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Re: Progestin intoleranceFrom: Raymond Stephen (Stephen.Raymond@dhhs.tas.gov.au)Wed Nov 28 19:20:22 2007
The Mirena shouldn't raise her circulating progestogen levels enough to cause systemic symptoms. She definitely needs something to suppress her proliferative endometrium even if it is 4 weeks of Provera. With that, it is quite possible that her bleeding will stop, and you may find nothing more needs to be done. Ablation has about 85% success rate in producing amenorrhoea so don't be reluctant if it comes to that. Being thin and muscular suggests she is anovulatory and not menopausal, so it would be worth rechecking her FSH and LH after the course of progestogen. Steve -----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Garry E. Siegel, M.D. Sent: Thursday, 29 November 2007 12:12 PM To: Multiple recipients of list OB-GYN-L Subject: Gyn: Progestin intolerance 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 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.
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