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Re: Depo-Provera From: Raymond Stephen (stephen.raymond@dhhs.tas.gov.au) Tue Jun 12 21:12:56 2007 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Anna Meenan, MD: "R.I.P." Previous message: DoctorJoe@aol.com: "Re: Ob: After delivery inspection/exploration" In reply to: Andrew Folley: "Re: Depo-Provera" Next in thread: Rafael Haciski: "Re: Depo-Provera" Reply: Rafael Haciski: "Re: Depo-Provera" Of course she will, but the issue here is not so much with getting a withdrawal bleed per se, but in kick starting the pituitary ovarian axis, by inducing the negative feedback mechanism of oestrogen on FSH. One two week course of oestrogen in my experience is enough to get the cycles restarted after the pituitary ovarian axis has been shut down by Depo Provera. If she doesn't want her fertility back then of course the pill is going to have a place, but I was assuming (perhaps wrongly) that she had stopped the Depo in order to return to fertile cycles. Steve -----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Andrew Folley Sent: Wednesday, 13 June 2007 3:36 AM To: Multiple recipients of list OB-GYN-L Subject: Re: Depo-Provera Disagree. Put an 80 year old woman on BCPs and she will start having periods. See Speroff. >From: Rafael Haciski <haciski@earthlink.net> >Reply-To: ob-gyn-l@obgyn.net >To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net> >Subject: Re: Depo-Provera >Date: Mon, 11 Jun 2007 22:25:35 -0500 > >I agree with the OCP vs HRT, as she technically is in the range of HRT tx >at present with her estrogen level. >I do not think that menses is the issue, and if she is amenorrheic it will >be OK (with me and the pt) but I am more concerned with the low estrogen >levels and the effects on bone, and possible sporadic ovulation leading to >an unintended pregnancy. Hence I would be perfectly OK with OCP treatment >for the time being. > >Rafael Haciski MD FACOG >Naples, FL. > >On Jun 11, 2007, at 6:59 PM, Raymond Stephen wrote: > >>Putting her on the OCP is not the best idea. It will probably produce a >>withdrawal bleed, but as her problem is endometrial atrophy due to long >>term progestogen exposure, what she needs is oestrogen. All OCPs produce >>endometrial quiescence (atrophy) so any pill you give her will, in >>theory, add to the problem unless there is sufficient oestrogen in what >>she takes to give her some endometrial proliferation. Hence she will get >>a better result from oestrogen alone, and that is why she should take >>Premarin (or any other oestrogen you prefer). Andrew's last statement >>"Estrogen supplement with pill or HRT would be adequate" is an oxymoron >>as the OCP is more progestagenic than oestrogenic. >> >>Steve CONFIDENTIALITY NOTICE AND DISCLAIMER The information in this transmission may be confidential and/or protected by legal professional privilege, and is intended only for the person or persons to whom it is addressed. If you are not such a person, you are warned that any disclosure, copying or dissemination of the information is unauthorised. If you have received the transmission in error, please immediately contact this office by telephone, fax or email, to inform us of the error and to enable arrangements to be made for the destruction of the transmission, or its return at our cost. No liability is accepted for any unauthorised use of the information contained in this transmission. If the transmission contains advice, the advice is based on instructions in relation to, and is provided to the addressee in connection with, the matter mentioned above. Responsibility is not accepted for reliance upon it by any other person or for any other purpose. Next message: Anna Meenan, MD: "R.I.P." Previous message: DoctorJoe@aol.com: "Re: Ob: After delivery inspection/exploration" In reply to: Andrew Folley: "Re: Depo-Provera" Next in thread: Rafael Haciski: "Re: Depo-Provera" Reply: Rafael Haciski: "Re: Depo-Provera"

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