08-18-2014, 07:59 PM
This patient most likely has primary dysmenorrhea, which occurs only during menstruation and is more common than secondary dysmenorrhea. Prostaglandin released during menstruation causes uterine cramping. Prostaglandin synthetase inhibitors such as nonsteroidal anti-inflammatory drugs (NSAIDs; including ibuprofen, naproxen, and indomethacin) are the first-line treatment options. However, if symptoms remain severe despite use of the latter agents, adding oral contraceptives to inhibit ovulation and thus limit prostaglandin release is usually effective.
A is not correct. 2% chose this.
Menstrual discomfort is caused when prostaglandin is released by the endometrium, which typically leads to cramping. Thus prostaglandin synthetase inhibitors (ie, NSAIDs) are typically used as first-line treatment, not topical analgesic patches. If ineffective, the next option for treating dysmenorrhea is inhibiting ovulation through oral contraceptives.
B is not correct. 0% chose this.
Hysterectomy is not yet indicated in this patient for several reasons. First, she is relatively young and may desire to maintain her fertility if possible. Second, hysterectomy is indicated only after multiple, less aggressive treatment options have been tried. The typical treatment progression is NSAIDs, then oral contraceptives, then further evaluation with laparoscopy before hysterectomy. Medical options should always be exhausted first when treating dysmenorrhea.
C is not correct. 28% chose this.
Laparoscopic evaluation typically is indicated if dysmenorrhea continues to be severe after medical therapy, including NSAIDs and oral contraceptives. Endometriosis may be present and can be treated by fulguration of the implants during laparoscopy, if possible.
D is not correct. 8% chose this.
Naproxen is indicated in the treatment of primary dysmenorrhea, but in the history the patient states that NSAIDs (the class to which naproxen belongs) have not been effective. Given this information, the next step would be to try oral contraceptives.
Bottom Line:
Primary dysmenorrhea occurs during menstruation and results from prostaglandin secretion causing uterine contractions. First-line therapy is prostaglandin synthetase inhibitors (NSAIDs); second-line therapy consists of blocking ovulation via oral contraceptives.
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