Tuesday , April 24 2018


MENSTRUAL  RELATED DISORDERSMenstrual related disorders are widespread.  These disorders include primary dysmenorrhea, endometriosis, abnormal uterine bleeding, premenstrual syndrome and premenstrual dysphoric disorder.  Treatment is individualized following a general standard of care.

Primary Dysmenorrhea

Primary dysmenorrhea is difficult or painful menstruation.  Symptomatic the individual experiences cramping and lower abdominal pain.  The pathology includes leukotrienes and prostaglandins, resulting in the inflammation and manifestation of this pain and cramping.  In addition to these symptoms includes fatigue, fever, nausea, vomiting, and headache.  It is treated with non-steroidal       anti- inflammatory agents, Aleve (naproxen), Motrin (ibuprofen).

Abnormal Uterine Bleeding

Abnormal uterine bleeding results in disrupted or imbalanced menstrual cycle  The bleeding is either acute or chronic.  Acute bleeding necessitates treatment quickly.  Chronic is uterine bleeding for the past six months  Transvaginal sonography and saline infusion sonhysterography are used for diagnostic purposes.  Endometrial sampling and biopsies are only utilized in conditions of suboptimal treatment.  Treatment includes estrogen and progestin products along with tranexamic and mefenamic acid.


Endometriosis is chronic inflammation of endometrial tissue.  It manifests with pelvic pain, painful urination, abnormal uterine bleeding, fatigue, and infertility.  Laparoscopy is used in diagnosis and can often take seven years to confirm.  Upon assessment, stages of endometriosis are identified.  For example, stage I is minimal with only small lesions as compared to stage 4 which is severe involving the greatest extent, size, and depth of cell growth.  It is more common among those with shorter menstrual cycles, irregular cycles, petite frame, and early menarche onset.  Treatment  entails progesterone agents such as norethindrone, medroxyprogesterone, and levonorgestrel-releasing intrauterine system.

Premenstrual Syndrome and Premenstrual Dysphoric Disorder

Premenstrual syndrome is a milder form of premenstrual dysphoric disorder in which symptoms occur in cyclic pattern during luteal phase, improving with menses, and resolving with follicular phase.  Premenstrual syndrome is diagnosed with the presence of moderate to severe emotional or physical symptoms in last week of luteal phase lasting for two to three months and resulting in daily impairments.  Premenstrual Dysphoric Disorder  requires five symptoms in behavioral, psychological, and  physical categories including lethargy, appetite changes, irritability, depressed mood, anxiety, and insomnia. Specifically, in the behavioral category, the symptoms are sleep changes, dizziness, appetite changes, and lethargy.  In psychological category, the symptoms include anxiety, tension, confusion, restlessness, reduced self-esteem, out of control feelings, and loneliness.  Physical symptoms are bloating, eight gain, back pain, headaches, breast tenderness and swelling.  The cause of the disorders are unknown but likely associated with serotonin reduction.  Treatment entails non pharmacologic and pharmacologic.  Non-pharmaceutical drugs are calcium carbonate 600 mg twice daily and pyridoxine 50-500 mg daily.  In addition, drug therapy includes anti-inflammatory agents, serotonin uptake inhibitors, diuretics, hormonal therapies such as combined oral contraceptives with conflicting evidence and progestin only therapies with lack of any role.

In conclusion, menstrual related disorders encompass primary dysmenorrhea, abnormal uterine bleeding, endometrosis, and premenstrual syndrome or premenstrual dysphoric disorder.  Some treatment standards include non- steroidal anti-inflammatories and hormonal therapies.  However, each individual is treated specifically.  Thus seek healthcare advice for the most optimal treatment.

About Kimberly Hoff Pharm D, BCPS, BCACP, CDE

My name is Kimberly Hoff. Currently, I am a Walgreens clinical advisor for MTM and health testing along with prn positions for independent pharmacy in Kirkwood and hospital pharmacy in Troy. I

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