Re: hyperplasia and endometrial ablation
From: Joanne Bulley, MD (islesannie@yahoo.com)
Sun Nov 28 20:48:25 2004
I have done quite a few ablations (but not in Larry's league of "lots" I
am sure) ...
There is a good reason why you should have that endometiral biopsy --
BEFORE the ablation -- not a curettage at the same time as the ablation.
Do the work up for the AUB before the ablation -- that is one of the
available treatments after diagnosis and goping through all the options.
You shouldn't fine out after tha ablation that there was an abnormal
endometirum.
Joanne
At Sat, 27 Nov 2004, Larry Glazerman wrote:
>
>I've done a lot of ablations, and taught ablation at numerous postgraduate
>courses. I have mixed feelings on this issue. Initially, when ablation was
>first developed (anyone remember the Nd:YAG laser?), ANY hyperplasia was
>considered a contraindication. This was because of the presumption that
>ablation would cause an Asherman's syndrome, and a possible carcinoma that
>developed might not be detected if it were in a "loculated" island of
>endometrium. The fact is that ablation generally does NOT cause an
>Ashermans.
>
>In addition, many believe that simple, non-atypical hyperplasia is a totally
>different bird than complex atypical hyperplasia, and that the former has
>virtually no risk of malignant transformation. I might judiciously ablate
>someone with simple hyperplasia, but I'd probably choose a resection.
>
> _____
>
>From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of
>RModugno@aol.com
>Sent: Saturday, November 27, 2004 6:53 PM
>To: Multiple recipients of list OB-GYN-L
>Subject: Re: hyperplasia and endometrial ablation
>
>In a message dated 11/18/2004 6:07:30 PM Eastern Standard Time,
>johnprov@sympatico.ca writes:
>
>If she had true endometrial hyperplasia then there is a good chance the
>abalation will fail. I would put here on provera 10 mg Q daily X 3
>months and then just do on office sampling. The sample should show
>atrophic or sectretory endodometrium. If atrophic I would just tell her
>to return for future sampling with and irregular bleeding. If secretory
>I would tell her the hyperplasia is gone but the abalation will most
>likely not stop her menses though hopefully they will be lighter.
>
>--
> Take care, John
>
>John - do you have any evidence that simple hyperplasia without atypia will
>not respond to endometrial ablation?
>
>Robert Modugno MD MBA FACOG
>
>marietta, GA
>
>http://www.novaobgyn.yourmd.com
>
--
Joanne Bulley, MD
Keene, NH, USA
"Every gun that is made, every warship launched, every rocket fired, signifies
in the final sense a theft from those who hunger and are not fed, those who
are cold and are not clothed."
President Dwight D. Eisenhower
April 16, 1953
