Treatment for primary dysmenorrhea:
- non-medication (hot packs, exercise)
- medication (NSAIDs, starting 1-2 days prior to bleeding if can predict, hormonal therapies)
Tx cont'd:
- CHCs (pills, patch, ring), continuous vs cyclic use
- POPs: can start at lower dose and increase if needed (e.g. 5-20 mg norethindrone acetate)
- Depo 💉: 50% in 1 yr have amenorrhea
- Implants : 52mg LNG IUD have best amenorrhea rates
Endometriosis!
Leading cause of secondary dysmenorrhea in adolescents
- in a study of adult endo patients, 67% reporting sx before 20, 20% had sx <15
- RFs: early menarche, shorter menstrual cycles, menorrhagia, FHx, anomalies
Management: can wax and wane in sx, is a chronic dz
- Surgical: removal/lysis of adhesions. Peritoneal stripping is NOT recommended in adolescents d/t increase risk of adhesive disease w/ growth
- Meds: continuous use or extended cycling is recommended to suppress growth #SAHM23
GnRH agonists (leuprolide) can be considered, however leads to low estrogen (leading to decreased BMD). If on longer than 6 months, do add back therapy with norethindrone +/- conjugated estrogen. SEs post-menopausal sx
- mass (large and sx) -->surgery
- PID - can happen in non-SA patients!
- Vulvodynia - pain for 3 months w/o clear causes. Dx of exclusion. Rule out infection, Q-tip test to identify where pain is #SAHM23
Late to the headache workshop but here now! Learning about importance of treating migraines, children with migraines miss significantly more school than those who do not. #SAHM23
Patients with migraines with aura have increased risk of strokes. Important to avoid estrogen when possible as well as smoking to not compound this risk. #SAHM23
Complicated migraines: can have brainstem auras - sx of dizziness, tinnitus, ataxia, dysarthria, vertigo.
Vestibular migraine: dizziness with the headache part
By request, here's a brief thread on avoidant restrictive food intake disorder (ARFID). 🧵 #EDAW2023
ARFID emerged as a diagnosis with the DSM-5 in 2013. In short, patients with ARFID have restrictive eating w/o evidence of body image disturbance. But let's dig a little more...
Here are the diagnostic criteria. You'll notice that other medical/mental health conditions don't prevent a dx of ARFID from being made (e.g. autism spectrum). However, if another condition is present the feeding disturbance has to be beyond what is typical for that condition...
I conceptualize ARFID in 3 major categories.
1⃣ Pts w/ fear of an adverse consequence (e.g. vomiting, choking abd pain)
2⃣ Pts w/ sensory concerns (e.g. sensitivity to food texture, smell, temperature)
3⃣ Pts w/ a lack of interest in eating, minimal appetite, a chore to eat