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Re: Leaving ovaries behind during hyst for endometriosis? From: Mark Perloe (mperloe@ivf.com) Mon Apr 1 05:00:16 2002 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Dean Huffman: "Margaret J. Gamper, a Chicago nurse who became a pioneer of" First, I have done two sigmoid resections on women on estrogen only ERT after hysterectomy for endometriosis. Unless you are agressively excising all deep culdesac and rectovaginal septum endometriosis, it will certainly flourish on ERT. Many women do better with progesterone than progestin. Look at the PEPI study, the adverse effects of HRT vs ERT on lipids is not seen with progesterone. As most oral progesterone is 5 alpha reduced to an relatively inactive metabolite, vaginal progesterone, ie prometrium 100mg per vagina may be sufficient. Daily oral prometrium 100mg/day continuous or 100mg bid if cycle are sufficient for endometrial protection. Either topical (skin cream) or oral progesterone are metabolized. The 5 alpha reduced progesterone metabolite binds to the chloride ion receptor (as does valium). As such, at night it may help improve the onset of sleep or be beneficial for those with anxiety. If fatigue, depression is an issue switch to vaginal administration. At 09:08 PM 3/31/2002 -0600, you wrote: >At Sun, 31 Mar 2002, Joanne Bulley, MD wrote: > > > >Like Mark - the "one size fits all" answer is that (most of the time) I > >take them out. Then institute combination HRT immediately. > > > >But then - like Joe - I do tailor it to the individual and the pre-op > >discussion. > >Ovarian removal or retention is dictated by the patieint's preop >wishes/age/discussion, and the intraop findings (with various scenarios >having been discussed). > >If the patient wishes to have HRT, then I start estrogen alone >immediately. My partner starts progestin only for a few months. > >Why are you guys using continuous combined therapy? Is it to give the >progestin to "balance" the estrogen? > >Garry > >-- >Garry E. Siegel, M.D., F.A.C.O.G. >Roswell, GA >Private Practice -- Mark Perloe, M.D. http://grs.ivf.com 404-843-2229 5445 Meridian Mark Rd, Suite 270, Atlanta, GA 30342 Live Chat Wednesday evenings 8:00-9:00 p.m. ET http://infertility.about.com/gi/chat/cs.htm Next message: Dean Huffman: "Margaret J. Gamper, a Chicago nurse who became a pioneer of"

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