Upon completion of the chapter, the reader will be able to:
Describe the underlying etiology of dysmenorrhea, amenorrhea, anovulatory bleeding, heavy menstrual bleeding, and menopause.
Explain the physiologic changes associated with dysmenorrhea, amenorrhea, anovulatory bleeding, heavy menstrual bleeding, and menopause.
Identify the signs and symptoms associated with dysmenorrhea, amenorrhea, anovulatory bleeding, heavy menstrual bleeding, and menopause.
Determine the desired therapeutic outcomes for patients with dysmenorrhea, amenorrhea, anovulatory bleeding, heavy menstrual bleeding, and patients taking menopausal hormone therapy (MHT).
Explain how to evaluate a patient for the appropriate use of MHT.
Recommend appropriate nonpharmacologic and pharmacologic interventions for dysmenorrhea, amenorrhea, anovulatory bleeding, heavy menstrual bleeding, and menopausal symptoms.
Design a monitoring plan to assess the safety and effectiveness of pharmacotherapy for dysmenorrhea, amenorrhea, anovulatory bleeding, heavy menstrual bleeding, and a patient taking MHT.
Menstrual cycle disorders are common amongst women of reproductive age. The most common include dysmenorrhea, amenorrhea, anovulatory bleeding, and heavy menstrual bleeding. Menstruation-related disorders can negatively affect quality of life (QOL), reproductive health, and productivity and may also lead to long-term health consequences. As menstruation begins to cease, the perimenopause and menopause phases begin. During this time, irregular menses, vaginal dryness, dyspareunia, hot flashes, and mood swings may occur. This chapter explores the most common menstruation-related disorders women face and symptoms associated with menopause.
Dysmenorrhea is pelvic pain, generally described as painful cramping, occurring during or just prior to menstruation. Primary dysmenorrhea occurs with normal pelvic anatomy and physiology, whereas secondary dysmenorrhea is associated with underlying pelvic pathology.1
Epidemiology and Etiology
Dysmenorrhea is the most commonly reported menstrual complaint, with over 50% of menstruating women reporting pain for at least 1 or 2 days each month.2 Of adolescents with dysmenorrhea, up to 12% report missing work or school each month due to pain.3 Risk factors include irregular or heavy menses, age less than 30, menarche prior to age 12, body mass index less than 20 kg/m2, history of sterilization or sexual abuse, and smoking.1,4 Causes of secondary dysmenorrhea may include endometriosis, pelvic inflammatory disease (PID), uterine or cervical polyps, and uterine fibroids.3,4
In primary dysmenorrhea, elevated arachidonic acid levels in the menstrual fluid lead to increased concentrations of prostaglandins and leukotrienes in the uterus. This induces uterine contractions, stimulates pain fibers, reduces uterine blood flow, and causes uterine hypoxia.4
Desired treatment outcomes (Figure 50–1) are reduction of pelvic pain, improved QOL, and fewer missed days from school and work.
Treatment algorithm for dysmenorrhea. (CHC, combination hormonal contraceptive; IUD, intrauterine device; MPA, medroxyprogesterone acetate; NSAID, nonsteroidal anti-inflammatory drug.) ...