Obstetrics & Gynecology>>>>>Infertility, Endocrinology, and Menstrual Dysfunction
Question 7#

A 17-year-old consults you for evaluation of disabling pain with her menstrual periods. The pain has been present since menarche, and is accompanied by nausea and headache. Her medical history is otherwise unremarkable, and pelvic examination is normal. She is not currently sexually active, and she has not tried any therapy for her dysmenorrhea.

For this patient, select the most ideal treatment for dysmenorrhea.

A. Acupuncture
B. Prostaglandin inhibitors
C. Gonadotropin-releasing hormone (GnRH) analogues
D. Oral contraceptives
E. Narcotic analgesics

Correct Answer is B

Comment:

Primary dysmenorrhea is painful menstruation associated with a normal pelvic examination and with ovulatory cycles. Dysmenorrhea is considered secondary if it is associated with pelvic disease such as endometriosis, uterine myomas, or pelvic inflammatory disease. The pain of dysmenorrhea may be accompanied by other symptoms (nausea, fatigue, diarrhea, and headache), which may be related to excess of prostaglandin F2α. In patients with dysmenorrhea, there is a significantly higher than normal concentration of prostaglandins in the endometrium and menstrual fluid. Conservative measures for treating dysmenorrhea include heating pads and exercise. The two major drug therapies effective in dysmenorrhea are oral contraceptives and antiprostaglandins. Nonsteroidal anti-inflammatory drugs (NSAIDs) function as prostaglandin synthase inhibitors, and are very effective for treatment of dysmenorrhea. These medications may include naproxen, ibuprofen, and mefenamic acid and are very effective in these patients. They are a reasonable first step to manage dysmenorrhea in a patient who does not require contraception. However, for patients who are sexually active, oral contraceptives will provide both protection from unwanted pregnancy and will alleviate the dysmenorrhea, and should be considered first-line therapy. GnRH analogues are sometimes used in several gynecologic pain conditions, but would not be first-line therapy for primary dysmenorrhea. Narcotics would generally be employed only in very severe cases when no other treatment provides adequate relief. There is inconsistent data about the usefulness of acupuncture to treat dysmenorrhea.