Expert answer:Treatment for Dysmenorrhea

Expert answer:Good post. Nonsteroidal anti-inflammatory drugs (NSAIDs) are usually the first line treatment for dysmenorrhea. Although their effects are quick, they have many negative side effects on the liver, kidneys, and digestive tract. Contraceptives are also used for the treatment of dysmenorrhea, but their side effects, including nausea and water retention, making it an unfavorable option. Chen et al., (2013) states that due to their disadvantages, Traditional Chinese Medicine (TCM) can be a feasible alternative. Herbal medicines can be used alone to prevent and treat primary dysmenorrhea or used to augment other therapies (nutritional, hydrotherapy, and/or pharmaceutical). One Cochrane Review of Chinese herbal medicine showed promising evidence for the use of traditional Chinese medicine (TCM) in reducing menstrual pain in primary dysmenorrhea (Lee, Choi, Myung, Lee & Lee, 2016). Herbal medicine is currently used in hospitals and clinics for the treatment of primary dysmenorrhea in East Asian countries including Korea, China, Taiwan, and Japan (Lee, Choi, Myung, Lee & Lee, 2016). One example is YuanHu painkillers (YHP), which is composed of Corydalis yanhusuo and Angelica dahurica. The quality standards of YHP have been recorded in 2000, 2005, and 2010 edition of the Chinese Pharmacopoeia (volume one), and their curative effects have been confirmed in the treatment of dysmenorrhea, migraines, stomach ache, and hypochondriac pain (Chen et al., 2013). Herbal medicine has much to offer women with primary dysmenorrhea. More clinical research is definitely warranted on the herbs before I would feel comfortable using them in my practice as of now. However, with the proper knowledge and evidenced base results of their use, they can readily be combined with conventional and nutritional/ supplemental approaches. Yarnell (2015) states, “herbs should be viewed as useful multifaceted tools with the real potential to help patients and not feared or discarded because of supposedly insufficient evidence, as their long historical uses may not be as well-documented but are still important for directing clinical practice” (p. 227). What are your thoughts on herbal treatment for dysmenorrhea? References Chen, Y., Cao, Y., Xie, Y., Zhang, X., Yang, Q., Li, X., & … Wang, S. (2013). Traditional Chinese medicine for the treatment of primary dysmenorrhea: How do Yuanhu painkillers effectively treat dysmenorrhea?. Phytomedicine,20(12), 1095-1104. doi:10.1016/j.phymed.2013.05.003 Lee, H., Choi, T., Myung, C., Lee, J. A., & Lee, M. S. (2016). Herbal medicine (Shaofu Zhuyu decoction) for treating primary dysmenorrhea: A systematic review of randomized clinical trials. Maturitas, 8664-73. doi:10.1016/j.maturitas.2016.01.012 Yarnell, E. (2015). Herbal Medicine for Dysmenorrhea. Alternative & Complementary Therapies, 21(5), 224-228. doi:10.1089/act.2015.29024.eya Great information provided in this week’s discussion. I agree with your information, The first line of defense when a patient has dysmenorrhea is NSAIDs to help with pain relief (Schuiling, & Likis 2017). Combined oral contraceptives are estrogen and progestin which act in suppressing ovulation. By suppressing ovulation dysmenorrhea is reduced. Oral contraceptive, progestin implants, IUDs and the Depot injection suppress ovulation (Schuiling, & Likis 2017). It is important to determine whether the dysmenorrhea is primary or secondary. This is important because if there is an underlining cause, causing the pain then the underlying cause must be treated before starting on any other medication or treatment options (Kaplan & Porter, 2011.) There are also many home remedies that can be used to help the patient manage the pain, and it depends on the patient culture (Schuiling, & Likis 2017). It is great also that you feel that way about patient care. The patient should always be included in making the decision they will chose for their health. Giving them the information, and allowing them to decide what is best for them is the best thing to do for them. References: Porter, R.S., & Kaplan, J.L. (2011). The Merck Manual of Diagnosis and Therapy, 19th Edition. Whitehouse Station, NJ: Merck Sharp & Dohme Corp. Schuiling, K. D., & Likis, F. E. (2017). Women’s gynecologic health (3rd ed.). Burlington, MA: Jones and Bartlett Publishers. Sasha, you provided great information to this week’s discussion posting. I enjoyed reading about case study two in your perspective. Contraceptive treatments are prescribed for different reasons and can be a challenge when providing care to all individuals. There are many women who struggle with menstrual cramping, and there are some that have the worse than others. It could be something as simple as their daily diet leading to more cramping or bloating or just their anatomy. Women are very active in today’s society, and it makes their jobs and lifestyles difficult when they are experiencing menstrual cramping. Taking a full history of the patient is paramount to help in the understanding of what she plans later in life, like having a family. Contraceptive methods are offered in various forms and are known to help with terrible menstruation cycles. NSAIDS and heat packs do help with women who have painful cycles, but over long periods of use can lead to gastric ulcerations or colon issues (Smith, & Kaunitz, 2017). Contraceptive methods help menstrual cramping as well as the heaviness of the flow (Knox, Viney, Street, Haas, Fiebig, Weisberg, & Bateson, 2012). During this clinic rotation, I have learned so much about the different side effects each patient experiences. There are some patients with the Mirena who have heavy menstruation and increase abdominal cramping. Then, some individuals who have no cycles while using Mirena. Once the provider knows the patient’s medical history, they can take into consideration their other health history. With all patients wanting contraceptive’s, it is important to educate the patient about all the differences patients experience on the same method. The patient will also need to know they may have to try several contraceptives until they get the relief they are wanting from the method. I would also discuss light exercise with the patient to also help with cramping. Which contraceptive have you found to have more success in decreasing cramping during your clinic rotation? References Knox, S. A., Viney, R. C., Street, D. J., Haas, M. R., & al, e. (2012). What’s good and bad about contraceptive products? Pharmaco Economics, 30(12), 1187-1202. doi:http://dx.doi.org.ezp.waldenulibrary.org/10.2165/1… Smith, R., & Kaunitz, A. (2017). Patient education: Painful menstrual periods (dysmenorrhea) (Beyond the basics).UpToDate. Retrieved from https://www.uptodate.com/contents/painful-menstrua… Thank you for your well-written and informative approach to case study two for week three. I agree with your treatment approach for the diagnosis of primary dysmenorrhea. Dysmenorrhea is often encountered in female populations that experience mensus (Pinkerton, 2017). However, as an advanced practice nurse (APN) it is vital to appropriately asses the degree of dysmenorrhea, the extent of discomfort, ensure that approapriate treatement is initiated, and that further diagnostics are utilized if necessary (Schuiling & Likis, 2017). I appreciate your highlight on the importance of education regarding sexually transmitted infection (STIs) prevention. Often I have encountered patient populations that lack health literacy related to contraception and STIs. Some populations with impaired health literacy are not aware that contraception does not protect against STIs. Therefore the APN must utilize each patient encounter to reinforce the importance of safe sexual encounters (Schuiling & Likis, 2017). How would you approach a patient interaction that involved a patient adamant about a method of contraception that indicated a high-risk of health risk versus benefit of use? Thank you for your response in advance. Very good recommendations for patients who do not agree with treatment Shasha, what do you think your first recommendation for this patient would be? References Pinkerton, J. V. (2017). Dysmenorrhea. Retrieved from https://www.merckmanuals.com/professional/gynecolo… Schuiling, K. D., & Likis, F. E. (2017). Women’s gynecologic health (3rd ed.). Burlington, MA: Jones & Bartlett Learning. I agree that determining the timing of symptoms is crucial to ensuring the patient is receiving the appropriate therapy. “Other conditions, such as depression or anxiety, may worsen during the luteal phase, but these can be distinguished from PMS because they persist throughout the menstrual cycle” (Hofmeister & Bodden, 2016). All other causes of the symptoms, such as “migraines, anemia, endometriosis, and hypothyroidism” should be ruled out (Hofmeister & Bodden, 2016). In addition to the hormonal therapy that you mentioned for treatment, patient’s may also benefit from a selective serotonin reuptake inhibitor (SSRI) and are often first-line treatment, especially if the symptoms are more psychiatric (Hofmeister & Bodden, 2016). Reference Hofmeister, S., & Bodden, S. (2016). Premenstrual syndrome and premenstrual dysphoric disorder. American Family Physician, 94(3), 236-240.

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