Re: Gyn: Fibroids/endometriosis/adenomyosis
From: art fougner, md (evsono@pipeline.com)
Thu Apr 7 07:11:35 2005
Kenny Rogers says : "Fold 'em."
Agree with Dan and Efrain - surgery.
art
At Wed, 6 Apr 2005, Efrain Ramirez wrote:
>
>Thrombophilia w/u (liability concerns)if negative add Micronor -- BTW -
>hard to stay away from the surgical solution.. good luck.
>
>>At Wed, 6 Apr 2005, Garry E. Siegel, M.D. wrote:
>>
>>49 YO P2102 with:
>>
>>known fibroids--4 cm intramural/subserosal one seen at lapscope a few
>>years ago, still seen on scan and felt on exam
>>
>>Stage 2 endometriosis from same lapscope, excised totally
>>
>>S/P endometrial ablation for menorrhagia, done concurrently with
>>lapscope. No fibroids in the cavity
>>
>>Also germane is that she has had a LEEP subsequent to the above for CIN2
>>(clear margins) with adenomyosis.
>>
>>Lastly, in college, she had a traumatic DVT and never has been on the
>>pill.
>>
>>She was seen in December with worsening menometrorrhagia and pelvic
>>pain, and placed on Lupron. She has become amenorrheic, has no pain,
>>and says her abdomen is smaller (clinically she is around 8 weeks size
>>today, no real change).
>>
>>She is very troubled by hot flashes.
>>
>>Options I've kicked around:
>>
>>1. Increasing her Zoloft dose (already on 100 mg/day).
>>2. Adding a progestin (which one? dose?).
>>3. Add low dose combination estrogen/progestin therapy (remember the
>>DVT); if this is considered, might thrombophilia testing be in order?
>>4. Of course, LAVH-BSO, but for the sake of discussion, let's stick to
>>non-surgical options for now.
>>
>>Garry
>>
>>--
>>Garry E. Siegel, M.D.
>>Private Practice
>>Roswell, GA
>>
>--
> I think I will do nothing for a long time but listen,
> And accrue what I hear into myself...and let sounds
> contribute toward me.
>
> ~walt whitman~
>
--
art fougner, md
"If you don't know where you are going, you will wind up somewhere else."
Lawrence Peter Berra
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