Risky






You're A Pain in My Uterus Bad Blood The Endo the world as we know it Potpourri
Primary dysmenorrhea
Secondary dysmenorrhea
_____ is painful menses without other identifiable pelvic pathology, while ______ is painful menses associated with pelvic pathology, frequently endometriosis or uterine fibroids.
Combined OCs
Levonorgestrel IUD
Name the most cost effective method of treating menorrhagia in the first year.
If successful, treatment then with _____ becomes the most cost effective.
Endometriosis
40-60%
_____ is the most common cause of chronic pelvic pain in women, responsible for dysmenorrhea in ____ % of women
Level A: Based on good and consistent scientific evidence
This level of evidence supports the recommendation that combined OCs should not be used to treat existing functional ovarian cysts.
What is 75-90%. The majority of these women will have primary dysmenorrhea
Dysmenorrhea is the most commonly reported menstrual disorder, up to ___% of women experience some type of dysmenorrhea, making it the leading cause of work or school absenteeism in young women.
30-40%
This is the amenorrhea rate for the etonorgestrel containing implant (Nexplanon) at one year of use.
Dysmenorrhea, Pelvic pain, Dyspareunia, GI symptoms, Infertility, Ovarian mass, Dysuria
Common presentations of endometriosis (Name 5)
20 years
Long term (equal to or greater than 5 years) use of OCs results in reduced risk of endometrial cancer for up to _____ years.
Age < 30
BMI <20
Menorrhagia
Metrorrhagia
History of Sexual Assault
Family History of dysmenorrhea
Name four of the risk factors for primary dysmenorrhea.
20 to 80%
At 12 months after insertion of the levonorgestrel IUD, rates of amenorrhea can range from ___ to ___%
Leuprolide acetate.
Endometriosis, uterine fibroids, prostate cancer, and central precocious puberty.
This is a GnRh analog which leads to a suppression of gonadal steroids (LH and FSH). Name three possible indications for its use.
Combined OCs, contraceptive patch, and DMPA (Depo provera)
Name three types of hormonal contraception shown to reduce or eliminate the hormonal fluctuations thought to precipitate menstrual migraines.
Endometrium
Arachidonic Acid
Prostaglandin
Hormonal contraception is a first line therapy for treating primary dysmenorrhea. It has been shown to thin the ______, which leads to less _______ ____ production, and thus less _____ production, which improves dysmenorrhea symptoms.
Little to no effect of combined OCs and Levonorgestrel IUDs on leiomyomas. This is based on limited or inconsistent scientific evidence (level B).
This is the effect of combined OCs and levonorgestrel IUD on the development of uterine leiomyomas. This is the level of evidence to support this data.
1. Depo medroxyprogesterone acetate (DMPA)
2. Nexplanon Progestin implant (etonorgestrel)
3. Mirena IUD (Levonorgestrel)
4. combined oral contraceptives
These four hormonal contraceptives have evidence of reducing the severity of dysmenorrhea in women with endometriosis.
Increase sex hormone binding globulin & suppress LH driven ovarian androgen production, which both reduce levels of free androgen responsible for initiating and maintaining acne and hair growth.
Describe the mechanism by which combined OCs improve hirsutism and acne.
1. Heat applied to the lower abdomen
2. Exercise
3. Dietary modifications: High dairy, fat-free vegan diet, vitamin supplements
4. Acupuncture (studies with conflicting results)
5. TENS units (improvement over placebo, not as effective as NSAIDs or hormonal contraception)
Name 4 non-pharmacologic therapies for dysmenorrhea
Cyclic combined OCs
Extended cycle or continuous OCs
Progestin only pills
Levonorgestrel IUD
DMPA
Progestin implant (nexplanon)
Excessive menstrual bleeding (60-80mL per cycle or greater) can be treated by multiple different types of hormonal contraceptives. Name three options.
Sampsom's theory of endometriosis
_____'s theory suggests that retrograde menstruation and implantation is the primary mechanism of _____.
Drospirenone and cyproterone acetate
These are two antiandrogenic progestins, when present in combined OCs were superior in some comparative trials for treating acne.
20%
Using combined OC's decreases ovarian cancer risk by ___% for every 5 years of use.

Noncontraceptive Uses of Hormonal Contraceptives

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