-VISIT OUR OTHER FORUMS- OB-GYN-L Ultrasound Ultrasound History Fibroid Forum Physicians-in-Training Tech Talk OBSTET-L (portuguese) OBGIN-L (spanish) Nursing

Re: Gyn: Amenorrhea From: Jane Helwig, MD (jane@helwig.net) Thu Sep 28 14:40:04 2006 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Henry Gregor: "Surprisingly Chrisitan" Previous message: Dean Huffman .: "Re: OT-completely" In reply to: Terrence.Jones@kp.org: "Re: Gyn: Amenorrhea" Next in thread: Elrod, Darryl G Maj 48 MDOS/SGOBO: "Re: Amenorrhea" TJ, where is the data about lower systemic progestin levels with Mirena? (I have a patient with Type I DM and CF and primary dysmenorrhea who recently had a DVT.) Thanks. At Wed, 27 Sep 2006, Terrence.Jones@kp.org wrote: > >This is a multipart message in MIME format. >Content-Type: text/plain; charset="us-ascii" > > Think the knee jerk rxn to this is add TZD (thiazolidinedione: >Actos or Avandia). But Her F Ins was only borderline elevated (12), and >FBS/Ins ratio was 7.1 (looking for ratio lower than 4.5). Strange that She >failed to withdraw bleed from initial progestin with an EEC of 16 mm. Was >that just recently? (Sometimes the progestin triggers ovulation, and the >bleed is delayed 2 weeks?) If prior F Ins was more elevated, would've >rechk'd while on the Biguanide, and added Actos if persistent elevation. >Given the marginal elevation, would leave the glitazone option up to the >Internist. One recently identified additional benefit of the TZD's is >correction of the transaminase in Patients who's Metabolic Syndrome >includes NASH (non-alcoholic steato-hepatitis). As mentioned WRT your >prior patient with PE and menomet, the lower systemic progestin levels >with Mirena can accomplish endometrial protection with less adverse >effects (insulin resistance, and weight gain). If the complexion worsens, >consider checking androgens. Think some Internists/Endocrinologists might >also check either 2 hr GTT or A1C (the FBS alone, sometimes leaves out a >part of the story). The homework You are doing will be rewarded, as You >will be seeing ever increasing numbers of Patients with this scenario. >Haven't had a chance to review it yet, but have a great article waiting on >my desk on the TZD's (PPARa's) and direct ovarian effects (Froment et al, >Jnl of Endocrinol (2006) 189:199-209). /tj -- Jane Helwig, MD, FACOG Private practice, 2 MDs Lancaster, SC Next message: Henry Gregor: "Surprisingly Chrisitan" Previous message: Dean Huffman .: "Re: OT-completely" In reply to: Terrence.Jones@kp.org: "Re: Gyn: Amenorrhea" Next in thread: Elrod, Darryl G Maj 48 MDOS/SGOBO: "Re: Amenorrhea"

Return to

Mail a New Message to the Forum: ob-gyn-l@obgyn.net Forum Administrator: geffrey.klein@obgyn.net Report Technical Problems: webmaster@obgyn.net Last Updated: Wed Jul 2 04:44:47 2008

The American Medical Association is no longer designating CME hours for AMA Category II CME credit. However, physicians themselves may self designate learning activities as Category II CME credit hours if they feel it is of sufficient educational merit and meets the formal definitions of continuing medical education. OBGYN.net believes these interaction in this forum meets these criteria. For further information see the AMA web site.