Re: Gyn: Progestin intolerance
From: Garry E. Siegel, M.D. (garrys@mindspring.com)
Wed Nov 28 18:54:26 2007
Couldn't agree more, and have suggest TVH but she has already needed a
TVT and she is a bit worried about support issues.
Garry
At Wed, 28 Nov 2007, Larry Glazerman wrote:
>
>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
>
--
Garry E. Siegel, M.D.
Private Practice
Roswell, GA
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