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Re: Progestin intoleranceFrom: ainsron (ainsron@sbcglobal.net)Thu Nov 29 12:42:03 2007
You still have to give progesterone if on ERT and patient has an ablation. Hysterectomy may be best option if she wants unopposed estrogen, unless she is willing to put up with acyclic bleeding and have yearly endometrial sampling and or TVUS. Ronald E. Ainsworth, MD, FACOG -----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Garry E. Siegel, M.D. Sent: Wednesday, November 28, 2007 5:11 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
-- Garry E. Siegel, M.D. Private Practice Roswell, GA
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