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Re: Endometriosis and abnormal uterine bleedingFrom: Atkinson, Samuel M (ATKINSONS@ecu.edu)Wed Aug 29 11:41:14 2007
Ashley: Your conundrum is because of the confusion between endometriosis externa (classic intraperitoneal endometriosis most frequently in nulliparous women) and endometriosis interna or rather adenomysis. It has long been accepted (I first heard the late Charles Flowers say this in the 70's) that BTB on strong progestational pills is is pathognomic for adenomysis. Thus the idea has persisted that "adenomyosis" is just endometriosis and does cause BTB. So MD's tell an adenomyosis pt that she has endometriosis. I prefer to demand that we differentiate what we mean...interna or externa. Then we won't confuse each other. Interna certainly does cause menorrhagia and cramps...and when I put them on Depo or pill, they then cramp and spot all month long although the flooding is better. Don't know if this observation is helpful but FWIW, its' free. sAm -----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of D. Ashley Hill Sent: Wednesday, August 29, 2007 12:42 AM To: Multiple recipients of list OB-GYN-L Subject: Endometriosis and abnormal uterine bleeding Listmembers: I could use a hand. I am co-authoring a monograph on abnormal uterine bleeding and one of the other authors has asked me to comment on endometriosis as a cause of abnormal uterine bleeding. I am unfamiliar with endo as a cause of AUB and can't think of a biologic reason why endo would cause AUB (outside of cervical endometriosis). A literature search revealed 2 references (1956 and 1980) and both appear fairly weak. I suspect it's an urban myth that endo causes AUB, but might change my mind with coherent references. Does anayone really consider endo as part of the differential diagnosis when a patient presents with endometriosis, and what treatment stratengies would you employ to treat AUB "caused" by endometriosis. Before someone says "Google is your friend," note that of the seemingly endless number of sites that mention endometriosis as a cause of AUB, none include a reference and the majority seem to be a cut and paste of other web sites. One author of a peds gynecology text mentions endo as a cause of AUB, but to my knowledge does not provide a reference (I don't have the latest edition) to support this belief. Does anyone have a valid reference describing the relationship between endometriosis and AUB? Thanks very much for your help. Ashley
-- D. Ashley Hill, MD Associate Director Department of Obstetrics and Gynecology Florida Hospital Family Practice Residency Medical Director, Loch Haven Ob/Gyn Group Division Director, Dept. of Ob/Gyn, Florida Hospital Orlando Orlando, Florida
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