What is the typical onset of Dysmenorrhea? Within 2 years of menarche Painful menstruation caused by excess prostaglandin and leukotriene levels Primary dysmenorrhea What Sx occur with primary dysmenorrhea? Uterine contraction, N/V, and Diarrhea Painful menstruation caused by an identifiable condition, normally of the uterus or pelvic Secondary dysmenorrhea What are some conditions that cause secondary dysmenorrhea? Endometriosis, Adenomyosis, Fibroids, PID, and IUDs What is the MC population that suffers from Secondary Dysmenorrhea? Women >25 yo What is the MC population that suffers from Primary Dysmenorrhea? Late teens and early 20's An 18 yo female presents to your clinic with complaints of cramps that radiate to her lower back and diarrhea. She says that it started when her period started, but has continues for 3 days now. You preform a PE, and note that everything is normal. Her labs also come back as normal. Dx? Tx? Primary dysmenorrhea NSAIDS --> start 2 days prior to start of menses and continue for 1-3 days A 27 yo female comes in with complaints of cramps that radiate to her lower back, bloating, and pain with sex. She states that it does not necessarily occur with the first day of her cycle. You note in her chart that she had an IUD placed ~6 months ago. You preform a PE and draw labs. PE is normal, and labs are all normal. Dx? Tx? Secondary Dysmenorrhea Treat underlying cause if possible, NSAIDS, if severe in this case, remove IUD What is the average length of time that perimenopause lasts? 3-5 years By definition, what is menopause? The last menses What is the average age of menopause? 51.5 years old What is the average age range most women enter Menopause in? 44-55 yo What is associated directly with early onset menopause? Smoking Premature menopause occurs before the age of what? 40 yo Which type of estrogen is the predominant circulating estrogen during Menopause? Estrone What is the MC Vasomotor Sx that menopausal women experience? When do they most commonly occur (time of day)? How long does it take for them to cease? Hot flashes At night 2-3 years What level of FSH is diagnostic of Menopause? >30 What lifestyle change has been directly associated with relieving Menopause Sx? Increasing exercise HRT for Menopause increases the women's chance of developing what? Cardiovascular probs, Breast CA, and Cognitive decline What are the absolute CI's to HRT in a menopausal women? Undiagnosed vaginal bleeding, acute vascular thrombosis, liver probs, and Hx of endometrial/ovarian CA Name that condition: Abnormal uterine bleeding in the absence of an anatomical lesion DUB What is the MC origin of DUB? Hypothalamic-pituatary-ovarian hormonal axis What are the MC times for DUB to occur? Shortly after Menarche and during Perimenopause How can you Tx DUB? 1. Conservative Tx 2. OCPs 3. Progestin trial 4. D&C 5. Hysterectomy Which virus is directly linked to Cervical CA? HPV strains 16, 18, 31, and 33 Which HPV strains are strongly linked to Condylomata Acuminata? HPV strains 6 and 11 What is the MC age group that suffers from CIN? MC age group for CIS? MC age group for Cervical CA? Women in their 20's Women 25-35 Women >40 yo