1) Please reply to the following discussion with one reference. Participate in the discussion by asking a question, providing a statement of clarification, providing a point of view with a rationale, challenging an aspect of the discussion, or indicating a relationship between two or more lines of reasoning in the discussion. Cite resources in your responses to other classmates.
2) Also, answer the following question in a separate small paragraph with one reference.
Question: She does not have insurance how much is an IUD?
Discussion
Family Medicine 32: 33-year-old with painful cycles
During the interview and health history taking for dysmenorrhea, it is important to inquisitive about the presenting symptoms. This would include the relationship of symptoms to the start and ending of menstrual cycle, characteristics of the pain and relieving factors (if there are any), amount of bleeding that is experienced, report of fevers accompanying the symptoms, STI and sexual history, pain with intercourse, chronic diseases and medications the patient is taking, including over the counter medications (Hawkins, Roberto-Nicholas & Stanley-Haney, 2020). 
Patients with dysmenorrhea can have a multitude of symptoms that may be present. Throbbing, aching, persistent pain in the lower abdomen that can radiate to the back are the most common symptom presentation. Patients’ pain usually begins 1-3 days before menses and peaks around 24 hours after the onset. Pain can continue up to 3 days after the beginning of menses (Hawkins, Roberto-Nicholas & Stanley-Haney, 2020). 
Diagnostic tests that can be conducted include chlamydia, gonorrhea and/or wet mount screening if appropriate. 
The primary diagnosis would be primary dysmenorrhea with differential diagnosis including: endometriosis, ovarian cysts and intrauterine polyps. 
The first line treatment for dysmenorrhea would be an NSAID. NSAIDs should be started at the start of menses and can continue taking them up to two days into the menstrual cycle. Cyclic combined hormonal contraceptives can also be used as second line treatment. Heat application and education on premenstrual guidelines for diet and other recommendations can also be used. The patient should have yearly physicals conducted and pap smears per established guidelines (Hawkins, Roberto-Nicholas & Stanley-Haney, 2020). 
Hawkins, J., Roberto-Nicholas,D. & Stanley-Haney, J. (2020). Guidelines for nurse practitioners in gynecologic settings (12th ed.). Springer Publishing. ISBN-13: 9780826173263
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