Re: Menorrhagia
From: Joanne Bulley (islesannie@yahoo.com)
Wed May 30 17:33:41 2001
TAH BSO is planned - if I can get the path put on disc - I will try to
post the path!
Just curious about what others thought...
Joanne
At Wed, 30 May 2001, Richard Chudacoff, MD wrote:
>
>I'd really like to exam this uterus once it was fixed and representative
>sections placed on a slide.
>
>--
>Richard Chudacoff, MD
>
>-----Original Message-----
>From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net]On Behalf Of Joanne
>Bulley
>Sent: Tuesday, May 29, 2001 8:54 PM
>To: Multiple recipients of list OB-GYN-L
>Subject: Menorrhagia
>
>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
>
--
Joanne Bulley, MD, FACOG
Keene, NH, USA
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