46. Dysmenorrhea

Duration = 3:24

00:00
APGO educational topic number 46
00:02
dysmenorrhea meet Aunt Flo she is a
00:05
popular euphemism that refers to a
00:07
woman’s menstrual cycle in this video we
00:10
will discuss what happens when Aunt Flo
00:12
turns painful the objectives of this
00:14
video are to define dysmenorrhea and
00:16
distinguish primary from secondary
00:18
dysmenorrhea describe the
00:20
pathophysiology and identify the
00:22
ideologies of dysmenorrhea discuss the
00:25
steps in the evaluation and management
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of dysmenorrhea dysmenorrhea is defined
00:30
as painful menstruation it can be severe
00:32
enough to prevent a woman from
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performing normal activities and it can
00:36
be accompanied by diarrhea nausea
00:37
vomiting headache and dizziness primary
00:41
dysmenorrhea has no clinically
00:42
identifiable cause so here is Aunt Flo
00:44
with a molotov cocktail of
00:46
prostaglandins secondary dysmenorrhea on
00:49
the other hand does have a clinically
00:50
identifiable cause so here is an
00:52
endometriosis cop handcuffing on Flo
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primary dysmenorrhea is thought to be
00:57
secondary to excess production of
00:59
prostaglandins which leads to painful
01:01
uterine muscle activity
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the greatest incidence is in women in
01:06
their late teens and early 20s let’s
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spend a moment to discuss the
01:10
pathophysiology of primary dysmenorrhea
01:13
prostaglandins are smooth muscle
01:14
stimulants
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prostaglandin f2 alpha is produced in
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the endometrium progesterone increases
01:20
production of prostaglandin f2 alpha and
01:23
don’t forget that progesterone levels
01:25
peak ad or soon before the start of
01:27
menstruation secondary dysmenorrhea has
01:30
a clinically identifiable cause it is
01:33
more common as a woman ages because it
01:35
accompanies the rising prevalence of
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causal factors common causes include
01:39
endometriosis adenomyosis pelvic
01:42
inflammatory disease and leiomyoma too
01:44
let’s now move to evaluation and
01:46
management take a careful history find
01:50
out if it’s lower abdominal or super
01:52
pubic area if there is fatigue low back
01:54
pain or headache which are common and
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ascertain how much the pain is
01:58
interfering with our daily activities
02:00
such as school work or sports on
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physical examination look for any clues
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for clinically identifiable causes of
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secondary dysmenorrhea irregular
02:10
enlargement of the uterus suggest
02:11
fibroids and enlarged boggy uterus
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suggest adenomyosis painful uterus
02:16
sacral nodules or restricted motion of
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the uterus suggest endometriosis also
02:21
remember to screen for gonorrhea and
02:22
chlamydia to evaluate for infection
02:24
let’s now move on to management one of
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the first-line treatments is
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non-steroidal anti-inflammatory drugs
02:31
for these are prostaglandin synthase
02:32
inhibitors other management options
02:35
include heat such as heating pads
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exercise psychotherapy and reassurances
02:40
oral contraception is effective for it
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suppresses ovulation and the stabilizes
02:45
estrogen and progesterone levels with
02:48
the resulting decrease in endometrial
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prostaglandin production the therapy for
02:52
secondary dysmenorrhea is similar to the
02:54
therapy for primary dysmenorrhea with
02:56
primarily symptomatic therapy and if
02:58
possible therapy should be directed at
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the underlying condition this concludes
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the aapko video on dysmenorrhea we have
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defined primary and secondary
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dysmenorrhea discuss pathophysiology and
03:09
discuss steps in the evaluation and
03:11
management of dysmenorrhea
03:20
you


Introductory Women's HealthCare