--
Myer S. Bornstein, MD, MMM, FACOG, FACPE, CPE
_____
From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Richard
Chudacoff, MD
Sent: Tuesday, February 24, 2004 10:23 AM
To: Multiple recipients of list OB-GYN-L
Subject: Re: chronic pelvic pain patient
Had her on it for one year with add-back therapy, but she still got
osteoporetic
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 Braun, R.
Daniel
Sent: Tuesday, February 24, 2004 5:22 AM
To: Multiple recipients of list OB-GYN-L
Subject: Re: chronic pelvic pain patient
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
