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Re: Soooooo Many Questions & Looking for the Right Answer(s) CORRECTIONFrom: D. Ashley Hill, M.D. (anonymous@obgyn.net)Tue, 29 Apr 1997 07:15:56 -0500 (CDT)
At Mon, 28 Apr 1997, SOS wrote: > >I'm a 34 yo, gravida 4, para 2, with endometriosis, tipped uterus, >irregular menses & dysmenorrhea, raging hormorne storms, seemingly >relentless HA'S and fibroids.
>Question 1: Concerning hormone therapy, how does one know what the The minimum dose required to prevent osteoporosis and cardiac disease appears to be the equivalent of 0.625mg of Premarin. If you had the hysterectomy most doctors would not prescribe a progesterone, although that's an individualized situation. Some younger women require 1.25mg of estrogen (or equivalent) after a hysterectomy but can go to the lower dose after a few months to years. It depends on the symptoms (dry vagina, hot flushes, etc). I have never found weight gain an issue with hormone replacement and feel that this is one of the myths surrounding this therapy.
Question 2: If the ovaries are
>spared, won't the presence of the remaining endometrial tissue in the Perhaps, and this is the tough issue. While some studies show that "only" 30% of women need ovarian removal later after a hyst for endometriosis, others report an 80% rate. The only known cure for severe endometriosis is a hysterectomy with removal of both ovaries, but since the ovaries are so critical for prevention of heart and bone disease (and probably a bunch of other things, too), many women choose to remove 1 ovary and leave the other, hoping for the best. Some don't ever want to have surgery again, and have both removed.
Question 3: Are there any contraindications to the
>LAVH technique specifically related to my tipped uterus and I routinely perform LAVH's in this situation. It depends on the descent of the uterus into the vagina, the uterine size, amount of scar tissue (especially bowel adhesions), etc. I'm not sure what the problem is with the staples, since I don't use them, anyway. There are a lot of other techniques that don't involve staples and that won't increase the risk of small bowel obstruction.
Question 4: If the ovaries are spared, does the ovary
>still release an egg, and if so, where does it go once the uterus is It's so tiny it's just reabsorbed by the body. You never know it's even there.
Question 5: Have heard of embolization therapy of the feeders to
>the fibroids. This technique seems quite effective, but won't help the endometriosis at all. Question 6: Depression. Is it really a concern? Having one's ovaries removed at a young age then *not* going on hormones could certainly precipitate depression. However, hormones themselves don't cause depression (if they did all women would be depressed 100% of the time)! In some postmenopausal patients hormone therapy can augment antidepressants and counseling, but the latter 2 therapies are the mainstay of depression. Plus, being in pain all the time is a common cause of depression and anxiety. Good luck with your decision. Endometriosis is a very tough condition and you have obviously put a lot of thought into your treatment options. Ashley
-- Ashley Hill D. Ashley Hill, M.D. Assistant Director, Department of Ob/Gyn Florida Hospital Family Practice Residency Orlando, FL dahmd@gate.net
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