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Re: Gyn: tough menorrhagia caseFrom: RModugno@aol.comWed Aug 11 06:52:22 2004
In a message dated 8/10/2004 9:12:29 PM Eastern Standard Time, dahmd@cfl.rr.com writes: Listers- I would appreciate your help. A nulligravida in her 20s presented 5 months after an abdominal "myomectomy" performed elsewhere for menorrhagia. She was bleeding every day, to the point of transfusion. Her operative report noted removal of a 7cm fundal myoma, but there was no evaluation of the endometrium. The path report revealed a 7cm adenomyoma. Her bleeding persisted and she dropped to a hemoglobin of 6.8. At her first visit with me I found what appeared be a large submucous myoma during saline infusion sonography, so I performed an operative hysteroscopy. I found a large, bulging anterior endometrial wall. Biopsy revealed adenomyosis. It was not discrete enough to remove; rather, it seemed to encompass the entire anterior uterus. Her bleeding resolved with 5mg of norethindrone twice daily but recurred. She has "failed" 3 months of GnRH therapy (Lupron) and continues to bleed a little each day. Saline sonography reveals what appears to be florid adenomyosis but no cavity defects, with a 4mm endometrium. She wants to retain childbearing potential. Any ideas? Thanks in advance. Ashley
-- D. Ashley Hill, MD Associate Director Department of Obstetrics and Gynecology Florida Hospital Family Practice Residency Orlando, Florida Ashley, would you consider inserting a Mirena?
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