Women's Health Final Review NSG 6430;
Questions & Answers 100% Verified
Primary Amenorrhea Correct answer-Absence of menses: by age 15 years
Often secondary to: dysfunction in the hypothalamus, pituitary, ovaries (HPO
axis), uterus, or vagina
DYSMENORRHEA Correct answer-Painful cramping: associated with menstruation caused
by spasmodic uterine
contractions
Most common GYN problem: in adolescents & adult females
HISTORY: is KEY!!!
Primary versus Secondary
Primary Dysmenorrhea: Absence of pelvic pathology Correct answer-CAUSE: Excessive
Prostaglandins
ONSET: in adolescence
PAIN: starts 1-2 days prior to onset of menses or with menses, resolving over
12-72 hours
ASSOCIATED: with nausea, diarrhea, dizziness, fatigue, HA, back pain
IMPROVES: with NSAIDs, hormonal contraceptives, AGE & PARITY
Secondary Dysmenorrhea: Presence of Pelvic Pathology Correct answer-ONSET: Usually
after age 25 years
, Women's Health Final Review NSG 6430;
Questions & Answers 100% Verified
Abnormal uterine bleeding (AUB)
Variable SX: N, V, D, back pain
Dyspareunia: (esp. w/Endometriosis)
Symptoms: OFTEN worsen over time
Causes: Endometriosis, fibroids, infection/PID, adenomyosis, etc.
Dysmenorrhea Management Correct answer-Get a good history: (medical & menstrual)
Physical exam: to identify a cause
Pelvic exam: may defer if young, non-sexually active adolescents with mild
symptoms
Consider pelvic US: to look for adnexal masses, fibroids, other pelvic
pathology
If secondary, address underlying cause.
Dysmenorrhea Non-Pharm Management Correct answer-HEAT: to lower abdomen = Oral
Analgesics
EXERCISE: improves symptoms
Dysmenorrhea Pharm Management Correct answer-NSAIDs: 80-86% efficacy
o Start at onset of menses for x 1-2+ days
, Women's Health Final Review NSG 6430;
Questions & Answers 100% Verified
o If no relief, consider starting 1-2+ days before
Combination Hormonal Contraceptives (CHC)
Consider BOTH, if no relief with NSAIDs
Intrauterine Contraceptive (IUC): Hormonal
o Mirena or Skyla (smaller) with Levonorgestrel
If NO relief, consider SECONDARY CAUSE
ABNORMAL UTERINE BLEEDING (AUB) Correct answer-Comprehensive, focused history
Many causes: PALM-COEIN classification
Consider DIFFERENTIAL by AGE & HISTORY
Post-menopausal:
o Any bleeding beyond 12 months since LMP o Even "1 drop of blood" is concerning
o Must REFER to OBGYN to R/o cancer
Classification/Differential: PALM-COEIN Correct answer-Structural
P
Polyps:
> 30 years
Questions & Answers 100% Verified
Primary Amenorrhea Correct answer-Absence of menses: by age 15 years
Often secondary to: dysfunction in the hypothalamus, pituitary, ovaries (HPO
axis), uterus, or vagina
DYSMENORRHEA Correct answer-Painful cramping: associated with menstruation caused
by spasmodic uterine
contractions
Most common GYN problem: in adolescents & adult females
HISTORY: is KEY!!!
Primary versus Secondary
Primary Dysmenorrhea: Absence of pelvic pathology Correct answer-CAUSE: Excessive
Prostaglandins
ONSET: in adolescence
PAIN: starts 1-2 days prior to onset of menses or with menses, resolving over
12-72 hours
ASSOCIATED: with nausea, diarrhea, dizziness, fatigue, HA, back pain
IMPROVES: with NSAIDs, hormonal contraceptives, AGE & PARITY
Secondary Dysmenorrhea: Presence of Pelvic Pathology Correct answer-ONSET: Usually
after age 25 years
, Women's Health Final Review NSG 6430;
Questions & Answers 100% Verified
Abnormal uterine bleeding (AUB)
Variable SX: N, V, D, back pain
Dyspareunia: (esp. w/Endometriosis)
Symptoms: OFTEN worsen over time
Causes: Endometriosis, fibroids, infection/PID, adenomyosis, etc.
Dysmenorrhea Management Correct answer-Get a good history: (medical & menstrual)
Physical exam: to identify a cause
Pelvic exam: may defer if young, non-sexually active adolescents with mild
symptoms
Consider pelvic US: to look for adnexal masses, fibroids, other pelvic
pathology
If secondary, address underlying cause.
Dysmenorrhea Non-Pharm Management Correct answer-HEAT: to lower abdomen = Oral
Analgesics
EXERCISE: improves symptoms
Dysmenorrhea Pharm Management Correct answer-NSAIDs: 80-86% efficacy
o Start at onset of menses for x 1-2+ days
, Women's Health Final Review NSG 6430;
Questions & Answers 100% Verified
o If no relief, consider starting 1-2+ days before
Combination Hormonal Contraceptives (CHC)
Consider BOTH, if no relief with NSAIDs
Intrauterine Contraceptive (IUC): Hormonal
o Mirena or Skyla (smaller) with Levonorgestrel
If NO relief, consider SECONDARY CAUSE
ABNORMAL UTERINE BLEEDING (AUB) Correct answer-Comprehensive, focused history
Many causes: PALM-COEIN classification
Consider DIFFERENTIAL by AGE & HISTORY
Post-menopausal:
o Any bleeding beyond 12 months since LMP o Even "1 drop of blood" is concerning
o Must REFER to OBGYN to R/o cancer
Classification/Differential: PALM-COEIN Correct answer-Structural
P
Polyps:
> 30 years
