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Re: Delayed menopause/prolonged climacteric From: Rafael Haciski (haciski@earthlink.net) Fri Mar 17 11:49:27 2006 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Lea Harth, Operations Manager: "Re: Wrong names appearing in the From line on posts" Previous message: kaycnm@aol.com: "Re: GBS testing for repeat cesarean" In reply to: Karen Lee: "Re: Delayed menopause/prolonged climacteric" Next in thread: Charlie Chambers: "Re: Delayed menopause/prolonged climacteric" On Mar 17, 2006, at 1:21 PM, Karen Lee wrote: > 1. Endometrial ablation, preceded by EMB, if the > fibroids are not encroaching on the endometrium No fibroids are small. However,I did offer her that option, but she is not too keen on it, and neither am I - amenorrhea achieved in only 65% of cases, thus in 35% cases I will still be left with the dilemma of what to do with her bleeding. > 2. Mirena She declined that, additionally, she has osteopenia, bordering on osteoporosis. -- Rafael Haciski MD FACOG Palmetto, FL > > --- Rafael Haciski <haciski@earthlink.net> wrote: > >> I am reaching out to the collective brain trust >> ----> >> >> I have a pt who is pushing 56 years of age, who >> is having irregular >> periods (heavy bleeding 2-3 times per year over >> last year) since I >> stopped her OCP. >> When I saw her for the first time last year at >> age 54, she was still >> on Yasmin (OCP) and happy. >> Wanting to know if she was menopausal, I >> checked her serum FSH 4 days >> after stopping OCP (between her OCP packs), her >> serum FSH was <1 >> Repeat bloods 2 months later (in June 05) after >> being off OCP for 3 >> weeks showed: >> .. estradiol 45, FSH 11 ==> neither in >> menopausal range >> She stayed off OCP with no bleeding until Dec. >> when major bleeding >> occurred. >> Repeat bloods in early Feb show E20 and >> FSH1 (could have been >> midcycle surge) with menses late February. >> Repeat bloods again in early Mar E2a FSH >> Menses in mid march. >> >> Sono was negative except for few small >> fibroids, thin (5 mm) >> endometrium, normal ovaries. >> >> My take on this is that she is in climacteric, >> albeit delayed and >> prolonged, but how to manage her irregular >> bleeding. >> .. Ignore it? how often to recheck menopausal >> status? (at which >> point does it become PMB?) >> .. OCP? increased risk of VTE in someone this >> age (although >> nonsmoker) In reality, if the VTE risk is from >> estrogen, her >> estrogen levels are higher now and therefore >> she would be at higher >> risk for VTE without OCP, but....? >> >> She does have small fibroids so I could always >> do Laparoscopic hyst >> and BSO (with pathology supporting surgery) but >> that is a bit drastic. >> >> Rafael Haciski MD FACOG >> Palmetto, FL >> Next message: Lea Harth, Operations Manager: "Re: Wrong names appearing in the From line on posts" Previous message: kaycnm@aol.com: "Re: GBS testing for repeat cesarean" In reply to: Karen Lee: "Re: Delayed menopause/prolonged climacteric" Next in thread: Charlie Chambers: "Re: Delayed menopause/prolonged climacteric"

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