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Re: Gyn: Progestin intolerance From: Joanne Bulley, MD (islesannie@gmail.com) Wed Nov 28 18:32:09 2007 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: DoctorJoe@aol.com: "Re: Gyn:  Progestin intolerance" Previous message: DoctorJoe@aol.com: "Re: GBS" In reply to: Garry E. Siegel, M.D.: "Gyn: Progestin intolerance" Next in thread: Raymond Stephen: "Re: Progestin intolerance" I agree that even with an ablation you still need to provide a progestin if giving estrogen - we can't guarantee that 100% endometrial cells are gone. A mirena would be great - but the patient would have to consent. Are you sure she is postmenopausal? Might be worth having her off all meds and see if spontaneous cycles or FSH. She ought to get the outside records for you! I would do a hyst after other eval and options rule out other causes / treatment options. Joanne At Wed, 28 Nov 2007, Garry E. Siegel, M.D. wrote: > >33 YO P3003 S/P TL > >Avid exerciser, thin and muscular > >Around 3 years ago, when 1 year PP, underwent TVT and LTL, and in the >PACU was found to be in CHF from likely viral/peripartum cardiomyopathy >that had been awfully well compensated. > >Her ejection fraction and anatomy are all normal again. > >She has been seeing two other MDs, one a regular Gyn with a "tilt" >towards hormonal regulation, etc.--he is a fine doc but is one that is a >bit elitist, no insurance, etc. She also has seen another doc, not a >gyn, and had "hormone tests" done. There are no records, but she says >she's menopausal and has been on a boatload on unopposed estrogen patch >for symptoms, and, guess what, she's bleeding continuoulsy. > >Her exam was normal and biopsy was disordered proliferative, and MPA as >well as Prometrium "drove her crazy." She is very reluctant to try >another progestin, even if only every two or three months. She has >asked about a hysterectomy, and while I'm glad to do one, I have >suggested a Mirena. Well, she has read about side effects and is very >reluctant to use any progestin, and asked about an ablation. > >I think that an ablation cannot eliminate her endometrium sufficiently >to preclude hyperplasia, and she may still bleed erratically. > >Any thoughts? > >Garry > >-- >Garry E. Siegel, M.D. >Private Practice >Roswell, GA > -- Joanne Bulley, MD, FACOG Solo gyn Keene, NH USA Next message: DoctorJoe@aol.com: "Re: Gyn:  Progestin intolerance" Previous message: DoctorJoe@aol.com: "Re: GBS" In reply to: Garry E. Siegel, M.D.: "Gyn: Progestin intolerance" Next in thread: Raymond Stephen: "Re: Progestin intolerance"

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