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Re: Infarcting leiomyomas From: Gerald P. Rodriguez (geraldpr@cybermesa.com) Thu Nov 30 07:51:35 2000 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: DuboseTerryJ@uams.edu: "History of Ultrasound on OBGYN.net" Previous message: art fougner, md: "Re: Endometriosis--is it an autoimmune disease?" Maybe in reply to: Jane Helwig, MD: "Infarcting leiomyomas" This pain probably not due to infarction of myomas. More likely either rapid growth of fibroids and/or development of concomitant adenomyosis is the cause of pain. -- Gerald P. Rodriguez, M.D., FACOG ++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ "I'm extraordinarily patient provided I get my own way in the end."--Margaret Thatcher ++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ >----- Original Message ----- From: "Jane Helwig, MD" <jane@seasonedsystems.com> To: "Multiple recipients of list OB-GYN-L" <ob-gyn-l@forum.obgyn.net> Sent: Thursday, November 30, 2000 7:05 AM Subject: Infarcting leiomyomas > Have had a run of perimenopausal patients with previously asymptomatic > myomatas who are now experiencing pain that can be replicated with > uterine manipulation on bimanual exam. In the past I have done > hysterectomy for these only when the pain was disabling. Most other > patients I have managed conservatively with NSAIDs. > > One such current patient has been in pain for several months now and is > requiring oral oxycodone and large doses of ibuprofen. Exam shows pain > with uterine manipulation. Vaginal ultrasound shows multiple small > myomata, none of which appear to have a necrotic core. CT scan normal. > All labs normal except mildly elevated platelets. C-reactive protein > normal. She has had 6 previous laparotomies including 2 ectopics so I > am not overeager to operate. > > Could pain lasting for 3-4 months be caused by infarcting myoma? > > I have another perimenopausal patient who has milder pain but whose > vaginal ultrasound shows a 3cm myoma with an echodense core surrounded > by fluid. She is doing fairly well with NSAIDs and I have told her to > expect pain to improve within a few weeks. > > Can anyone refer me to a review of this subject? My literature review > didn't turn up much. > > Thanks for any help. > > -- > Jane Helwig, MD, FACOG > Private practice > Nassawadox, VA > Next message: DuboseTerryJ@uams.edu: "History of Ultrasound on OBGYN.net" Previous message: art fougner, md: "Re: Endometriosis--is it an autoimmune disease?" Maybe in reply to: Jane Helwig, MD: "Infarcting leiomyomas"

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