DOCSLIB.ORG

Download Article (PDF)

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Download Article (PDF) CASE REPORT Osteopathic Manipulative Treatment and Psychosocial Management of Dysmenorrhea Starr Matsushita, OMS IV; Bonnie Wong, DO; Raghu Kanumalla, OMS IV, MS; Leonard Goldstein, DDS, PhD From the A.T. Still University Dysmenorrhea, or painful menstruation, is a common cause of acute pelvic School of Osteopathic pain that affects approximately two-thirds of women who are postmenarchal Medicine in Mesa, Arizona. in the United States. Dysmenorrhea pain is frequently severe enough to Financial Disclosure: None reported. disrupt daily activities and often accompanied by other symptoms, such as diarrhea, nausea, vomiting, headache, and dizziness. Primary dysmenorrhea Support: None reported. is likely due to an excess of prostaglandins and is traditionally treated with Address correspondence to fl Bonnie Wong, DO, A.T. Still nonsteroidal anti-in ammatory drugs and hormonal therapy. Secondary dys- University School of menorrhea can have multiple origins and requires targeted therapy. Currently, Osteopathic Medicine, musculoskeletal dysfunction and psychosocial factors are not listed as 5850 E Still Cir, Mesa, AZ 85206-3618. causes of secondary dysmenorrhea. The authors present a case in which the Email: [email protected] cause of secondary dysmenorrhea was thought to be related to both muscu- loskeletal dysfunction and emotional stress. Osteopathic manipulative treat- Submitted April 13, 2019; ment and lifestyle changes helped resolve secondary dysmenorrhea. fi nal revision received J Am Osteopath Assoc. 2020;120(7):479-482 August 12, 2019; doi:10.7556/jaoa.2020.076 accepted September 17, 2019. Keywords: dysmenorrhea, osteopathic medicine, somatic dysfunction ysmenorrhea, or painful menstruation, is a common cause of acute pelvic pain. It affects approximately two-thirds of women who are postmenarchal in the D United States and should be differentiated from chronic pelvic pain, which is noncyclic and lasts for 6 months or more.1,2 Pain from dysmenorrhea is frequently severe enough to disrupt daily activities and is often accompanied by other symptoms, such as diarrhea, nausea, vomiting, headache, and dizziness.1,2 Dysmenorrhea is classi- fied as primary or secondary, with neither affected by childbearing.1 Primary dysmenorrhea is likely due to excess prostaglandins, particularly prostaglandin 1 F2-α, which leads to painful uterine contractions. Onset is typically during the late teens to early 20s, and incidence declines with age.1 Secondary dysmenorrhea is more common with aging, has a clinically identifiable cause, and requires targeted management.1,3 Currently, musculoskeletal and viscerosomatic contributions are not commonly listed as causes of secondary dysmenorrhea, but gynecologic (eg, endometriosis, ovarian cysts) and nongynecologic (eg, tumors, inflammation, adhesions, psychogenic disorders, irritable bowel syndrome, and irritable bowel disease) causes are listed.1 A relationship among visceral function and the musculoskeletal and autonomic nervous systems (ANS) has been suggested.4 Therefore, somatic dysfunction (SD) related to the ANS, specifically the lower thoracic and upper lumbar segments, hypogastric plexus, and the sacral plexi, can contrib- ute to dysmenorrhea symptoms. By extension, managing these SDs might improve dys- menorrhea symptoms as evidenced by randomized controlled trials showing the efficacy The Journal of the American Osteopathic Association July 2020 | Vol 120 | No. 7 479 CASE REPORT of manual therapy.5-7 Furthermore, psychological and and worsened to grade 3 in December. She then social issues should be considered with other secondary improved to grade 2 in January and was finally back to causes because of the connection of mind and body.1,8-11 her predysmenorrhea baseline by March 2018 with THere we present a case of adult-onset, nongyneco- nondebilitating, mild colicky pain that did not interfere logic secondary dysmenorrhea that resolved using a with her daily activities. holistic approach with both osteopathic manipulative The patient reported no significant physical trauma treatment (OMT) and management of psychosocial except for an adductor strain before symptom onset. The factors. We propose that these 2 elements should only abnormal historical information reported was stress be included as part of the treatment of patients with from first-year medical school coursework and living secondary dysmenorrhea. with a roommate during the 4 months prior to presentation. As a self-described introvert, she noted that her living situation added a lot of psychological stress to her life. Report of Case The review of systems was notable for a 12-pound A 32-year-old female medical student presented to our weight loss from July 2017 to February 2018 that was osteopathic medicine center in October 2017 with back accompanied by decreased appetite and inconsistent and hip pain. At the time of her presentation, the pain eating habits. She also reported headaches, lumbar back was so severe that she considered missing classes. pain, changes in mood (eg, “feeling short with people”), Three weeks later, at her second visit, she disclosed the mild breast tenderness, nausea, diffuse abdominal pain, onset of dysmenorrhea during the previous week. constipation, and diarrhea during these dysmenorrheic Although her back and hip pain resolved after 2 visits periods. She denied menorrhagia, oligomenorrhea, inter- and OMT sessions, the patient was seen during the next menstrual bleeding, mittelschmerz, bloating, vomiting, 5 months for continued dysmenorrhea described as “hor- dysuria, urinary retention, vaginal discharge or irritation, rible pain and crampingness” that lasted several hours and dyschezia. She was advised to follow up with a per day for up to 1 week in the perimenopausal period. primary care physician for further evaluation of symptoms. The patient’s gynecologic history before dysmenorrhea was normal, with menarche at age 12 years, 28-day cycles, Clinical Findings 4 to 5 days of regular flow, and nondebilitating, mild The patient had normal cardiopulmonary, neurologic, and colicky pain that did not interfere with her daily activities. abdominal examination results. The osteopathic structural She had never been sexually active. She had normal pelvic examination results showed considerable asymmetries of examination and Papanicolaou test results in September the occipitoatlantal joint, thoracic spine, lumbar spine, 2017. She regularly tracked her periods with a smartphone sacrum, and innominate bones throughout treatment. application and noted that the only significant change to A right-side superior shear of her ilium and a left-on-left her periods was the severity of pain experienced. Of note, sacral torsion during dysmenorrhea were consistently her older sister had severe grade 3 dysmenorrhea for most found. The patient had a decreased cranial rhythmic of her adult life, which was resolved with hysterectomy impulse early in the course of treatment, accompanied after unsuccessful treatment with hormonal therapy. With by hypertonicity in the suboccipital muscles. the exception of her sister’s dysmenorrhea, her medical and family histories were noncontributory. Therapeutic Intervention According to the verbal, multidimensional scoring The patient received 6 OMT sessions that took place system for the assessment of dysmenorrhea,12 she over 5 months (Figure). The patient was treated with reported being grade 0 or 1 before October 2017. She techniques that were tailored to each specificSD, progressed to grade 2 during October and November including myofascial release, strain-counterstrain, soft 480 The Journal of the American Osteopathic Association July 2020 | Vol 120 | No. 7 CASE REPORT Start of medical school and abnormal living situtation July 2017 Initial evaluation; OMT No.1 (10/10/17); Oct 2017 OMT No.2 (10/31/17) Nov 2017 OMT No.3 (11/14/17) Dec 2017 OMT No.4 (12/13/17) Jan 2018 OMT No.5 (02/04/18); Feb 2018 final evaluation; and OMT No.6 (02/28/17) Resolution of dysmenorrhea to baseline symptoms of nondebilitating, mild colicky pain that did not interfere with daily activities Figure. Timeline of events for patient with secondary dysmenorrhea. Abbreviation: OMT, osteopathic manipulative treatment. tissue, muscle energy, suboccipital release, abdominal lifestyle changes, the patient had normal menstrual plexus release, and joint articulation. Throughout treat- periods without dysmenorrhea. By February 2018, she ment, we discussed outside stressors and counseled the had only mild cramps that lasted for 10 to 20 minutes patient on the importance of adequate caloric intake and at a time, headache, fatigue, and some moodiness that aerobic exercise. As a result, she implemented mindful- decreased on the second day. In the following month, ness meditation and yoga on a weekly basis. Her irregu- her moodiness resolved, her other symptoms were lar eating was an effect of stress and improved when back to baseline, and her verbal multidimensional she implemented the other lifestyle changes. score12 was back to her baseline of grade 1. The The patient’s pain improved, and there was a patient confirmed that her dysmenorrhea symptoms decrease in the severity of SD throughout the 6 OMT remained at baseline in a 1-year follow-up interview. sessions. Her back and hip pain resolved within the first 2 OMT sessions, but her dysmenorrhea persisted. Her last 2 OMT sessions focused on relieving pelvic Discussion and sacral restrictions using balanced ligamentous and Given the timing of onset and relative ease of resolution, balanced
Load more

Recommended publications
  • Prolactin Level in Women with Abnormal Uterine Bleeding Visiting Department of Obstetrics and Gynecology in a University Teaching Hospital in Ajman, UAE
    Prolactin level in women with Abnormal Uterine Bleeding visiting Department of Obstetrics and Gynecology in a University teaching hospital in Ajman, UAE Jayakumary Muttappallymyalil1*, Jayadevan Sreedharan2, Mawahib Abd Salman Al Biate3, Kasturi Mummigatti3, Nisha Shantakumari4 1Department of Community Medicine, 2Statistical Support Facility, CABRI, 4Department of Physiology, Gulf Medical University, Ajman, UAE 3Department of OBG, GMC Hospital, Ajman, UAE *Presenting Author ABSTRACT Objective: This study was conducted among women in the reproductive age group with abnormal uterine bleeding (AUB) to determine the pattern of prolactin level. Materials and Methods: In this study, a total of 400 women in the reproductive age group with AUB attending GMC Hospital were recruited and their prolactin levels were evaluated. Age, marital status, reproductive health history and details of AUB were noted. SPSS version 21 was used for data analysis. Descriptive statistics was performed to describe the population, and inferential statistics such as Chi-square test was performed to find the association between dependent and independent variables. Results: Out of 400 women, 351 (87.8%) were married, 103 (25.8%) were in the age group 25 years or below, 213 (53.3%) were between 26-35 years and 84 (21.0%) were above 35 years. Mean age was 30.3 years with a standard deviation 6.7. The prolactin level ranged between 15.34 mIU/l and 2800 mIU/l. The mean and SD observed were 310 mIU/l and 290 mIU/l respectively. The prolactin level was high among AUB patients with inter-menstrual bleeding compared to other groups. Additionally, the level was high among women with age greater than 25 years compared to those with age less than or equal to 25 years.
    [Show full text]
  • Endometriosis for Dummies.Pdf
    01_050470 ffirs.qxp 9/26/06 7:36 AM Page i Endometriosis FOR DUMmIES‰ by Joseph W. Krotec, MD Former Director of Endoscopic Surgery at Cooper Institute for Reproductive Hormonal Disorders and Sharon Perkins, RN Coauthor of Osteoporosis For Dummies 01_050470 ffirs.qxp 9/26/06 7:36 AM Page ii Endometriosis For Dummies® Published by Wiley Publishing, Inc. 111 River St. Hoboken, NJ 07030-5774 www.wiley.com Copyright © 2007 by Wiley Publishing, Inc., Indianapolis, Indiana Published by Wiley Publishing, Inc., Indianapolis, Indiana Published simultaneously in Canada No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, scanning, or otherwise, except as permit- ted under Sections 107 or 108 of the 1976 United States Copyright Act, without either the prior written permission of the Publisher, or authorization through payment of the appropriate per-copy fee to the Copyright Clearance Center, 222 Rosewood Drive, Danvers, MA 01923, 978-750-8400, fax 978-646-8600. Requests to the Publisher for permission should be addressed to the Legal Department, Wiley Publishing, Inc., 10475 Crosspoint Blvd., Indianapolis, IN 46256, 317-572-3447, fax 317-572-4355, or online at http:// www.wiley.com/go/permissions. Trademarks: Wiley, the Wiley Publishing logo, For Dummies, the Dummies Man logo, A Reference for the Rest of Us!, The Dummies Way, Dummies Daily, The Fun and Easy Way, Dummies.com, and related trade dress are trademarks or registered trademarks of John Wiley & Sons, Inc., and/or its affiliates in the United States and other countries, and may not be used without written permission.
    [Show full text]
  • The Prevalence of and Attitudes Toward Oligomenorrhea and Amenorrhea in Division I Female Athletes
    POPULATION-SPECIFIC CONCERNS The Prevalence of and Attitudes Toward Oligomenorrhea and Amenorrhea in Division I Female Athletes Karen Myrick, DNP, APRN, FNP-BC, Richard Feinn, PhD, and Meaghan Harkins, MS, BSN, RN • Quinnipiac University Research has demonstrated that amenor- hormone and follicle-stimulating hormone rhea and oligomenorrhea may be common shut down stimulation to the ovary, ceasing occurrences among female athletes.1 Due production of estradiol.2 to normalization of menstrual dysfunction The effect of oral contraceptives on the within the sport environment, amenorrhea menstrual cycle include ovulation inhibi- and oligomenorrhea tion, changes in cervical mucus, thinning may be underreported. of the uterine endometrium, and motility Key PointsPoints There are many underly- and secretion in the fallopian tubes, which Lean sport athletes are more likely to per- ing causes of menstrual decrease the likelihood of conception and 3 ceive missed menstrual cycles as normal. dysfunction. However, implantation. Oral contraceptives contain a a similar hypothalamic combination of estrogen and progesterone, Menstrual dysfunction is one prong of the amenorrhea profile is or progesterone only; thus, oral contracep- female athlete triad. frequently seen in ath- tives do not stop the production of estrogen. letes, and hypothalamic Menstrual dysfunction is one prong of the Menstrual dysfunction is often associated dysfunction is com- female athlete triad (triad). The triad is a with musculoskeletal and endothelial monly the root of ath- syndrome of linking low energy availability compromise. lete’s menstrual abnor- (EA) with or without disordered eating, men- malities.2 The common strual disturbances, and low bone mineral Education and awareness of the accultur- hormone pattern for density, across a continuum.
    [Show full text]
  • Prevalence of Menstrual Irregularities in Correlation with Body Fat Among Students of Selected Colleges in a District of Tamil Nadu, India
    National Journal of Physiology, Pharmacy and Pharmacology RESEARCH ARTICLE Prevalence of menstrual irregularities in correlation with body fat among students of selected colleges in a district of Tamil Nadu, India Sherly Deborah G1, Siva Priya D V2, Rama Swamy C2 1Department of Physiology, Faculty of Medicine, AIMST University, Bedong, Kedah, Malaysia, 2Department of Physiology, Saveetha Medical College, Chennai, Tamil Nadu, India Correspondence to: Sherly Deborah G, E-mail: [email protected] Received: March 05, 2017; Accepted: March 22, 2017 ABSTRACT Background: Menstrual irregularities are usually due to imbalance of hormones. Although menstrual irregularities may be normal during the early postmenarchal years, pathological conditions require proper and prompt management. Obesity associated with many health consequences including hormonal imbalance has a direct effect on menstrual cycle. Hence, attention to obesity is obligatory for the inclusion of diagnosis and treatment of menstrual complaints which has become a leading issue in women’s life. Aims and Objectives: The aims and objectives of the study are to assess the menstrual irregularities and to find the association between menstrual irregularities and body fat among students. Materials and Methods: A cross-sectional study was conducted in three selected colleges in a district of Tamil Nadu in India. A total of 399 samples were included in the study. A 10-item questionnaire was administered to assess the menstrual irregularity in each student. The demographic variables along with anthropometric measurements were collected. Anthropometric measurements were taken to calculate the body fat percentage using modified YMCA formula. Results: The prevalence of menstrual irregularities was high in obesity compared with those with normal body fat and particularly oligomenorrhea, amenorrhea, and hypomenorrhea had statistically significant increase in obese students.
    [Show full text]
  • Polycystic Ovary Syndrome, Oligomenorrhea, and Risk of Ovarian Cancer Histotypes: Evidence from the Ovarian Cancer Association Consortium
    Published OnlineFirst November 15, 2017; DOI: 10.1158/1055-9965.EPI-17-0655 Research Article Cancer Epidemiology, Biomarkers Polycystic Ovary Syndrome, Oligomenorrhea, and & Prevention Risk of Ovarian Cancer Histotypes: Evidence from the Ovarian Cancer Association Consortium Holly R. Harris1, Ana Babic2, Penelope M. Webb3,4, Christina M. Nagle3, Susan J. Jordan3,5, on behalf of the Australian Ovarian Cancer Study Group4; Harvey A. Risch6, Mary Anne Rossing1,7, Jennifer A. Doherty8, Marc T.Goodman9,10, Francesmary Modugno11, Roberta B. Ness12, Kirsten B. Moysich13, Susanne K. Kjær14,15, Estrid Høgdall14,16, Allan Jensen14, Joellen M. Schildkraut17, Andrew Berchuck18, Daniel W. Cramer19,20, Elisa V. Bandera21, Nicolas Wentzensen22, Joanne Kotsopoulos23, Steven A. Narod23, † Catherine M. Phelan24, , John R. McLaughlin25, Hoda Anton-Culver26, Argyrios Ziogas26, Celeste L. Pearce27,28, Anna H. Wu28, and Kathryn L. Terry19,20, on behalf of the Ovarian Cancer Association Consortium Abstract Background: Polycystic ovary syndrome (PCOS), and one of its cancer was also observed among women who reported irregular distinguishing characteristics, oligomenorrhea, have both been menstrual cycles compared with women with regular cycles (OR ¼ associated with ovarian cancer risk in some but not all studies. 0.83; 95% CI ¼ 0.76–0.89). No significant association was However, these associations have been rarely examined by observed between self-reported PCOS and invasive ovarian cancer ovarian cancer histotypes, which may explain the lack of clear risk (OR ¼ 0.87; 95% CI ¼ 0.65–1.15). There was a decreased risk associations reported in previous studies. of all individual invasive histotypes for women with menstrual Methods: We analyzed data from 14 case–control studies cycle length >35 days, but no association with serous borderline including 16,594 women with invasive ovarian cancer (n ¼ tumors (Pheterogeneity ¼ 0.006).
    [Show full text]
  • Consensus Statement
    CONSENSUS STATEMENT ISUOG Consensus Statement on rationalization of gynecological ultrasound services in context of SARS-CoV-2 INTRODUCTION Given the challenges of the current coronavirus (SARS-CoV-2) pandemic and to protect both patients and ultrasound providers (physicians, sonographers, allied professionals), the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) has compiled the following expert-opinion-based guidance for the rationalization of ultrasound investigations for gynecological indications. While the provision of ultrasound is an essential service and all individuals with gynecological complaints deserve high-quality investigation, the current coronavirus disease 2019 (COVID-19) pandemic warrants triaging of referrals for gynecological ultrasound assessment. This is based on the following principles related to a pandemic: 1. Medical resources should be spared and prioritized. 2. Maximum care should be taken to avoid unnecessary contact between (potentially infected) medical personnel and (potentially infected) patients. The risk of transmission is particularly high during ultrasound investigations as neither the medical personnel nor the patient can abide by the social distancing recommendations. 3. Visits should be limited to those strictly necessary to avoid spread of the virus. Therefore, ultrasound appointments for gynecological indications should be triaged based on the clinical scenario, as follows: 1. Ultrasound assessments that should be performed without delay (NOW); 2. Ultrasound assessments
    [Show full text]
  • LNG-IUS) in Patients Affected by Menometrorrhagia, Dysmenorrhea and Adenomimyois: Clinical and Ultrasonographic Reports
    European Review for Medical and Pharmacological Sciences 2021; 25: 3432-3439 The treatment with Levonorgestrel Releasing Intrauterine System (LNG-IUS) in patients affected by menometrorrhagia, dysmenorrhea and adenomimyois: clinical and ultrasonographic reports F. COSTANZI, M.P. DE MARCO, C. COLOMBRINO, M. CIANCIA, F. TORCIA, I. RUSCITO, F. BELLATI, A. FREGA, G. COZZA, D. CASERTA Department of Surgical and Medical Sciences and Translational Medicine, Sant’Andrea University Hospital, Sapienza University of Rome, Rome, Italy Abstract. – OBJECTIVE: Adenomyosis is p=0.025; p=0.014). The blood loss decreased the consequence of the myometrial invasion significantly in both the cohorts (p<0.001) and by endometrial glands and stroma. Transvag- particularly in adenomyotic patients. Pain relief inal ultrasonography plays a decisive role in was observed in all the patients (p<0.001). the diagnosis and monitoring of this patholo- CONCLUSIONS: LNG-IUS can be considered gy. Our study aims to evaluate the efficacy of an effective treatment for managing symptoms LNG-IUS (Levonorgestrel Releasing Intrauter- and improving uterine morphology. ine System) as medical therapy. We analyzed both clinical symptoms and ultrasonograph- Key Words: ic aspects of menometrorrhagia and dysmen- Benign disease of uterus, Dysmenorrhea, Gyne- orrhea in patients with adenomyosis and the cologic imaging, Leiomyomas of the uterus/adeno- control group. myosis. PATIENTS AND METHODS: A prospective co- hort study was carried out on 28 patients suf- fering from symptomatic adenomyosis treat- ed with LNG-IUS. Adenomyosis was diagnosed Introduction through transvaginal ultrasonography by an ex- pert sonographer. A control group of 27 symp- Adenomyosis is a benign gynecological dis- tomatic patients (menorrhagia and dysmenor- ease with a large variety of clinical manifestation; rhea) without a transvaginal ultrasonograph- the most frequent include menorrhagia, metror- ic diagnosis of adenomyosis was treated in the rhagia, dysmenorrhea and chronic pelvic pain1.
    [Show full text]
  • Jceme114.Pdf
    JCEM ONLINE Brief Report—Endocrine Research Menstrual Irregularity and Cardiovascular Mortality Erica T. Wang, Piera M. Cirillo, Eric Vittinghoff, Kirsten Bibbins-Domingo, Barbara A. Cohn, and Marcelle I. Cedars Center for Research on Women’s and Children’s Health, Public Health Institute, University of California San Francisco, San Francisco, California 94115 Downloaded from https://academic.oup.com/jcem/article/96/1/E114/2833816 by guest on 29 September 2021 Background: Polycystic ovary syndrome, the most common cause of irregular menstrual cycles, is associated with an adverse cardiovascular risk profile. However, there are limited prospective studies confirming the link between polycystic ovary syndrome and cardiovascular mortality. Methods: We studied 15,005 pregnant women recruited from the Kaiser Foundation Health Plan in California between 1959 and 1966. The menstrual cycle pattern was assessed at baseline ac- cording to self-report, physician report, and medical record abstraction. Participants were matched to California Vital Status files annually until 2007 to identify deaths due to overall cardiovascular disease (CVD) and subsets of coronary heart disease (CHD) and cerebrovascular disease based on International Classification of Diseases codes. Cox proportional hazards models were used to es- timate the association between irregular cycles and cardiovascular mortality. Missing covariate data were multiply imputated using standard methods. Results: During 456,298.5 person-years of follow-up, there were 666 CVD deaths, including 301 CHD deaths and 149 cerebrovascular deaths. Compared with women with regular cycles, women with irregular cycles had an increased risk for CHD mortality [age adjusted hazards ratio (HR) 1.42, 95% confidence interval (CI) 1.03–1.94]; however, the association was not statistically significant after adjustment for body mass index (adjusted HR 1.35, 95% CI 0.98–1.85).
    [Show full text]
  • American Family Physician Web Site At
    Diagnosis and Management of Adnexal Masses VANESSA GIVENS, MD; GREGG MITCHELL, MD; CAROLYN HARRAWAY-SMITH, MD; AVINASH REDDY, MD; and DAVID L. MANESS, DO, MSS, University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee Adnexal masses represent a spectrum of conditions from gynecologic and nongynecologic sources. They may be benign or malignant. The initial detection and evaluation of an adnexal mass requires a high index of suspicion, a thorough history and physical examination, and careful attention to subtle historical clues. Timely, appropriate labo- ratory and radiographic studies are required. The most common symptoms reported by women with ovarian cancer are pelvic or abdominal pain; increased abdominal size; bloating; urinary urgency, frequency, or incontinence; early satiety; difficulty eating; and weight loss. These vague symptoms are present for months in up to 93 percent of patients with ovarian cancer. Any of these symptoms occurring daily for more than two weeks, or with failure to respond to appropriate therapy warrant further evaluation. Transvaginal ultrasonography remains the standard for evaluation of adnexal masses. Findings suggestive of malignancy in an adnexal mass include a solid component, thick septations (greater than 2 to 3 mm), bilaterality, Doppler flow to the solid component of the mass, and presence of ascites. Fam- ily physicians can manage many nonmalignant adnexal masses; however, prepubescent girls and postmenopausal women with an adnexal mass should be referred to a gynecologist or gynecologic oncologist for further treatment. All women, regardless of menopausal status, should be referred if they have evidence of metastatic disease, ascites, a complex mass, an adnexal mass greater than 10 cm, or any mass that persists longer than 12 weeks.
    [Show full text]
  • Intermenstrual Bleeding (Bleeding Between Periods)
    Intermenstrual Bleeding (Bleeding between periods) What is Intermenstrual bleeding? This is unscheduled bleeding that can occur in between periods. There are many different causes of bleeding between periods but seek medical advice if you are experiencing this, even if it is for reassurance in many situations. What is the nature of bleeding? Bleeding that occurs randomly without any relation to your monthly period should not be ignored, unless the cause is known. The bleeding may be light blood, spotting, a bloody or dark brown vaginal loss or heavy bleeding mimicking a period. Mid cycle pain and bleeding Mittelschmerz is one-sided, lower abdominal pain associated with ovulation, about 14 days before your next menstrual period. In most cases, mittelschmerz does not require medical attention and may be associated with light vaginal bleeding for a day or so. It may not occur every month. If you are concerned, seek advice. Spotting in the lead up to or at the end of the period Usually, this just suggests that levels of progesterone fall slightly more slowly in some cycles and can lead to spotting seen in the lead up to the proper menstrual flow. This is usually not a concern. Spotting or a brown vaginal loss as the period finishes is also not abnormal, unless lasting for days or associated with other symptoms. (See information on a normal menstrual cycle under the leaflet on Irregular Periods) What are the possible causes of bleeding between periods? (not an exhaustive list) Hormonal contraceptives, such as the combined or progesterone only pill, implant, injection, intrauterine system, patch, ring can all cause bleeding between cycles, especially in the first few months of starting them.
    [Show full text]
  • Gynecology Revised: 11/2013
    Emergency Medical Training Services Emergency Medical Technician – Paramedic Program Outlines Outline Topic: Gynecology Revised: 11/2013 21 questions on exam 8 from this outline • Menstruation - normal periodic discharge of blood, mucus, and cellular debris from uterus. The normal menstrual cycle lasts about 28 days. 25 to 60mL average flow. Flow lasts usually 4 to 6 days. Lining of the uterus is called endometrium. Onset of menses (menarche) begins around 12 years of age. Menopause starts at age 47 on average. But can range from 30 to 60 years of age. Estrogen stimulates endometrium to grow and increase in thickness. • Ovaries contain about 5 million cells to make oocytes (immature ova/eggs). At puberty 350,000 are present. In a lifetime the ovary will release 400 through menstruation • The release of the egg is termed ovulation. • The pituitary released FSH to stimulate the ovaries to produce estrogen. As a result of the estrogen builds up in blood stream just before ovulation the pituitary releases luteinizing hormone to initiate the release of eggs. • Up to seven days after ovulation (day 21) the uterus is ready to receive an embryo if fertilization has happened. • Recap: Day 14 ovulation. Up to day 21 fertilization window, day 22 thru 28 period if not pregnant. GYN emergencies are classified as: Non-traumatic • PID - infection entered the pelvis cavity. Most common causes are non-sterile exam equipment and if sexually transmitted is N. Gonorrhea and Chlamydia. Lower abdominal pain, hurts with sex, vaginal discharge and additional bleeding after period is over. Antibiotic therapy is needed. • Ovarian cyst - can be a bleeding/shock emergency.
    [Show full text]
  • Management of Primary Dysmenorrhea in Young Women with Frameless LNG-IUS
    Open Access Journal of Contraception Dovepress open access to scientific and medical research Open Access Full Text Article REVIEW Management of primary dysmenorrhea in young women with frameless LNG-IUS Dirk Wildemeersch1 Abstract: The objective of this paper is to discuss the potential advantages of intrauterine treat- Sohela Jandi2 ment with a frameless levonorgestrel (LNG)-releasing intrauterine system (IUS) in young women Ansgar Pett2 presenting with primary dysmenorrhea associated with heavy menstrual bleeding. The paper is Thomas Hasskamp3 based on clinical reports of 21 cases of primary and secondary dysmenorrhea treated with the frameless LNG-IUS. Three typical examples of young women between 16 and 20 years of age, 1Gynecological Outpatient Clinic and IUD Training Center, Ghent, who presented with moderate-to-severe primary dysmenorrhea associated with heavy menstrual Belgium; 2Gynecological Outpatient bleeding, are presented as examples. Following pelvic examination, including vaginal sonography, 3 Clinic, Berlin, Germany; GynMünster, a frameless LNG-IUS, releasing 20 µg of LNG/day, was inserted. The three patients developed Münster, Germany amenorrhea, or scanty menstrual bleeding, and absence of pain complaints within a few months. We conclude that continuous, intrauterine progestogen delivery could be a treatment of choice of this inconvenient condition. In addition, the good experiences with the frameless LNG-IUS in other studies suggests that the frameless design may be preferred over a framed LNG-IUS, as the absence of a frame, resulting in optimal tolerance, is particularly advantageous in these women. Keywords: heavy menstrual bleeding, contraception, FibroPlant, intrauterine system Video abstract Introduction In an epidemiologic study of an adolescent population, Klein and Litt reported a prevalence of dysmenorrhea of 59.7%.1 Of patients reporting pain, 12% described it as severe, 37% as moderate, and 49% as mild.
    [Show full text]