When a period is more than a punctuation mark: Contemporary Perspectives on Dysmenorrhea Management

Transcription

1 When a period is more than a punctuation mark: Contemporary Perspectives on Dysmenorrhea Management Chen Xiao Chen, MS, RN, PhD Candidate University of Wisconsin-Madison

2 Outline Background Definition Classification Impact Pathophysiology Clinical Assessment Management of Dysmenorrhea Pharmacological Treatment Complementary Alternative Treatments Other Treatments

3 Definition Symptoms: Abdominal pain that occurs just before or during menstruation. Other symptoms: low back pain, radiation of pain to the upper thighs, nausea, vomiting, diarrhea, bloating. (IASP, 1994; IASP, 2011; Smith, & Kaunitz, 2013)

4 Definition (con t) Dysmenorrhea vs. Premenstrual Syndrome (PMS) (Chen, Kwekkeboom, & Ward, 2014)

5 Classification Primary Dysmenorrhea No structural lesion. Secondary Dysmenorrhea: Associated with underlying pathology e.g., endometriosis, uterine fibroids, pelvic inflammatory diseases. (IASP, 1994; IASP, 2011)

6 Risk / protective factors Risk factors: Young age Nulliparity Family history Smoking Longer and heavier menstrual flow Protective factors Use of oral contraceptives (Ju, Jones, & Mishra, 2014)

7 Impact Prevalence: 16% - 91% of women of reproductive age. The leading cause of lost work hours in women % of women miss work because of dysmenorrhea. A loss of 600 million working hours. A loss of up to 2 billion dollars annually. Negative impact on physical activity, productivity, healthrelated quality of life, productivity. (Chantler, Mitchell, & Fuller, 2009; Coco, 1999, Dawood, 1988; Iacovides, Avidon, Bentley, & Baker, 2013)

8 Impact Links between Dysmenorrhea and Other Chronic Pain Conditions Dysmenorrhea Commonly co-occurs with other chronic pain conditions. Can exacerbate other chronic pain conditions. Its treatment can relieve symptoms associated with other chronic pain conditions. May increases risks for future pain. (Altman et al., 2006; Amital et al., 2010; Berkley, 2013; Mannix, 2008; Olafsdottir et al., 2012; Yunus et al., 1989; Shaver et al., 2006)

9 Impact (con t) Links between Dysmenorrhea and Other Chronic Pain Conditions Dysmenorrhea Causes significant changes (structural & functional) in the brain. Increases sensitivity to pain. May explain gender disparity in pain. (Brinkert, et al., 2007; Berkley, 2011; Berkley, 2013; Giamberardino et al., 2001; Giamberardino et al., 1997; Giamberardino, 2008; Tu et al., 2009; Tu et al., 2010; Tu et al., 2013; Iacovides, Baker, Avidon, & Bentley, 2013; Vincent et al., 2011)

10 Pathophysiology Membrane phospholipids Prostaglandins Dysrhythmic uterine contractions, ischemia, hypoxia, hyper-sensitization of the peripheral nerve Symptoms of Dysmenorrhea (Chan, Dawood, & Fuchs, 1981; Dawood, 1984; Dawood, 1988; Dawood, 2006)

11 Clinical Assessment of Dysmenorrhea History Physical Examination Pelvic ultrasound Laparotomy or laparoscopy (gold standard for diagnosis of endometriosis) (Smith & Kaunitz, 2013; Speer, 2014)

12 Treatments of Dysmenorrhea Pharmacological Treatments Complementary/Alternative Medicine (CAM) Other Treatments

13 Pharmacological Treatments NSAIDs Well established as effective therapy. More effective than acetaminophen. No evidence suggests any particular NSAIDs is more effective than others. Ideally, administered prior to the onset of menses. (Marjoribanks et al., 2010, Smith et al., 2013; Speer 2014; Tu, 2007)

14 Pharmacological Treatments (con t) Combined oral contraceptives are effective for prevention of dysmenorrhea. Continuous regimens may provide better control than traditional cyclic regimens. (Smith & Kaunitz, 2013; Smith & Kaunitz, 2014; Speer, 2014)

15 Pharmacological Treatment (con t) Levonorgestrel intrauterine system (IUD, LNg20/ Mirena R ) is associated with improvement in menstrual pain. (Dean & Goldberg, 2014; Smith & Kaunitz, 2013; Smith & Kaunitz, 2014)

16 Pharmacological Treatment (con t) The injectable contraceptive depot medroxyprogesterone acetate (DMPA) given every 3 months to induce anovulation. (Smith & Kaunitz, 2013; Smith & Kaunitz, 2014)

17 Complementary Alternative Medicine (CAM) High-frequency transcutaneous electrical nerve stimulation (TENS) is effective in relieving menstrual pain. Dietary and herbal supplements Magnesium, Vitamin B1, Vitamin B6, Vitamin E, Omega 3 Fatty acid are possibly effective. Acupuncture may be effective, but the related studies are limited by methodological flaws. Behavioral interventions may be effective, but results should be viewed with caution. Spinal manipulation is unlikely to be beneficial. (Cho & Hwang, 2010; Kannan & Claydon, 2014; Proctor, Hing, Johnson, & Murphy, 2006; Proctor, Smith, Farquhar, & Stones, 2002; Proctor & Murphy, 2001; Proctor, Smith, Farquhar, & Stones, 2002; Proctor, Murphy, Pattison, Suckling, & Farquhar, 2007; Smith & Kaunitz, 2014; Smith, Zhu, He, & Song, 2011)

18 Other treatments Topical heat leads to significant reductions in pain severity. Surgical cutting uterine nerves is likely to be ineffective or harmful. (Kannan & Claydon, 2014; Proctor, Smith, Farquhar, & Stones, 2002; Smith & Kaunitz, 2014)

19 Thank you! For more information,

20 References Altman, G., Cain, K. C., Motzer, S., Jarrett, M., Burr, R., & Heitkemper, M. (2006). Increased symptoms in female IBS patients with dysmenorrhea and PMS. Gastroenterology Nursing: The Official Journal Of The Society Of Gastroenterology Nurses And Associates, 29(1), Andersch, B., & Milsom, I. (1982). An epidemiologic study of young women with dysmenorrhea. American Journal Of Obstetrics And Gynecology, 144(6), Banikarim, C. (2013). Primary dysmenorrhea in adolescents. In A. B. Middleman & M. Geffner (Eds.), UpToDate. Retrieved from Banikarim, C., Chacko, M. R., & Kelder, S. H. (2000). Prevalence and impact of dysmenorrhea on Hispanic female adolescents. Archives of Pediatrics & Adolescent Medicine, 154(12), Berkley, K. J. (2013). Primary Dysmenorrhea: An Urgent Mandate. PAIN, 1. Retrieved from

21 References (con t) Berkley, K. J., & McAllister, S. L. (2011). Don t dismiss dysmenorrhea! Pain, 152(9), doi: /j.pain Brinkert, W., Dimcevski, G., Arendt-Nielsen, L., Drewes, A. M., & Wilder-Smith, O. H. G. (2007). Dysmenorrhoea is associated with hypersensitivity in the sigmoid colon and rectum. Pain, 132 Suppl 1, S doi: /j.pain Chan, W. Y., Yusoff Dawood, M., & Fuchs, F. (1981). Prostaglandins in primary dysmenorrhea: Comparison of prophylactic and nonprophylactic treatment with ibuprofen and use of oral contraceptives. The American Journal of Medicine, 70(3), doi: / (81) Chantler, I., Mitchell, D., & Fuller, A. (2009). Actigraphy quantifies reduced voluntary physical activity in women with primary dysmenorrhea. The Journal of Pain: Official Journal of the American Pain Society, 10(1), doi: /j.jpain Chen, C., & Kwekkeboom, K. (2013). Ambulatory office visits and chronic pain comorbidities associated with dysmenorrhea. The Journal of Pain : Official Journal of the American Pain Society, 14(4), S33. Chen, C., Kwekkeboom, K., & Ward, S. E. (2014). Self-report Pain and Symptom Measures for Primary Dysmenorrhea: A Critical Review. European Journal of Pain.

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23 References (con t) Dean, G., & Goldberg, A. B. (2014). Intrauterine contraception (IUD): Overview. In M. Zieman (Ed.), UpToDate. Retrieved from Giamberardino, M. A. (2008). Women and visceral pain: are the reproductive organs the main protagonists? Mini-review at the occasion of the European Week Against Pain in Women European Journal Of Pain (London, England), 12(3), doi: /j.ejpain Giamberardino, M. A., Berkley, K. J., Iezzi, S., de Bigontina, P., & Vecchiet, L. (1997). Pain threshold variations in somatic wall tissues as a function of menstrual cycle, segmental site and tissue depth in non-dysmenorrheic women, dysmenorrheic women and men. Pain, 71(2), Iacovides, S., Avidon, I., Bentley, A., & Baker, F. C. (2013). Reduced quality of life when experiencing menstrual pain in women with primary dysmenorrhea. Acta Obstetricia Et Gynecologica Scandinavica. Iacovides, S., Baker, F. C., Avidon, I., & Bentley, A. (2013). Women With Dysmenorrhea Are Hypersensitive to Experimental Deep Muscle Pain Across the Menstrual Cycle. The Journal of Pain: Official Journal of the American Pain Society, 14(10), doi: /j.jpain

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