what is the treatment for dysmenorrhea? coc taper

Dysmenorrhea may have a pronounced impactamong adolescents due to undertreatment. In a na-tional probability sample, Klein and Litt4reportedthat only 14% of U.S. adolescents with dysmenorrheasought help from a physician, including only 29% ofthose reporting severe dysmenorrhea. Most adoles-cents who use pain medicine choose over-the-countertreatments such as nonsteroidal anti-inflammatorydrugs. The efficacy of such medications in adolescentsis not well-established because published clinical trialshave largely been conducted in adult women.5Oral contraceptives (OCs) are commonly used totreat dysmenorrhea, and both small laboratory studiesand observational data suggest that OCs effectivelyreduce prostaglandin production and pain.1Few con-trolled trials, however, have examined the efficacy ofOCs for dysmenorrhea. A recent evidence review andmeta-analysis by the Cochrane Collaboration6con-cluded that OCs may be more effective than placebobased on 5 controlled trials of OCs compared withplacebo. The authors emphasized that these trialswere of poor quality, were conducted more than 20years ago, and only included high-dose OCs notcurrently in use.

Full Answer

What are the treatments for dysmenorrhea?

Jan 26, 2012 · Combined oral contraceptives (COCs) reduce menstrual pain in some women, a Swedish long-term study has found. Although COCs are commonly recommended to treat primary dysmenorrhea, a 2009 Cochrane Review called their efficacy into question. The longitudinal, case-control study at Gothenburg University followed 3 groups of 19-year-old women ...

What is the role of contraceptives in the treatment of dysmenorrhea?

Dysmenorrhea is the medical term for painful menstrual periods which are caused by uterine contractions. Primary dysmenorrhea refers to recurrent pain, while secondary dysmenorrhea results from reproductive system disorders. Both can be treated. Appointments 216.444.6601. Appointments & Locations.

What is dysmenorrhea?

Mar 17, 2022 · Primary dysmenorrhea (PD) is a common, disregarded, underdiagnosed, and inadequately treated complaint of both young and adult females. It is characterized by painful cramps in the lower abdomen, which start shortly before or at the onset of menses and which could last for 3 days. In particular, PD negatively impacts the quality of life (QOL ...

Why is primary dysmenorrhea important to pharmacists?

progestin or COC for 10‐14 days • COC: 1 tab TID x 7 days then taper – Progestin: medroxyprogesterone acetate 20mg TID x 7 days – Tranexamic acid 1.3 g TID x 5 days • Other options: D&C, foleybulb tamponade, emergency hysterectomy Bradley, AJOG, 2016 COC Taper • Don’t want to give 2‐4 COC’s per day and then stop

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What Causes Dysmenorrhea (Pain of Menstrual cramps)?

Menstrual cramps are caused by contractions (tightening) in the uterus (which is a muscle) by a chemical called prostaglandin. The uterus, where a...

How Does Secondary Dysmenorrhea Cause Menstrual Cramps?

Menstrual pain from secondary dysmenorrhea is caused by a disease in the woman's reproductive organs. Conditions that can cause secondary dysmenorr...

What Are The Symptoms of dysmenorrhea?

1. Aching pain in the abdomen (pain may be severe at times) 2. Feeling of pressure in the abdomen 3. Pain in the hips, lower back, and inner thighs...

What is the best treatment for dysmenorrhea?

Hormonal contraceptives are the first-line treatment for dysmenorrhea caused by endometriosis. Topical heat, exercise, and nutritional supplementation may be beneficial in patients who have dysmenorrhea; however, there is not enough evidence to support the use of yoga, acupuncture, or massage.

How long does dysmenorrhea last?

1, 9 – 18 Pain typically lasts eight to 72 hours and usually occurs at the onset of menstrual flow.

Does dysmenorrhea affect quality of life?

It negatively affects patients' quality of life and sometimes results in activity restriction. A history and physical examination, including a pelvic examination in patients who have had vaginal intercourse, may reveal the cause. Primary dysmenorrhea is menstrual pain in the absence of pelvic pathology. Abnormal uterine bleeding, dyspareunia, ...

What is primary dysmenorrhea?

Primary dysmenorrhea is menstrual pain in the absence of pelvic pathology. Abnormal uterine bleeding, dyspareunia, noncyclic pain, changes in intensity and duration of pain, and abnormal pelvic examination findings suggest underlying pathology (secondary dysmenorrhea) and require further investigation.

When does dysmenorrhea start?

Dysmenorrhea is considered primary in the absence of underlying pathology. Onset is typically six to 12 months after menarche, with peak prevalence occurring in the late teens or early twenties. Secondary dysmenorrhea results from specific pelvic pathology.

What are the symptoms of adenomyosis?

Symptoms and signs of adenomyosis include dysmenorrhea, menorrhagia, and a uniformly enlarged uterus. Management options for primary dysmenorrhea include nonsteroidal anti-inflammatory drugs and hormonal contraceptives. Hormonal contraceptives are the first-line treatment for dysmenorrhea caused by endometriosis.

Is pelvic pain cyclic or noncyclic?

Cyclic (can be noncyclic) pelvic pain with menstruation; may be associated with deep dyspareunia, dysuria, dyschezia, and subfertility; rectovaginal examination findings include fixed or retroverted uterus or reduced uterine mobility, adnexal masses, and uterosacral nodularity 10, 11.

What is the first line of treatment for dysmenorrhea?

First-line therapies for primary dysmenorrhea generally involve nonsteroidal anti-inflammatory drugs (NSAIDs) or hormonal contraception. No studies have directly compared the two methods; thus, no conclusions may be reached regarding preferential selection between these two options based on efficacy alone.

Is dysmenorrhea a self-treatment?

ABSTRACT: Primary dysmenorrhea is the most common menstrual complaint, and it is frequently self-treated by patients of all ages. Teenagers are especially prone to experiencing dysmenorrhea symptoms and selecting OTC therapies without adult supervision. Nonsteroidal anti-inflammatory drugs and combined oral contraceptives represent first-line ...

What is the pain of dysmenorrhea?

Dysmenorrhea typically presents as crampy pain along the midline of the lower abdomen. 3,4 Pain may be accompanied by complaints of diarrhea, nausea, vomiting, fatigue, dizziness, headache, and backache. 3,4 Primary dysmenorrhea symptoms first present just after a stable menstrual cycle has been established; accordingly, any patient experiencing pain prior to or within the first 6 months of menarche should be referred for further evaluation. The same is true for patients presenting with first-time pain after several years of asymptomatic cycles. 3

What is the therapeutic objective of primary dysmenorrhea?

The therapeutic objective for treating primary dysmenorrhea is reduction of pain so that the patient can participate in usual activities of daily living without limitation. Common nonpharmacologic strategies include hot baths, heating pads, and exercise. 8 Unfortunately, data supporting these methods are lacking, and drug therapy is often necessary. 11-13 Drug treatments generally target inhibition of PG synthesis or reduction in the number of endometrial cells present at the time of menstruation.

Does acupuncture help with dysmenorrhea?

Various acupuncture methods have also been studied as a remedy for primary dysmenorrhea. Acupuncture is known to increase levels of endorphins, serotonin, and acetylcholine in the central nervous system.

Is dysmenorrhea a common complaint?

Primary dysmenorrhea is a common menstrual complaint that is frequently self-treated by patients of all ages. Teenagers are especially likely to experience dysmenorrhea symptoms and to select OTC therapies without adult supervision. Pharmacists should provide education to patients regarding proper drug selection and dosing, when possible, in order to optimize patient outcomes.

Is acupuncture better than placebo?

Systematic reviews have suggested that various acupuncture methods may be more effective than placebo, herbal remedies, and NSAIDs for treating dysmenorrhea pain. 21,22 Thus, patients interested in nonpharmacologic methods of treatment may want to explore this possible treatment.

How long does menorrhagia last?

Menorrhagia is defined as excessive cyclic uterine bleeding that occurs at regular intervals over several cycles, or prolonged bleeding that lasts for more than seven days. 1 Anovulatory bleeding and menorrhagia, although often grouped together in discussions of treatment, do not have the same etiology or require the same diagnostic testing.

What are the risk factors for menorrhagia?

Established risk factors for menorrhagia include increased age, 8 premenopausal leiomyomata, 9 and endometrial polyps. 10 Parity, body mass index, and smoking are not risk factors. 8 For some women, a cause of menorrhagia is not identified.

What is the definition of menorrhagia?

The classic definition of menorrhagia (i.e., greater than 80 mL of blood loss per cycle) is rarely used clinically. Women describe the loss or reduction of daily activities as more important than the actual volume of bleeding. Routine testing of all women with menorrhagia for inherited coagulation disorders is unnecessary.

Can menorrhagia cause anemia?

Menorrhagia can result in severe anemia. Of 115 women with physician-diagnosed menorrhagia, 58 percent reported a history of anemia, for which 89 percent received treatment. 11 Additionally, 4 percent had received transfusion. Treatment of menorrhagia results in substantial improvement in quality of life. 25

What is the best treatment for anovulatory bleeding?

The treatment of choice for anovulatory bleeding is medical therapy with oral contraceptive pills or progestogens. 1 High-quality comparative evidence on which to base therapy for menorrhagia, however, is limited.

What percentage of women have heavy periods?

In 34 percent of women, the subjective complaint of “heavy periods” appears to correlate with a significantly higher quantified average blood loss. 5 Some women, however, do not consider heavy menstrual flow to be abnormal.

What is the physical exam for acute AUB?

A physical examination of a patient who presents with acute AUB should focus on signs of acute blood loss (hypovolemia and anemia) and findings that suggest the etiology of the bleeding. The patient should be evaluated to determine that she has acute AUB and not bleeding from other areas of the genital tract. Thus, a pelvic examination (including a speculum examination and a bimanual examination) should be performed to identify any trauma to the genital tract and vaginal or cervical findings that could cause vaginal bleeding. The pelvic examination also will determine the amount and intensity of bleeding and will identify any uterine enlargement or irregularity, which can be associated with a structural cause of the acute AUB (leiomyoma).

What are the etiologies of AUB?

The etiologies of acute AUB, which can be multifactorial, are the same as the etiologies of chronic AUB. The Menstrual Disorders Working Group of the International Federation of Gynecology and Obstetrics proposed a classification system and standardized terminology for the etiologies of the symptoms of AUB, which has been approved by the International Federation of Gynecology and Obstetrics’ executive board and supported by the American College of Obstetricians and Gynecologists 1 2. With this system, the etiologies of AUB are classified as “related to uterine structural abnormalities” and “unrelated to uterine structural abnormalities” and categorized following the acronym PALM–COEIN: P olyp, A denomyosis, L eiomyoma, M alignancy and hyperplasia, C oagulopathy, O vulatory dysfunction, E ndometrial, I atrogenic, and N ot otherwise classified Figure 1. Determining the most likely etiology of acute AUB is essential for choosing the most appropriate and effective management for the individual patient and is accomplished by obtaining a history, performing a physical examination, and requesting laboratory and imaging tests, when indicated.

What is AUB in medical terms?

Abnormal uterine bleeding (AUB) may be acute or chronic and is defined as bleeding from the uterine corpus that is abnormal in regularity, volume, frequency, or duration and occurs in the absence of pregnancy 1 2.

What is an acute AUB?

Acute AUB refers to an episode of heavy bleeding that, in the opinion of the clinician, is of sufficient quantity to require immediate intervention to prevent further blood loss 1. Acute AUB may occur spontaneously or within the context of chronic AUB (abnormal uterine bleeding present for most of the previous 6 months).

What is an AUB?

Abnormal uterine bleeding (AUB) may be acute or chronic and is defined as bleeding from the uterine corpus that is abnormal in regularity, volume, frequency, or duration and occurs in the absence of pregnancy 1 2. Acute AUB refers to an episode of heavy bleeding that, in the opinion of the clinician, is of sufficient quantity to require immediate ...

Causes

Signs and symptoms

Epidemiology

Diagnosis

Treatment

• A Cochrane review of 73 randomized controlled trials (RCTs) demonstrated strong evidence to support nonsteroidal anti-inflammatory drugs (NSAIDs) as the first-line treatment for primary dysmenorrhea22 (Table 323). The choice of NSAID should be based on effectiveness and tolerability for the individual patient, because no NSAID has been proven more ...

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Management

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