Female Health
Begins with onset of menses and ends with ovulation
What is the Follicular phase of the menstrual cycle
Remember the physiology -
Corpus luteum from previous cycle involutes --> decreased levels of estradiol and progesterone --> release of GnRH
(gonadotropin-releasing hormone) --> increased levels of LH and FSH
Begins with ovulation – ends with menstruation
What is the Luteal phase - this is known as the most constant phase
Painful menstruation in the absence of pelvic pathology
What is Primary Dysmenorrhea
This accounts for ~ 90% of dysmenorrhea (cause of...)
Remember:
Primary dysmenorrhea begins when adolescents attain ovulatory cycles
Within 6-12 months of menarche (ACOG, 2019) - some say 1-2 years
PATHO – hyperactivity of the myometrium with accompanying uterine ischemia – considered to
play a significant role in pain.
Prostaglandins = increase myometrial hyperactivity
◦ During the cycle Prostaglandins -->cause uterine contraction to expel the lining -->Elevated levels of PG increase contractions and compress surrounding vessels -->cuts off oxygen to the tissues --> PAIN and CRAMPING --> which is often the presenting symptom patients will admit or present with.
Inhibit the production of prostaglandins --> decrease cramping --> decrease pain
What are NSAIDS
Characterized by depressed or labile mood, anxiety, irritability and anger occurring exclusively during the 2 weeks preceding menses
vs
A group of physical, cognitive, affective and behavioral symptoms that occur several days to 1-2 weeks before menses
What is PMDD vs PMS
PMDD-
The symptoms must be severe enough to interfere with functioning (school/occupational/social)
• A distressing and disabling condition that requires treatment (unlike the more common PMS)
• DSMV – established 5 criteria for the diagnosis of PMDD
PMS- characterized by the following:
Recurrent during the luteal phase of the menstrual cycle
• Resolves within 4 days after the onset of menstruation
• Variable but significant severity that can result in deterioration of interpersonal relationships and normal activity
Important for the PNP to remember that there is a screening tool that we can use -
The PSST- A Validated tool that scores the severity of premenstrual symptoms