Re: Amenorreia
From: Efrain Ramirez (eramirezt@coqui.net)
Wed Apr 24 16:29:41 2002
I had a patient who developed headache, nervousness, generalized fatigue
and dizzines after DMPA (really nervous - restless)- it was shortly
after it was introduced here in Puerto Rico - it was treated with
Estrogen - did fine.
At Wed, 24 Apr 2002, Steve & Eryl Raymond wrote:
>
>Dr. Nouroddin,
>Where is the evidence for breast lumps, liver tumours and "psychic symptoms" in
>users of Depo Provera? And what are the "psychic symptoms"? I have been using
>it for the last 30 years and have never had such problems. Amenorrhoea is
>common, indeed expected, and of benefit for those for whom the method is best
>indicated i.e. the woman whose family is complete but who has yet to decide on a
>permanent method. As has been said, if the amenorrhoea worries the patient
>after reassurance that it is normal, a withdrawal bleed can be induced with
>Ethinyl oestradiol 50 mcg for a week. Ultrasound tracking of the endometrium is
>unnecessary, and so is the addition of progestagens. This does not require them
>to come off the injection.
>Contrary to what you said about the fertility index being delayed by 2 years,
>the delay in the return of fertility after finishing Depo is 3 months on
>average, but for those in whom it is longer, and this is a problem, the same 50
>mcg oestrogen course usually kick-starts ovulatory cycles. Clomiphene is only
>indicated if ovulatory cycles are not established after that.
>
>mohammad nouroddin wrote:
>
>> >people who use injectable contaceptive such as depo provera for a long time
>> >very often experience amenorhea. the test you have done would be normal and
>> >they will fail to bleed with progesterone withdrawal because the
>> >endometrium is already thin . what you should do is to try oestrogen instead
>> at
>> >increased doses for two weeks and control the endometrium growth with
>> >ultrasound .than introduce progesterone in low dose for a week. she will
>> >probably bleed than.
>> >once you have that response try to induce regular cycle using clomiphene
>> >citrate for two cycles (the patient must be aware of the risk of pregnancy)
>> >.Normal status should resume than and you will shoose another contraception
>> >method.
>> >
>> just do not do any thing for that patient and give her another
>> combined hormonal contraceptive pills , she'll bleed spontaneously
>> and i want to tell that i don't priscribe that injectable depot provera
>> because it causes prolonged amenorrhoea and psychic symptoms
>> and breast lumps and liver tumors and the fertility index will be late
>> by about 2 years if the patient stops the injections for getting pregnant
>> in future
>> Dr.nouroddin / egypt
>
>--
>
>Dr.S.H. Raymond
>Head of Department of O & G
>Empangeni Hospital
>South Africa 3880
>Phone: (+27) 35-9028560
>Fax: (+27) 35-7922596
>
--
"Life is neither the notes nor the silence between the notes, but the music that
arises out of sound and silence felt as a living whole. Stop choosing...between
chaos and order, and live at the boundary between them, where rest and action
move together..." David Whyte
