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MenorrhagiaFrom: Joanne Bulley (islesannie@yahoo.com)Tue May 29 20:50:08 2001
Shortened version of history... 52yo G2P2 woman with DUB sent to me by her PCP - when an US showed some sort of intrauterine mass. H/S - submucus myoma - resected at same time as diagnostic H/S being done. Pathology - leiomyoma and disordered proliferative endometrium. Post op treated initially with cyclic progesterone. Next 3 months she continued to bleed in various amounts and was placed on continuous medroxprogesterone. Then one day begins a major hemorrhage... Rx with 25 mg Premarin IV, quit bleeding. U/S shows reduced uterine size bu still show numerous intramural fibroids. Sent home from ER on PremPro 5 (0.625 CEE and 5 MPA) - to take 2 daily X 5 days. Pelvic exam shows rather large fiboid change with fiboid filling posterior cul de sac, still able to free up / move uterine fundus (some). Quit bleeding immediately. 3 days after completing the above, she had another BIG bleed - went to covering MD - admitted overnight for IV premarin and fluids. Sent home on Premarine (CEE) 2.5 mg twice daily for 5 days. Hemoglobin: 12.9 (January) 11.7 (March) 7.9 (now) Who would do what? TAH +/- BSO Lupron DepoProvera (150mg, 200mg, 400mg?) different Estrogen/Progestin treatment Of course iron replacment - how much and which kind? Other? Hyst
-- Joanne Bulley, MD, FACOG Keene, NH, USA
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