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Re: Gyn: Progestin intolerance From: Larry Glazerman (l.glazerman@rcn.com) Wed Nov 28 18:17:42 2007 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: DoctorJoe@aol.com: "Re: GBS" Previous message: Dean Huffman .: "Re: GBS" In reply to: Garry E. Siegel, M.D.: "Gyn: Progestin intolerance" Next in thread: Garry E. Siegel, M.D.: "Re: Gyn: Progestin intolerance" Reply: Garry E. Siegel, M.D.: "Re: Gyn: Progestin intolerance" Why not a simple TVH or LSH? I feel strongly that we don't need to make our patients jump through successive hoops to get what they probably want in the first place. She seems educated enough, and a TVH or LSH is a reasonable option. Larry -- Larry R. Glazerman, MD, FACOG St. Luke's Center for Advanced Gynecologic Care 250 Cetronia Road Suite 305 Allentown PA 18104 484-223-3279 484-223-2830 FAX glazerl@slhn.org On Nov 28, 2007, at 8:09 PM, Garry E. Siegel, M.D. wrote: > 33 YO P3003 S/P TL > > Avid exerciser, thin and muscular > > Around 3 years ago, when 1 year PP, underwent TVT and LTL, and in the > PACU was found to be in CHF from likely viral/peripartum > cardiomyopathy > that had been awfully well compensated. > > Her ejection fraction and anatomy are all normal again. > > She has been seeing two other MDs, one a regular Gyn with a "tilt" > towards hormonal regulation, etc.--he is a fine doc but is one that > is a > bit elitist, no insurance, etc. She also has seen another doc, not a > gyn, and had "hormone tests" done. There are no records, but she says > she's menopausal and has been on a boatload on unopposed estrogen > patch > for symptoms, and, guess what, she's bleeding continuoulsy. > > Her exam was normal and biopsy was disordered proliferative, and MPA > as > well as Prometrium "drove her crazy." She is very reluctant to try > another progestin, even if only every two or three months. She has > asked about a hysterectomy, and while I'm glad to do one, I have > suggested a Mirena. Well, she has read about side effects and is very > reluctant to use any progestin, and asked about an ablation. > > I think that an ablation cannot eliminate her endometrium sufficiently > to preclude hyperplasia, and she may still bleed erratically. > > Any thoughts? > > Garry > > -- > Garry E. Siegel, M.D. > Private Practice > Roswell, GA Next message: DoctorJoe@aol.com: "Re: GBS" Previous message: Dean Huffman .: "Re: GBS" In reply to: Garry E. Siegel, M.D.: "Gyn: Progestin intolerance" Next in thread: Garry E. Siegel, M.D.: "Re: Gyn: Progestin intolerance" Reply: Garry E. Siegel, M.D.: "Re: Gyn: Progestin intolerance"

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