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Re: chronic pelvic pain patientFrom: Braun, R. Daniel (rbraun@iupui.edu)Tue Feb 24 04:19:29 2004
OR perhaps she had a "Placebo" response to the Depo-Lupron. One of the problems that I see with using Depo Lupron as a test for endometriosis is that you can't leave people on it long enough to overcome the placebo response. Dan "Sound is like water. If you drill one hole in the wall the sound will leak right through." - JAY BRAUN, a band member by love, a soundproofer by necessity. -----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Rafael Haciski Sent: Monday, February 23, 2004 9:41 PM To: Multiple recipients of list OB-GYN-L Subject: Re: chronic pelvic pain patient I definitely do not think that just because no endometriosis was seen on laparoscopy that the patient does not have endometriosis - it may be beneath serosal surface, it may be adenomyosis, etc. The fact that Depo lupron resolved the pain actually strongly suggests that endometriosis (interna or externa) may be involved. Why not give her 6 months of lupron, then put her on continuous OCP? Rafael Haciski, MD FACOG Gynecology & Infertility Associates On Feb 23, 2004, at 2:52 PM, Steve Raymond wrote: 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
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