1282020 Nathaelf Hyppolite 2 Primary dysmenorrhea which is

Ø Primary dysmenorrhea, which is defined as painful menses in women with normal pelvic

Ø The prevalence of dysmenorrhea is highest in adolescent women, with estimates ranging from

Ø Dysmenorrhea is thought to be caused by the release of prostaglandins in the

Ø Age < 20 years Ø Attempts to lose weight Ø Depression/anxiety Ø Disruption

Ø History and physical examination – perform only an abdominal examination in young adolescents

ØA = consistent, good-quality, patient-oriented evidence Ø B = inconsistent or limited quality patient-oriented

Ø NSAIDs are the initial therapy of choice in patients with presumptive primary dysmenorrhea.

Ø American Family Physician January 15, 2005 Volume 71, Number 2 12/8/2020 Nathaelf Hyppolite

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12/8/2020 Nathaelf Hyppolite 2

Ø Primary dysmenorrhea, which is defined as painful menses in women with normal pelvic anatomy, usually begins during adolescence. It is characterized by crampy pelvic pain beginning shortly before or at the onset of menses and lasting one to three days. 12/8/2020 Nathaelf Hyppolite 3

Ø The prevalence of dysmenorrhea is highest in adolescent women, with estimates ranging from 20 to 90 percent, depending on the measurement method used. Ø A longitudinal study of a representative cohort of Swedish women found a prevalence of dysmenorrhea of 90 percent in women 19 years of age and 67 percent in women 24 years of age. 12/8/2020 Nathaelf Hyppolite 4

Ø Dysmenorrhea is thought to be caused by the release of prostaglandins in the menstrual fluid, which causes uterine contractions and pain. Ø Vasopressin also may play a role by increasing uterine contractility and causing ischemic pain as a result of vasoconstriction. – Elevated vasopressin levels have been reported in women with primary dysmenorrhea. 12/8/2020 Nathaelf Hyppolite 5

Ø Age < 20 years Ø Attempts to lose weight Ø Depression/anxiety Ø Disruption of social networks Ø Heavy menses Ø Nulliparity Ø Smoking 12/8/2020 Nathaelf Hyppolite 6

Ø History and physical examination – perform only an abdominal examination in young adolescents with a typical history who have never been sexually active Ø Always R/O secondary dysmenorrhea – Pelvic mass, abnormal vaginal discharge… Ø Ultrasonography Ø laparoscopy 12/8/2020 or laparotomy with biopsy Nathaelf Hyppolite 7

ØA = consistent, good-quality, patient-oriented evidence Ø B = inconsistent or limited quality patient-oriented evidence Ø C = consensus, disease-oriented evidence, usual practice, opinion, or case series. 12/8/2020 Nathaelf Hyppolite 8

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Ø NSAIDs are the initial therapy of choice in patients with presumptive primary dysmenorrhea. Because all NSAIDs are equal in efficacy, agent selection should be guided by cost, convenience, and patient preference, with ibuprofen or naproxen being a good choice for most patients. 12/8/2020 Nathaelf Hyppolite 13

Ø American Family Physician January 15, 2005 Volume 71, Number 2 12/8/2020 Nathaelf Hyppolite 14

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