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Re: Gyn: Amenorrhea From: Jane Helwig, MD (jane@helwig.net) Thu Sep 28 14:40:04 2006 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Henry Gregor: "Surprisingly Chrisitan" Previous message: Dean Huffman .: "Re: OT-completely" In reply to: Terrence.Jones@kp.org: "Re: Gyn: Amenorrhea" Next in thread: Elrod, Darryl G Maj 48 MDOS/SGOBO: "Re: Amenorrhea" TJ, where is the data about lower systemic progestin levels with Mirena? (I have a patient with Type I DM and CF and primary dysmenorrhea who recently had a DVT.) Thanks. At Wed, 27 Sep 2006, Terrence.Jones@kp.org wrote: > >This is a multipart message in MIME format. >Content-Type: text/plain; charset="us-ascii" > > Think the knee jerk rxn to this is add TZD (thiazolidinedione: >Actos or Avandia). But Her F Ins was only borderline elevated (12), and >FBS/Ins ratio was 7.1 (looking for ratio lower than 4.5). Strange that She >failed to withdraw bleed from initial progestin with an EEC of 16 mm. Was >that just recently? (Sometimes the progestin triggers ovulation, and the >bleed is delayed 2 weeks?) If prior F Ins was more elevated, would've >rechk'd while on the Biguanide, and added Actos if persistent elevation. >Given the marginal elevation, would leave the glitazone option up to the >Internist. One recently identified additional benefit of the TZD's is >correction of the transaminase in Patients who's Metabolic Syndrome >includes NASH (non-alcoholic steato-hepatitis). As mentioned WRT your >prior patient with PE and menomet, the lower systemic progestin levels >with Mirena can accomplish endometrial protection with less adverse >effects (insulin resistance, and weight gain). If the complexion worsens, >consider checking androgens. Think some Internists/Endocrinologists might >also check either 2 hr GTT or A1C (the FBS alone, sometimes leaves out a >part of the story). The homework You are doing will be rewarded, as You >will be seeing ever increasing numbers of Patients with this scenario. >Haven't had a chance to review it yet, but have a great article waiting on >my desk on the TZD's (PPARa's) and direct ovarian effects (Froment et al, >Jnl of Endocrinol (2006) 189:199-209). /tj -- Jane Helwig, MD, FACOG Private practice, 2 MDs Lancaster, SC Next message: Henry Gregor: "Surprisingly Chrisitan" Previous message: Dean Huffman .: "Re: OT-completely" In reply to: Terrence.Jones@kp.org: "Re: Gyn: Amenorrhea" Next in thread: Elrod, Darryl G Maj 48 MDOS/SGOBO: "Re: Amenorrhea"

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