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INTRODUCTION

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CASE LEARNING OBJECTIVES

  • Describe the clinical presentation of dysmenorrhea and menorrhagia

  • Recommend appropriate nonpharmacologic and pharmacologic interventions for patients with dysmenorrhea and menorrhagia

  • Develop a monitoring plan to assess the effectiveness and safety of pharmacologic therapies for dysmenorrhea and menorrhagia

  • Identify the goals of therapy for dysmenorrhea and menorrhagia

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PATIENT PRESENTATION

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Chief Complaint

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"My cramps are unbearable!"

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History of Present Illness

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Anita Jacob is a 21-year-old Caucasian woman who presents to the clinic complaining of painful menses for the past few months. Her menses last between 6 and 8 days on average and have become increasingly painful. The pain begins 1 day prior to the onset of menses and lasts 2–3 days. The pain is "crampy" in nature. She has heavy menses for 2 days that require her to change feminine hygiene products every 2–3 hours. She has a history of iron-deficiency anemia secondary to menorrhagia that has been successfully treated with iron supplementation. She has tried OTC products that contain ibuprofen without success. Today, she is also complaining of abdominal pain, but denies vaginal discharge.

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Past Medical History

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Iron-deficiency anemia × 6 months

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Menorrhagia × 6 months

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Seasonal allergic rhinitis × 2 years

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Family History

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Father is alive at age 56 with CHD, H/O MI at age 55, dyslipidemia, HTN, and osteoarthritis. Mother is alive at age 54 with osteopenia, HTN, and H/O ovarian cancer. She has one older brother (age 30) and one older sister (age 27) who are both alive and well.

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Social History

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The patient is a single, heterosexual, sexually active female. She has been sexually active since age 15. She does not desire pregnancy at this time. She has had vaginal intercourse with multiple partners (approximately 10–12 men). Her partners use condoms only occasionally. She has been in a monogamous relationship for the past 8 months. She is a student at the local university.

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Tobacco/Alcohol/Substance Use

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Social drinker (3–5 drinks per weekend); (+) tobacco use (1 ppd); (−) illicit drug use. The patient is not ready to quit smoking at this time.

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Allergies/Intolerances/Adverse Drug Events

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Penicillin (rash)

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Medications (Current)

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Fexofenadine 180 mg PO once daily

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Ferrous sulfate 325 mg PO twice daily

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Ibuprofen 200 mg two tablets PO PRN headache and menstrual cramps

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Midol Menstrual Complete two tablets PO PRN menstrual cramps

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Medications (Past)

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Kava kava root capsules 500 mg PO two to three times daily PRN menstrual cramps

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Review of Systems

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Occasional HA relieved with NSAID medication; ...

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