dyspareunia (pain with intercourse), postcoital bleeding, and
abnormal uterine bleeding.
o The pelvic pain associated with secondary dysmenorrhea may occur before,
, NR 602: MIDTERM STUDY GUIDE
QUIZ
during, or after menses.
o The most common cause of secondary dysmenorrhea is endometriosis—a
chronic condition in which the endometrial lining is implanted outside the
uterus.
o Another cause of secondary dysmenorrhea is uterine fibroids (leiomyomas, myomas).
• The pain associated with either primary or secondary dysmenorrhea may be similar,
although pain that has increased over time is more often associated with secondary
dysmenorrhea.
• Treatment
o Nonpharmacologic Treatments
• Heat
• Lifestyle changes
• Vitamins and herbal supplements
• Acupuncture
o Pharmacologic Treatments
• NSAIDS: start taking 2-3 days before the start of menses; more likely to
be effective for primary dysmenorrhea than for secondary
dysmenorrhea because of the associated underlying pathology that
often accompanies the latter
• Oral contraceptives
, NR 602: MIDTERM STUDY GUIDE
QUIZ
• Progestin implants
• Progestin IUD
• Depo Medroxyprogesterone Acetate
• Surgical intervention—extreme measure
Differentiate between PMS & PMDD
• Premenstrual syndrome (PMS) describes the cyclical recurrence of symptoms that
impair a woman’s health, relationships, and occupational functioning.
o PMS can be defined as a cluster of mild to moderate physical and psychological
symptoms that occur during the late luteal phase of menses and resolve with
menstruation
• Premenstrual dysphoric disorder (PMDD) is a diagnostic label that applies to a much smaller
number of menstruating women experiencing severe PMS with predominantly negative
affective symptoms.
o PMDD encompasses cognitive, behavioral, emotional, and negative
symptomatic changes that severely impair daily functioning, relationships,
parenting, and ability to work in the late luteal menstrual phase
The diagnostic criteria for PMDD are as follows:
o In the majority of cycles, five or more symptoms, including affective and
physical symptoms, are present during the week before menses and are
absent in the follicular phase.
o One (or more) of the following symptoms is present: irritability,
depressed mood, marked anxiety, tension, or affective lability.
o One or more of the following symptoms must additionally be present (the
combination of symptoms in I and II must total five): decreased interest in
usual activities, difficulty concentrating, fatigue, appetite change (decreased or
increased), changes in sleep patterns (hypersomnia or insomnia), sense of
feeling overwhelmed, physical symptoms such as breast tenderness, joint or
muscle pain, bloating, or weight gain.
o The symptoms markedly interfere with occupational or social functioning.
