Family Medicine Clerkship

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Menstrual Disorders

OVERVIEW

Common disorders of menstruation seen by family physicians include dysmenorrhea, premenstrual syndrome, and abnormal uterine bleeding. Painful menses is a common complaint that must be critically evaluated by the family physician to rule out serious pathology and provide relief to patients. Premenstrual syndrome occurs in 10-15% of menstruating women in the United States. Abnormal uterine bleeding is also a common complaint in family practice. At the completion of a clinical rotation in family medicine, students should be able to recognize and treat these common disorders.

TOPIC LEARNING GOALS AND OBJECTIVES
(Organized by ACGME Competencies)

Patient Care

GOAL: Students will accurately assess signs and symptoms of dysmenorrhea, premenstrual syndrome, and abnormal uterine bleeding.

OBJECTIVES: Students will be able to:

• Complete an appropriate abdominal and pelvic examination and Pap smear.
• Interpret Pap smear results.

GOAL: Students will appropriately discuss dysmenorrhea, premenstrual syndrome, and/or abnormal uterine bleeding with patients.

OBJECTIVES: Students will be able to:

• Explain indicators of control and complications of dysmenorrhea, premenstrual syndrome, and/or abnormal uterine bleeding to patients.
• Describe to patients the risks of dysmenorrhea, premenstrual syndrome, or abnormal uterine bleeding and goals of management.

GOAL: Students will be sensitive to individual and cultural differences in their development of treatment plans.

OBJECTIVES: Students will be able to:

• Develop treatment plans in the context of each patient's life and environment.

Medical Knowledge

GOAL: Students will understand the significance of dysmenorrhea, premenstrual syndrome, or abnormal uterine bleeding in health promotion and disease prevention.

OBJECTIVES: Students will be able to:

• Discuss the epidemiology of cervical, uterine, and ovarian cancer, including racial, ethnic, and socioeconomic differences.
• Describe the USPSTF recommendations for screening for cervical, uterine, and ovarian cancer.

GOAL: Students will understand the pathophysiology of endometriosis, cervical, uterine, and ovarian cancer, ectopic pregnancy, pelvic inflammatory disease, and threatened or missed abortion.

OBJECTIVES: Students will be able to:

• Describe the differential diagnosis of abnormal uterine bleeding and/or pelvic pain.

GOAL: Students will understand the rationale for treatment plans for dysmenorrhea, premenstrual syndrome, and abnormal uterine bleeding.

OBJECTIVES: Students will be able to:

• Describe the appropriate therapy for dysmenorrhea, premenstrual syndrome, and abnormal uterine bleeding.
• Discuss the evidence for the role of lifestyle changes.
• Discuss the side effects and costs of commonly used medications.

Practice-Based Learning and Improvement

GOAL: Students will understand the role of screening for cervical/uterine cancer in practice and community settings.

OBJECTIVES: Students will be able to:

• Describe how Pap smears are monitored in the assigned clerkship site.
• Describe and contrast the impact of environment and neighborhood on availability of screening and treatment for cervical/uterine cancer.

GOAL: Students will understand the role of practice-based improvement.

OBJECTIVES: Students will be able to:

• Analyze their clerkship practice regarding vulnerable populations for cervical or uterine cancer.

GOAL: Students will bring up-to-date evidence to the point of clinical care.

OBJECTIVES: Students will be able to:

• Identify gaps in their own knowledge and frame appropriate clinical questions in regard to dysmenorrhea, premenstrual syndrome, and abnormal uterine bleeding
• Utilize best evidence to answer clinical questions about dysmenorrhea, premenstrual syndrome, and abnormal uterine bleeding.

Interpersonal and Communication Skills

GOAL: Students will understand the importance of effective communication with patients and families in the management of dysmenorrhea, premenstrual syndrome, and abnormal uterine bleeding.

OBJECTIVES: Students will be able to:

• Describe the long-term treatment plans for premenstrual syndrome and dysmenorrhea.
• Include patients and families in the development of treatment plans.
• Demonstrate effective listening skills and empathy to improve patient adherence to lifestyle modifications, such as diet, exercise, and medications.

Professionalism

GOAL: Students will demonstrate the ability to care for patients with dysmenorrhea, premenstrual syndrome, and abnormal uterine bleeding from diverse patient backgrounds and at different points in their illness.

OBJECTIVES: Students will be able to:

• Demonstrate sensitivity and responsiveness with patients who are not adhering to treatment plans.
• Reflect on personal frustrations and transform this response into a deeper understanding when patients are not adherent to plans.
• Demonstrate understanding of the relationship of dysmenorrhea, premenstrual syndrome, and abnormal uterine bleeding to culture, age, and disabilities.

Systems-Based Practice

GOAL: Students will understand the impact of health care systems and environment on the management of dysmenorrhea, premenstrual syndrome, and abnormal uterine bleeding.

OBJECTIVES: Students will be able to:

• Describe cost-effective strategies for treatment of dysmenorrhea, premenstrual syndrome, and abnormal uterine bleeding using different formularies.
• Analyze barriers to effective integrated treatment of dysmenorrhea, premenstrual syndrome, and abnormal uterine bleeding.
• Consider the role of other disciplines (e.g., pharmacy, nursing, social work, and allied health) in the treatment of dysmenorrhea, premenstrual syndrome, and abnormal uterine bleeding.
  

Lead Author: Ann O'Brien Gonzales, PhD
Clerkship/Post-Clerkship Workgroup members: Ann O'Brien-Gonzales, PhD (Chair), Alexander Chessman, MD (EC Liaison), Caryl Heaton, DO, Janice Nevin, MD, MPH, Lauren Oshman, MD, Deborah McPherson, MD, Mark. E Quirk, EdD, David Schneider, MD, MSPH, William B. Shore, MD, Richard Usatine, MD

Family Medicine Curriculum Resource (FMCR) Project HRSA Contract 240-00-0107.

For questions or comments, please contact Webmaster or Ardis Davis

This page last updated November 6, 2004