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Re: Amenorrhea From: Garry E. Siegel, M.D. (garrys@mindspring.com) Thu Oct 6 15:40:04 2005 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Barbara Nicol MD: "Re: false positive screen rates" Previous message: rmodugno@aol.com: "Re: Standing Room Only- triage strategies" In reply to: Atkinson, Samuel M: "Re: Amenorrhea" Galactorrhea confirmed by office micro exam showing fat globules. No red stain was done. I've not heard of the red stain, and if true galactorrhea requires an elevated prolactin, then I guess I'm using the wrong definition. Do the other listers share in my ignorance here? What term should I be using if not galactorrhea? I absolutely think that the amenorrhea is due to the IUD, and that her Lexapro is most likely the cause of the milky nipple discharge formerly known as galactorrhea. Since her hormonal testing was normal, I'm going to suggest that the treating psychiatrist adjust her meds accordingly, and that her expressable galactorrhea (or the condition formely known as galactorrhea) be ignored. However, if the patient is bothered, then changing SSRIs may be something for the psychiatrist and patient to consider. Thanks to all, Garry At Thu, 6 Oct 2005, Atkinson, Samuel M wrote: > >Your Question is interesting. How was galactorrhea confirmed by micro. >True galactorrhea must have fat.. Thus did you have an oil red O stain >for fat cells. True galactorrhea is almost always accompanied by an >elevation of prolactin. Most causes listed in Speroff also elevate >prolactin. As long as the prolactin is low, there is no medically >dangerous condition. Common causes of true galactorrhea are high >estrogen pills of decades ago, suckling, and all of the psychotropics. >But all of these cause elevations of prolactin. So I suspect an >intraductal lesion unless you have an oil red O positive slide for fat >cells. I would not suggest lowering the dose of Lexapro just to get rid >of galactorrhea. Tell her to quit checking the nipples, just as we do to >postpartum pts who haven't yet dried up.Treat her psychi appropriately. >I would also consider the amenorrhea to be due to the MIRENA. I would >not remove it just so she could have a mense. True, amenorrhea and >galactorrhea combined hint at pit tumor but you have ruled that out with >a normal prolactin. If she really wants to bleed, cycle her with >Premarin and Provera. >sAm Atkinson > >-----Original Message----- >From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Garry >E. Siegel, M.D. >Sent: Wednesday, October 05, 2005 6:20 PM >To: Multiple recipients of list OB-GYN-L >Subject: Gyn: Amenorrhea > >38 YO P2002 with a Mirena IUD since 12/02; she's been amenorrheic since >placement. > >She complains of expressable galacotorrhea (proven by micro) for a >month, emotional changes, moody, hot, etc. She is seeing a psychiatrist >and is Lexapro 30 mg/day, and before he adjusts her meds, the question >"are my hormones normal" has come up. > >FSH 6.9, TSH 4.3 (normal), and AM non-fasting prolactin before breast >exam is 2.5, which is a bit low (normal 2.9 to 30). > >Any thoughts? > >Garry > >-- >Garry E. Siegel, M.D. >Private Practice >Roswell, GA > -- Garry E. Siegel, M.D. Private Practice Roswell, GA Next message: Barbara Nicol MD: "Re: false positive screen rates" Previous message: rmodugno@aol.com: "Re: Standing Room Only- triage strategies" In reply to: Atkinson, Samuel M: "Re: Amenorrhea"

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