Re: PMB after ablation
From: art fougner, md (evsono@pipeline.com)
Mon Apr 7 15:34:03 2008
How do you proceed if cervical stenosis precludes endometrial sampling?
Art
At Mon, 7 Apr 2008, Garry E. Siegel, M.D. wrote:
>
>Rafael:
>
>I don't disagree at all, but not everyone is set up to do a quick office
>hysteroscopy, and not all patients can have it done.
>
>So. . .a simple biopsy MIGHT yield an answer, but if if didn't, then
>furhter investigation is, of course, warranted.
>
>Garry
>
>At Mon, 7 Apr 2008, Rafael Haciski wrote:
>>
>>I am not comfortable with just watching without some viewing/
>>sampling. Office hysteroscopy I do without any anesthesia beyond
>>paracervical block so if I have to bx/cut out, etc I need to do it in
>>the anesthesized pt.
>>
>>Speaking of such "ignored" problems, I just saw:
>>.. 94 yo very healthy pt (looks better than most 60 yo)
>>.. last year developed spotting, had sono
>>.. was told that she just had some fibroids, nothing else done
>>.. I see her and do a sono which clearly shows 3 cm endometrium
>>(does not look like a fibroid)
>>.. I do SHG which clearly shows this to be a polyp like structure
>>(soft, as opposed to a hard fibroid)
>>.. do an EBx at same time -- path: adenoCA grade 3
>>
>>Moral of the story: no menopausal bleeding should go unevaluated with
>>direct vision and bx.
>>
>>--
>>Rafael Haciski MD FACOG
>>Anchor Health Centers GYN
>>800 Goodlette Rd #360
>>239-643-8780 office
>>239-571-0292 cell
>>Naples, FL.
>>
>>On Apr 7, 2008, at 9:50 AM, Garry E. Siegel, M.D. wrote:
>>
>>> I agree that it needs explanation, and simply stopping the PremPro and
>>> seeing what happens isn't sufficient, even though the PremPro may
>>> be the
>>> cause.
>>>
>>> How about an attempt at an office biopsy?
>>>
>>> Garry
>>>
>>> At Sun, 6 Apr 2008, Rafael Haciski wrote:
>>>>
>>>> Got a new pt recently:
>>>> 53 yo WF p3013 declared to be menopausal some years ago, but still
>>>> having bleeding.
>>>> In fact she underwent evaluation for that bleeding last year,
>>>> culminating in thermal ablation (dec 2007) for DUB - however, pt
>>>> still has bleeding
>>>> Was started on the PremPro since thermal ablation, which she is still
>>>> taking.
>>>> Still c/o of the symptoms that she had before the Prempro and for
>>>> which she was started on that med - feeling warm (not hot flashes).
>>>> That's when I saw her. Stopped the PremPro
>>>> I obtained E2 = 42 and FSH = 30
>>>> repeat one week later E2 = 16 and FSH = 47
>>>>
>>>> Thus she is menopausal, and I think I should treat her like the
>>>> menopausal bleeder that she is, so I will schedule her for
>>>> hysteroscopy. But I have never before looked into a uterus after
>>>> ablation so I am not sure what to expect. If she has a lesion such
>>>> as cancer, will that be obscured by the scarring?
>>>>
>>>> --
>>>> Rafael Haciski MD FACOG
>>>> Anchor Health Centers GYN
>>>> 800 Goodlette Rd #360
>>>> 239-643-8780 office
>>>> 239-571-0292 cell
>>>> Naples, FL.
>>>>>
>>> --
>>> Garry E. Siegel, M.D.
>>> Private Practice
>>> Roswell, GA
>>
>--
>Garry E. Siegel, M.D.
>Private Practice
>Roswell, GA
>
--
art fougner, md
"May The Wings of Liberty Never Lose a Feather." - Jack Burton
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