Re: Gyn: Fibroids/endometriosis/adenomyosis

From: Henry Gregor (henrygregor@yahoo.com)
Thu Apr 7 14:42:33 2005

I live in an area with many folks who pursue alternative therapies very enthusiastically. I've had many patients tell me black cohosh helped there hot flashes to some degree...have had some patients, for whom I've recommended it, with a very modest positive followup response. Of course, literature citations on it are all over the map re utility.

Also, tho' you asked to keep it non-surgical for the time being, I can't resist following Dan's comment up with an "Amen to that!"

Hank

"R. Daniel Braun" <rd.braun@gmail.com> wrote: Sounds like a perfect candidate for VAGINAL Hysterectomy.

On Apr 6, 2005 8:38 PM, 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
>

--
R. Daniel Braun
Kinky for Governor


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