Re: Fibroids/endometriosis/adenomyosis
From: Richard Chudacoff, MD (rchudacoff@mylinuxisp.com)
Thu Apr 7 11:51:12 2005
1. Does she still have dysplasia? If not, then LSH is okay.
2. Ablation is only 50-60 % successful, Mirena more. You asked or
non-surgical options, remember?
Personally, if she has no evidence of dysplasia, then LSH, same day surgery,
minimal morbidity...why not? If there is still evidence of dysplasia, then
LAVH or LH.
--
Richard Chudacoff, MD
-----Original Message-----
From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Garry E.
Siegel, M.D.
Sent: Thursday, April 07, 2005 10:25 AM
To: Multiple recipients of list OB-GYN-L
Subject: Re: Fibroids/endometriosis/adenomyosis
Mirena after an ablation?
LSH after a LEEP for dysplasia? If she comes to hyst, I would remove the
cervix.
Garry
At Thu, 7 Apr 2005, Richard Chudacoff, MD wrote:
>
>Mirena, although I favor LSH
>
>--
>Richard Chudacoff, MD
>
>-----Original Message-----
>From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Garry E.
>Siegel, M.D.
>Sent: Wednesday, April 06, 2005 8:39 PM
>To: Multiple recipients of list OB-GYN-L
>Subject: Gyn: Fibroids/endometriosis/adenomyosis
>
>49 YO P2102 with:
>
>known fibroids--4 cm intramural/subserosal one seen at lapscope a few
>years ago, still seen on scan and felt on exam
>
>Stage 2 endometriosis from same lapscope, excised totally
>
>S/P endometrial ablation for menorrhagia, done concurrently with
>lapscope. No fibroids in the cavity
>
>Also germane is that she has had a LEEP subsequent to the above for CIN2
>(clear margins) with adenomyosis.
>
>Lastly, in college, she had a traumatic DVT and never has been on the
>pill.
>
>She was seen in December with worsening menometrorrhagia and pelvic
>pain, and placed on Lupron. She has become amenorrheic, has no pain,
>and says her abdomen is smaller (clinically she is around 8 weeks size
>today, no real change).
>
>She is very troubled by hot flashes.
>
>Options I've kicked around:
>
>1. Increasing her Zoloft dose (already on 100 mg/day).
>2. Adding a progestin (which one? dose?).
>3. Add low dose combination estrogen/progestin therapy (remember the
>DVT); if this is considered, might thrombophilia testing be in order?
>4. Of course, LAVH-BSO, but for the sake of discussion, let's stick to
>non-surgical options for now.
>
>Garry
>
>--
>Garry E. Siegel, M.D.
>Private Practice
>Roswell, GA
>
--
Garry E. Siegel, M.D.
Private Practice
Roswell, GA
