Re: 2 cases
From: R. Berg (robert.berg@nyu.edu)
Mon Mar 20 13:26:39 2006
I've been using Effexor XR for about a year now, for vasomotor sx in pts who
don't want HRT. I've had variable success, but some people seem to do well
on it.
______________________________
Robert E. Berg, M.D., FACOG, FACS
--
______________________________
And this affects me, how?
>----- Original Message -----
From: "Joanne Bulley, MD" <islesannie@yahoo.com>
To: "Multiple recipients of list OB-GYN-L" <ob-gyn-l@dns.obgyn.net>
Sent: Sunday, March 19, 2006 1:03 PM
Subject: GYN: 2 cases
>
> Case 2. Vasomotor symptoms that are intolerable to the patient and
> recurring on Estratest 1.25/2.5
> 50yo G3P3 woman S/P TAH-USO at age 22. Menopause approximately age 47
> by symptoms and FSH. Initally treated with estradiol with reasonable
> results. Then vasomotor symptoms returned so changed to Estratest HS
> (0.625 of conjugated estrogens and 1.25mg of methytestosterone) for the
> testoterone to decrease SHBG allowing more availability of free
> estrogen. She did better for about 4 months then symtpoms increased and
> seh was put on the "full strength" Estratest 1.25/2.5. TSH also tested
> 5.6 (lab normal of 0.3-5.5) with Anti-Thyroid peroxidase antibodies at
> 2014 (normal <60) consistent with autoimmune thyroiditis. 50mcg of
> levothyroxine started. Vasomotor symtoms persist. PCP says it can't be
> the thyroid. TSH now 3.6 (my preferred treatment range is 1-2.9)
> Levothyroxine increased to 75 mcg. I want to have her euthroid before
> changing estrogen.
>
> My thought is to bypass the liver and go with transdermal estradiol.
>
> Looking for your thoughts on work up & treatment of persistent basomotor
> symptoms not responding to hormones? Any other metabolic evaluation I
> ought to do?
>
> --
> Joanne Bulley, MD
> Keene, NH, USA
>
> "Love is indescribable and unconditional.
> I could tell you a thousand things that it is not, but not one that it
> is."
> - Duke Ellington, American jazz artist (1899-1974).
>
