Re: Gyn: tough menorrhagia case
From: D. Ashley Hill (dahmd@cfl.rr.com)
Wed Aug 11 21:32:41 2004
Mirena is the plan. Thanks,
Ashley
At Wed, 11 Aug 2004, Richard Chudacoff, MD wrote:
>
>Mirena?
>
>--
>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
>
--
D. Ashley Hill, MD
Associate Director
Department of Obstetrics and Gynecology
Florida Hospital Family Practice Residency
Orlando, Florida
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