Nuvaring for SYSTEMIC estrogen, Depo-Provera for AMENORRHEA. Harder to do
five things at once at my old age.
--
Richard Chudacoff, MD
A government that robs Peter to pay Paul can always depend on
the support of Paul.
George Bernard Shaw
Democracy is a device that insures we shall be governed no
better than we deserve.
George Bernard Shaw
-----Original Message-----
From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net]On Behalf Of Richard
Chudacoff, MD
Sent: Monday, February 23, 2004 2:30 PM
To: Multiple recipients of list OB-GYN-L
Subject: Re: chronic pelvic pain patient
I misunderstood, and assumed if there was adequate vaginal estrogen, there
would be adequate pelvic estrogen. However, her pain did resolve with
Depo-Lupron, but she became osteoporetic. She was switched to Depo-Provera
for induced amenorrheic, and then on vaginal estrogen/progesterone
(Nuvaring) for endogenous estrogen to help her bone mass.
I appreciate everyone's help, as you can tell, I'm conflicted in my possible
treatment of this pain patient.
I think that I shall try the Neurontin, find a pelvic physical therapist,
and then, before operating, leave the country under the cover of darkness.
Richard Chudacoff, MD
A government that robs Peter to pay Paul can always depend on
the support of Paul.
George Bernard Shaw
Democracy is a device that insures we shall be governed no
better than we deserve.
George Bernard Shaw
-----Original Message-----
From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net]On Behalf Of Steve
Raymond
Sent: Monday, February 23, 2004 1:52 PM
To: Multiple recipients of list OB-GYN-L
Subject: Re: chronic pelvic pain patient
I didn't say vaginal atrophy. This is not the same thing. This is
progestagen induced "pelvic peritoneal atrophy" which results in pelvic
pain and goes away when you reverse the progestagen or withdraw it. I
am suggesting you try it first before doing something irreversible.
Endometriosis and adenomyosis are usually improved by progestagens.
Endometriosis has been excluded on laparoscopy. I repeat, I'll be
willing to bet she has no improvement after adnexectomy!
Steve
Richard Chudacoff, MD wrote:
>She is on Depo-Provera and the Nuvaring. She actually had a menstrual cycle
>this last month (first in about a year) and the pain was worse, suggesting
>adenomyosis as well. I don't believe she has pelvic atrophy. The vaginal is
>pink, moist and Pap smear doesn't show basal cells
>
>Richard Chudacoff, MD
>
>-----Original Message-----
>From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net]On Behalf Of Steve &
>Eryl Raymond
>Sent: Saturday, February 21, 2004 1:12 PM
>To: Multiple recipients of list OB-GYN-L
>Subject: Re: chronic pelvic pain patient
>
>The reason she is getting pain is all the progestagen that she has on
board.
>She has what I call, for want of a better term, "pelvic atrophy". Stop her
>progestagens or give her a bit of oestrogen, or both and I'll be willing to
>bet she will be pain free. I am also willing to bet that if you remove her
>right adnexa she will still have pain.
>Steve
>
