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% Document Info
\author{Teas}
\pdfinfo{
  /Title (dysmenorrhea.pdf)
  /Creator (Cheatography)
  /Author (Teas)
  /Subject (Dysmenorrhea Cheat Sheet)
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\noindent
\begin{multicols}{3}
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    \vspace{-7pt}
    {\parbox{\dimexpr\textwidth-2\fboxsep\relax}{\noindent
        \hspace*{-6pt}\includegraphics[width=5.8cm]{/web/www.cheatography.com/public/images/cheatography_logo.pdf}}
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\begin{tabulary}{11cm}{L}
    \vspace{-2pt}\large{\bf{\textcolor{DarkBackground}{\textrm{Dysmenorrhea Cheat Sheet}}}} \\
    \normalsize{by \textcolor{DarkBackground}{Teas} via \textcolor{DarkBackground}{\uline{cheatography.com/181443/cs/37719/}}}
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\noindent
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  \mymulticolumn{2}{p{5.377cm}}{\bf\textcolor{white}{Cheatographer}}  \\
  \vspace{-2pt}Teas \\
  \uline{cheatography.com/teas} \\
  \end{tabulary}
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  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Cheat Sheet}}  \\
   \vspace{-2pt}Not Yet Published.\\
   Updated 16th March, 2023.\\
   Page {\thepage} of \pageref{LastPage}.
\end{tabulary}
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  \vspace{-5pt}
  %\includegraphics[width=48px,height=48px]{dave.jpeg}
  Measure your website readability!\\
  www.readability-score.com
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\begin{multicols*}{2}

\begin{tabularx}{8.4cm}{p{0.8 cm} p{0.8 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{SECONDARY DYSMENORRHEA: CAUSES AND MANAGEMENT}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- Pelvic disease considered in patients who do not respond to NSAIDs or CCs or combination of these agents} \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- The diagnosis should also be considered when symptoms appear after many years of painless menses} \tn 
% Row Count 5 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{{\emph{ - cervical stenosis}}} \tn 
% Row Count 6 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{{\emph{ - endometriosis}}} \tn 
% Row Count 7 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{{\emph{ - adenomyosis}}} \tn 
% Row Count 8 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{{\emph{ - fibroids}}} \tn 
% Row Count 9 (+ 1)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{{\emph{ - pelvic inflammation}}} \tn 
% Row Count 10 (+ 1)
% Row 7
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{{\emph{ - pelvic congestion, congenital obstructive Mullerian malformations, diseases of the gastrointestinal tract, and mental health conditions}}} \tn 
% Row Count 13 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{p{0.8 cm} p{0.8 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{DYSMENORRHEA}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{A cyclic, painful cramping sensation in the lower abdomen accompanied by other biologic symptoms} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{Primary dysmenorrhea refers to pain with no obvious pathologic pelvic disease. It is currently recognized that these patients are suffering from the effects of endogenous prostaglandin.} \tn 
% Row Count 6 (+ 4)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{Secondary dysmenorrhea is associated with pelvic conditions or pathology that causes pelvic pain in conjunction with the menses} \tn 
% Row Count 9 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{p{0.8 cm} p{0.8 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{INDICDENCE AND EPIDEMIOLOGY}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{approximately 75\%} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{younger age at first childbirth, high parity, and physical exercise} \tn 
% Row Count 3 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{pregnancy itself without actual birth does not seem to alleviate dysmenorrhea} \tn 
% Row Count 5 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{p{0.8 cm} p{0.8 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{RISK FACTORS}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- age less than 30} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- BMI less than 20} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- premenstrual syndrome} \tn 
% Row Count 3 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- PID} \tn 
% Row Count 4 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- sterilization} \tn 
% Row Count 5 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- history of sexual assault} \tn 
% Row Count 6 (+ 1)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- heavy smoking} \tn 
% Row Count 7 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
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\begin{tabularx}{8.4cm}{p{0.8 cm} p{0.8 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{PRIMARY DYSMENORRHEA}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- elevated prostaglandin F2a (PGF2a) levels in the secretory endometrium and the symptoms of dysmenorrhea} \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- arachidonic acid, has been found in increased amounts on the endometrium during ovulatory cycles} \tn 
% Row Count 5 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- {\emph{converted to PGF2a, PGE2, and leukotrienes}}} \tn 
% Row Count 6 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- PGF2a and PGE2 correlate with the severity of dysmenorrhea} \tn 
% Row Count 8 (+ 2)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{{\emph{ - nausea, vomiting, and diarrhea}}} \tn 
% Row Count 9 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{p{0.8 cm} p{0.8 cm} }
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\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{DIAGNOSIS}}  \tn
% Row 0
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\mymulticolumn{2}{x{8.4cm}}{- History and physical exam} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- midline, crampy, lower abdominal pain, which begins with the onset of menstration} \tn 
% Row Count 3 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- the pain can be severe and can also involve the lower back and thighs. Pain does not occur at tines other than menses and only occurs during ovulatory cycles} \tn 
% Row Count 7 (+ 4)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{{\emph{ - diarrhea, headache, fatigue, and malaise}}} \tn 
% Row Count 8 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- normal pelvic examination} \tn 
% Row Count 9 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{{\emph{ - no laboratory or imaging abnormalities}}} \tn 
% Row Count 10 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
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\par\addvspace{1.3em}

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\mymulticolumn{1}{x{8.4cm}}{\bf\textcolor{white}{TREATMENT}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{8.4cm}}{- treatment for primary dysmenorrhea begins with providing patient education and reassurance} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{8.4cm}}{- individualized, supportive therapy can be tailored to the patient's specific symptoms, degree of disability from those symptoms, and other health care considerations, such as need for contraception} \tn 
% Row Count 6 (+ 4)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{8.4cm}}{{\bf{NONPHARMACOLOGIC INTERVENTION}}} \tn 
% Row Count 7 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{8.4cm}}{- exercise} \tn 
% Row Count 8 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{8.4cm}}{- heat} \tn 
% Row Count 9 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{8.4cm}}{- behavioral interventions} \tn 
% Row Count 10 (+ 1)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{8.4cm}}{- vitamins and diet} \tn 
% Row Count 11 (+ 1)
% Row 7
\SetRowColor{white}
\mymulticolumn{1}{x{8.4cm}}{{\bf{MEDICATIONS}}} \tn 
% Row Count 12 (+ 1)
% Row 8
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{8.4cm}}{- NSAIDs} \tn 
% Row Count 13 (+ 1)
% Row 9
\SetRowColor{white}
\mymulticolumn{1}{x{8.4cm}}{{\emph{ - prostaglandin synthase inhibitors (PGSIs)}}} \tn 
% Row Count 14 (+ 1)
% Row 10
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{8.4cm}}{{\emph{ - these substances are non-steroidal and anti-inflammatory}}} \tn 
% Row Count 16 (+ 2)
% Row 11
\SetRowColor{white}
\mymulticolumn{1}{x{8.4cm}}{{\emph{- arylcarboxylic acids, which include acetylsalicylic acid (aspirin) and fenamates (mefenamic acid)}}} \tn 
% Row Count 19 (+ 3)
% Row 12
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{8.4cm}}{{\emph{ - arylalkanoic acids, including the arylpropionic acids (ibuprofen, naproxen, and ketoprofen) and the indoleacetic acids (indomethacin)}}} \tn 
% Row Count 22 (+ 3)
% Row 13
\SetRowColor{white}
\mymulticolumn{1}{x{8.4cm}}{- Cyclooxygenase (COX2) inhibitors have similarly been shown to alleviate the primary dysmenorrheal symptoms} \tn 
% Row Count 25 (+ 3)
% Row 14
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{8.4cm}}{{\emph{ - reduction of contractility}}} \tn 
% Row Count 26 (+ 1)
% Row 15
\SetRowColor{white}
\mymulticolumn{1}{x{8.4cm}}{- COX-2 expression in the uterine glandular epithelium was maximal during menstruation in one trial of ovulatory women} \tn 
% Row Count 29 (+ 3)
% Row 16
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{8.4cm}}{- COX-2 inhibitors may be considered for women with gastrointestinal toxicity due to NSAISs} \tn 
% Row Count 31 (+ 2)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{8.4cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{8.4cm}}{\bf\textcolor{white}{TREATMENT (cont)}}  \tn
% Row 17
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{8.4cm}}{- Estrogen and progesterone will relieve the symptoms of primary dysmenorrhea in approximately 905 of patients} \tn 
% Row Count 3 (+ 3)
% Row 18
\SetRowColor{white}
\mymulticolumn{1}{x{8.4cm}}{- Suppress ovulation and endometrial proliferation and the progestin component also blocks the production of the precursor to prostaglandin formation} \tn 
% Row Count 6 (+ 3)
% Row 19
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{8.4cm}}{- The thinned endometrium from CCs then contains less arachidonic acid, which is the precursor to prostaglandins} \tn 
% Row Count 9 (+ 3)
% Row 20
\SetRowColor{white}
\mymulticolumn{1}{x{8.4cm}}{- If the woman also requires contraception, CC therapy may prove to be the treatment of choice} \tn 
% Row Count 11 (+ 2)
% Row 21
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{8.4cm}}{- The vaginal ring CC reduce dysmenorrhea in a similar fashion as COCs} \tn 
% Row Count 13 (+ 2)
% Row 22
\SetRowColor{white}
\mymulticolumn{1}{x{8.4cm}}{- Dysmenorrhea was not, however, as well controlled in women using the transdermal CC patch as compared with COCs} \tn 
% Row Count 16 (+ 3)
% Row 23
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{8.4cm}}{{\bf{PROGESTIN-ONLY FORMULATIONS}}} \tn 
% Row Count 17 (+ 1)
% Row 24
\SetRowColor{white}
\mymulticolumn{1}{x{8.4cm}}{- Depot medroxyprogesterone, a long-acting injectable contraceptive, has been studied specifically for primary dysmenorrhea} \tn 
% Row Count 20 (+ 3)
% Row 25
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{8.4cm}}{- The 20ug levonorgestrel releasing intrauterine system (LNGIUS) has been shown in randomized controlled trails to reduce menstrual pain} \tn 
% Row Count 23 (+ 3)
% Row 26
\SetRowColor{white}
\mymulticolumn{1}{x{8.4cm}}{- Copper T380A intrauterine device (IUD)} \tn 
% Row Count 24 (+ 1)
% Row 27
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{8.4cm}}{- Etonogestrel-releasing contraceptive (Implanon) / Nexplanon} \tn 
% Row Count 26 (+ 2)
% Row 28
\SetRowColor{white}
\mymulticolumn{1}{x{8.4cm}}{{\bf{TOCOLYTICS}}} \tn 
% Row Count 27 (+ 1)
% Row 29
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{8.4cm}}{- tocolytics may be beneficial in the treatment of dysmenorrhea} \tn 
% Row Count 29 (+ 2)
% Row 30
\SetRowColor{white}
\mymulticolumn{1}{x{8.4cm}}{{\emph{ - nifedipine at a dose of 20-40mg orally}}} \tn 
% Row Count 30 (+ 1)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{8.4cm}{X}
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\mymulticolumn{1}{x{8.4cm}}{\bf\textcolor{white}{TREATMENT (cont)}}  \tn
% Row 31
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{8.4cm}}{- glyceryl trinitrate and magnesium} \tn 
% Row Count 1 (+ 1)
% Row 32
\SetRowColor{white}
\mymulticolumn{1}{x{8.4cm}}{- not often utilized for contemporary management of dysmenorrhea} \tn 
% Row Count 3 (+ 2)
% Row 33
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{8.4cm}}{{\bf{OTHER TREATMENTS}}} \tn 
% Row Count 4 (+ 1)
% Row 34
\SetRowColor{white}
\mymulticolumn{1}{x{8.4cm}}{- narcotic analgesics} \tn 
% Row Count 5 (+ 1)
% Row 35
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{8.4cm}}{- acupuncture} \tn 
% Row Count 6 (+ 1)
% Row 36
\SetRowColor{white}
\mymulticolumn{1}{x{8.4cm}}{- laparoscopic uterine nerve ablation  (LUNA) or laparoscopic presacral neurectomy (LPSN)} \tn 
% Row Count 8 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{8.4cm}}{\bf\textcolor{white}{SECONDARY DYSMENORRHEA}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{8.4cm}}{} \tn 
% Row Count 0 (+ 0)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
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\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{p{0.8 cm} p{0.8 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{SECONDARY DYSMENORRHEA: CAUSES AND MANAGEMENT}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- Pelvic disease considered in patients who do not respond to NSAIDs or CCs or combination of these agents} \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- The diagnosis should also be considered when symptoms appear after many years of painless menses} \tn 
% Row Count 5 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{{\emph{- cervical stenosis}}} \tn 
% Row Count 6 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{{\emph{- endometriosis}}} \tn 
% Row Count 7 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{{\emph{- adenomyosis}}} \tn 
% Row Count 8 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{{\emph{- fibroids}}} \tn 
% Row Count 9 (+ 1)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{{\emph{- pelvic inflammation}}} \tn 
% Row Count 10 (+ 1)
% Row 7
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{{\emph{- pelvic congestion, congenital obstructive Mullerian malformations, diseases of the gastrointestinal tract, and mental health conditions}}} \tn 
% Row Count 14 (+ 4)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{p{0.8 cm} p{0.8 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{CERVICAL STENOSIS}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- Severe narrowing of the cervical canal causing an increase in intrauterine pressure at the time of menses} \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- Associated with pelvic endometriosis} \tn 
% Row Count 4 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- Congenital or secondary to cervical injury} \tn 
% Row Count 5 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- Inflammatory process} \tn 
% Row Count 6 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- History of scant menstrual flow and if severe cramping continues throughout the menstrual period} \tn 
% Row Count 8 (+ 2)
% Row 5
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- Diagnosis is generally documented by the inability to pass a thin probe of a few millimeters' diameter through the internal os or by a hysterosalpingogram, which demostrates a thin, stringy-appearing canal} \tn 
% Row Count 13 (+ 5)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- Treatment consists of dilating the cervix} \tn 
% Row Count 14 (+ 1)
% Row 7
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{{\emph{ - often recurs after therapy, necessitating repeat procedures}}} \tn 
% Row Count 16 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{p{0.8 cm} p{0.8 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{ECTOPIC ENDOMETRIAL TISSUE}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{{\bf{Endometriosis}}} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- presence of endometrial glands and stroma outside of the uterus defines endometriosis} \tn 
% Row Count 3 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- generalized pelvic pain, cyclic pain, dysmenorrhea, infertility, and bowel or bladder dysfunction} \tn 
% Row Count 5 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- history of pain becoming more severe during menses} \tn 
% Row Count 7 (+ 2)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{{\bf{Adenomyosis}}} \tn 
% Row Count 8 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- presence of endometrial glands and stroma in the myometrium} \tn 
% Row Count 10 (+ 2)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- this ectopic endometrial tissue may induce hypertrophy and hyperplasia of the adjacent myometrium} \tn 
% Row Count 12 (+ 2)
% Row 7
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{{\emph{ - manifest in heavy }}} \tn 
% Row Count 13 (+ 1)
% Row 8
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{{\emph{ - painful menses that tends to be progressive}}} \tn 
% Row Count 14 (+ 1)
% Row 9
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- Prostaglandin level in endometriosis implants increase painful menstruation} \tn 
% Row Count 16 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{p{0.8 cm} p{0.8 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{PELVIC CONGESTION SYNDROME}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- Pelvic congestion syndrome (PCS), which was first described by Taylor in 1949, results from the engorgement of pelvic vasculature} \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- Chronic pelvic discomfort (often burning or throbbing in nature) worsened by prolonged standing and intercourse in women who have periovarian varicosities on imaging studies} \tn 
% Row Count 7 (+ 4)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- Etiology is unclear and optimum treatment is uncertain} \tn 
% Row Count 9 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- Pelvic pain, dysuria, dysmenorrhea, and dyspareunia} \tn 
% Row Count 11 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{p{0.8 cm} p{0.8 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{PREMENSTRUAL SYNDROME}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- A group of mild to moderate symptoms, physical and behavioral, that occur in the second half of the menstrual cycle and that may interfere with work and personal relationships} \tn 
% Row Count 4 (+ 4)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- Breast tenderness, bloating, and headache} \tn 
% Row Count 5 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- These are followed by a period entirely free of symptoms} \tn 
% Row Count 7 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- Family history of PMS in the mother, personal past or current psychiatric illness involving mood or anxiety disorders, history of alcohol abuse, and history of postpartum depression} \tn 
% Row Count 11 (+ 4)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{p{0.8 cm} p{0.8 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{PREMENSTRUAL DYSPHORIC DISORDER}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- A more severe disorder, with marked behavioral and emotional symptoms.} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- PMDD differs from PMS in the severity of symptoms and the fact that women with PMDD must have one severe affective symptom.} \tn 
% Row Count 5 (+ 3)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- Markedly depressed mood or hopelessness, anxiety or tension, affective lability, or persistent anger, which occur regularly during the last week of the luteal phase in most menstrual cycles} \tn 
% Row Count 9 (+ 4)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- PMDD also differs from PMS because there is substantial impairment in personal functioning} \tn 
% Row Count 11 (+ 2)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- PMS and PMDD are similar in that the symptoms manifest in the luteal phase of the menstrual cycle and resolve during menses} \tn 
% Row Count 14 (+ 3)
% Row 5
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- Premenstrual symptoms occur in 75\% of women at some point in their reproductive lives. The incidence of clinically relevant PMS occurs in 3\% to 8\% of women and 2\% of reproductive-age women will suffer from PMDD} \tn 
% Row Count 19 (+ 5)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{{\bf{SYMPTOMS}}} \tn 
% Row Count 20 (+ 1)
% Row 7
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- Abdominal bloating, breast tenderness, and various pain constellations, such as headache} \tn 
% Row Count 22 (+ 2)
% Row 8
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{{\emph{ - Fatigue, irritability, and tension to anxiety, labile mood, and depression}}} \tn 
% Row Count 24 (+ 2)
% Row 9
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- Depression} \tn 
% Row Count 25 (+ 1)
% Row 10
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- Causes} \tn 
% Row Count 26 (+ 1)
% Row 11
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- Estrogen excess} \tn 
% Row Count 27 (+ 1)
% Row 12
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- Imbalance of estrogen and progesterone, endogenous hormone allergy, hypoglycemia, vitamin B6 deficiency, prolactin excess, fluid retention, inappropriate prostaglandin activity, elevated monoamine oxidase (MAO) levels, endorphin malfunction, and a number of psychological disturbances.} \tn 
% Row Count 33 (+ 6)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{8.4cm}{p{0.8 cm} p{0.8 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{PREMENSTRUAL DYSPHORIC DISORDER (cont)}}  \tn
% Row 13
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{{\bf{DIAGNOSIS}}} \tn 
% Row Count 1 (+ 1)
% Row 14
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- History of two consecutive menstrual cycles demonstrating luteal phase symptoms of PMS and PMDD.} \tn 
% Row Count 3 (+ 2)
% Row 15
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- After a complete history and physical examination, the physician should rule out any medical problems that could be influencing the symptomatology} \tn 
% Row Count 6 (+ 3)
% Row 16
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- DSM-V criteria, which require 5 of 11 symptoms of PMS, including one affective symptom} \tn 
% Row Count 8 (+ 2)
% Row 17
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{{\emph{ - feeling sad or hopeless or having self-deprecating thoughts, anxiety or tension, mood lability and crying, and persistent irritability, anger, and increased interpersonal conflicts}}} \tn 
% Row Count 12 (+ 4)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{8.4cm}}{\bf\textcolor{white}{PMS or PMDD}}  \tn
\SetRowColor{LightBackground}
\mymulticolumn{1}{p{8.4cm}}{\vspace{1px}\centerline{\includegraphics[width=5.1cm]{/web/www.cheatography.com/public/uploads/teas_1678901096_Screenshot 2023-03-16 012351.png}}} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{p{0.8 cm} p{0.8 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{TREATMENT}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{{\bf{Pharmacologic Agents}}} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- Psychoactive Drugs} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{{\emph{ - SSRIs have been shown to be extremely effective for treating PMS and have become first-line treatment for PMDD}}} \tn 
% Row Count 5 (+ 3)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{{\bf{Hormonal Suppression}}} \tn 
% Row Count 6 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- Progesterone} \tn 
% Row Count 7 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- Oral Contraceptives} \tn 
% Row Count 8 (+ 1)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- Nonsteroidal Anti-inflammatory Drugs} \tn 
% Row Count 9 (+ 1)
% Row 7
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- Diuretics} \tn 
% Row Count 10 (+ 1)
% Row 8
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- Bromocriptine} \tn 
% Row Count 11 (+ 1)
% Row 9
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- Gonadotropin-Releasing Hormone Agonists} \tn 
% Row Count 12 (+ 1)
% Row 10
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{{\bf{Surgical Treatment: Bilateral Oophorectomy with or without Hysterectomy}}} \tn 
% Row Count 14 (+ 2)
% Row 11
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{- For women with severe, disabling symptoms who have been refractory to other medical therapies, surgical management may be considered} \tn 
% Row Count 17 (+ 3)
% Row 12
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{- Reasonable alternative for select patients for whom all other treatment regimens have failed.} \tn 
% Row Count 19 (+ 2)
% Row 13
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{{\emph{ - GnRH analogue for 3 to 6 months, with or without estrogen add-back}}} \tn 
% Row Count 21 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{8.4cm}}{\bf\textcolor{white}{TREATMENT}}  \tn
\SetRowColor{LightBackground}
\mymulticolumn{1}{p{8.4cm}}{\vspace{1px}\centerline{\includegraphics[width=5.1cm]{/web/www.cheatography.com/public/uploads/teas_1678902596_Screenshot 2023-03-16 014943.png}}} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{p{0.8 cm} p{0.8 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{SECONDARY DYSMENORRHEA: CAUSES AND MANAGEMENT}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{} \tn 
% Row Count 0 (+ 0)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}


% That's all folks
\end{multicols*}

\end{document}