--
Richard Chudacoff, MD
A countryman between two lawyers is like a fish between two cats.
Benjamin Franklin
Heaven grant that the burden you carry may have as easy an exit as it had an
entrance.
[Prayer To A Pregnant Woman]
-Desiderius Erasmus
-----Original Message-----
From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of D. Ashley
Hill
Sent: Tuesday, August 10, 2004 9:02 PM
To: Multiple recipients of list OB-GYN-L
Subject: Re: Gyn: tough menorrhagia case
Good point, Garry. Thanks. She did try continuous monophasic pills for
the 5 months after her adenoma removal, but still bled. Her hemocrit is
stable, and she's on Lupron with norethindrone add-back (after trying
estrogen/progestin add-back). She is very unhappy with the daily
bleeding and continous pad usage. I wish she were married and would
have at least one child, because we're heading down a non-conservative
road. Thanks!
Ashley
At Tue, 10 Aug 2004, Garry E. Siegel, M.D. wrote:
>
>Ashley:
>
>While she has "failed" Lupron in that she bleeds a bit every day, if
>you've stabilized her Hematocrit by cutting down on blood loss, then
>you've done a lot. Why not keep her on Lupron long term with add back?
>
>Have you (or anyone) tried the pill in an extended or continous fashion?
>
>Again, you may not be able to totally stop bleeding, but if you get her
>Hematocrit up and it stays there (even if she takes iron), then you've
>done a good bit.
>
>Garry
>
>At Tue, 10 Aug 2004, D. Ashley Hill wrote:
>>
>>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
>>
>--
>Garry E. Siegel, M.D.
>Private Practice
>Roswell, GA
>
--
D. Ashley Hill, MD
Associate Director
Department of Obstetrics and Gynecology
Florida Hospital Family Practice Residency
Orlando, Florida
