Re: BTB on OCPs
From: Jay Kulkin (jkulkin@mindspring.com)
Fri Jun 27 21:50:38 2003
Let me say it a different way......I've "never" used a 50 mcg pill in the
years I've practiced, since 82, and "never" did a D&C for DUB in those
years as well. Yes, many office hysteroscopies finding many submucous myomas
and polypoid lesions in young women. I find too many physicians making too
many changes in bcp's due to btb with minimal councelling of the patients as
to what their expectations should be regarding expected btb on any
prescribed pill. I've seen too many of these abrupt changes lead to too
many unnecessary invasive procedures. I agree with never saying never or
always in our profession but every rule has an exception! What does Dan
Mishell say on the subject? I would take his teachings with more weight
than my experience but I would be surprised to see him support the use of
50mcg pills.
--
Jay M. Kulkin MD MBA FACOG
Women's Institute For Health PC
975 Johnson Ferry Road
Suite 460
Atlanta, GA. 30342
ph: 404-832-0300
fax: 404-832-0070
http://www.wifh.com
This email may contain confidential or proprietary information which may be
legally privileged. If you are not the named recipient, you should
immediately delete it from your computer system.
>----- Original Message -----
From: "Efrain Ramirez" <eramirezt@coqui.net>
To: "Multiple recipients of list OB-GYN-L" <ob-gyn-l@dns.obgyn.net>
Sent: Friday, June 27, 2003 9:54 PM
Subject: Re: BTB on OCPs
> Agree!!
>
> >At Fri, 27 Jun 2003, Steve & Eryl Raymond wrote:
> >
> >Ever hear of the expression "non sequitur"? BTB is usually due to a
> >relative excess of progestagen, thus you can either decrease the PRG or
> >increase the oestrogen. Either way it is not reasonable to say that you
> >would never use a higher oestrogen containing pill. If you are already
> >using a very low progestagen containing pill you would have no
> >alternative but to increase to a 50 mcg pill. If you are concerned
> >about the level of oestrogen over the long term it is usually sufficient
> >to use the higher oestrogen pill for about three cycles.
> >
> >Repeat after me "Never say never or always in medicine"!
> >Steve
> >
> >Jay Kulkin wrote:
> >
> >>In this case I really believe never is an OK answer. It's never the
dose in
> >>my experience. It's the ratio, the progestin or the estrogenic compound.
If
> >>none work I'm thinking, and looking, for anatomical etiologies.
> >>Hysteroscopy or hysterosonogram
> >>
> >>Jay
> >>
> >>Jay M. Kulkin MD MBA FACOG
> >>Women's Institute For Health PC
> >>975 Johnson Ferry Road
> >>Suite 460
> >>Atlanta, GA. 30342
> >>ph: 404-832-0300
> >>fax: 404-832-0070
> >>http://www.wifh.com
> >>
> >>This email may contain confidential or proprietary information which may
be
> >>legally privileged. If you are not the named recipient, you should
> >>immediately delete it from your computer system.
> >>
>> >>>----- Original Message -----
> >>From: "Garry E. Siegel, M.D." <garrys@mindspring.com>
> >>To: "Multiple recipients of list OB-GYN-L" <ob-gyn-l@dns.obgyn.net>
> >>Sent: Thursday, June 26, 2003 3:32 PM
> >>Subject: Re: BTB on OCPs
> >>
> >>>Never say never in our business, my friend.
> >>>
> >>>I do it twice a year, if that.
> >>>
> >>>What do you do with BTB if lateral changes haven't been sucessful?
> >>>
> >>>Garry
> >>>
> >>>At Wed, 25 Jun 2003, Jay Kulkin wrote:
> >>>
> >>>>NEVER!
> >>>>
> >>>>--
> >>>>Jay M. Kulkin MD MBA FACOG
> >>>>Women's Institute For Health PC
> >>>>975 Johnson Ferry Road
> >>>>Suite 460
> >>>>Atlanta, GA. 30342
> >>>>ph: 404-832-0300
> >>>>fax: 404-832-0070
> >>>>http://www.wifh.com
> >>>>
> >>>>This email may contain confidential or proprietary information which
may
> >>>>
> >>be
> >>
> >>>>legally privileged. If you are not the named recipient, you should
> >>>>immediately delete it from your computer system.
> >>>>
>> >>>>>>----- Original Message -----
> >>>>>
> >>>>From: "Garry E. Siegel, M.D." <garrys@mindspring.com>
> >>>>To: "Multiple recipients of list OB-GYN-L" <ob-gyn-l@dns.obgyn.net>
> >>>>Sent: Wednesday, June 25, 2003 2:43 PM
> >>>>Subject: Gyn: BTB on OCPs
> >>>>
> >>>>>Are any of you stepping up to 50 mcg. pills when various 30 and 35
> >>>>>
> >>mcg.
> >>
> >>>>>pills aren't controlling BTB?
> >>>>>
> >>>>>Garry
> >>>>>
> >>>>>--
> >>>>>Garry E. Siegel, M.D.
> >>>>>Private Practice
> >>>>>Roswell, GA
> >>>>>
> >>>--
> >>>Garry E. Siegel, M.D.
> >>>Private Practice
> >>>Roswell, GA
> >>>
> >--
> >S.H. Raymond FRCOG
> >Principal Specialist
> >Department of Obstetrics & Gynaecology
> >Empangeni Hospital
> >Private Bag X20005
> >Empangeni
> >SOUTH AFRICA 3880
> >
> >Phone: (+27)-35-9028560
> >Fax: (+27)-35-7922596
> >
>
> --
> "The opposite of a correct statement is a false statement.
> But the opposite of a profound truth may well be another profound truth."
>
> Niels Bohr (1885 - 1962)
