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Re: PMB after ablation From: Charles Bloom (cdsb@bellsouth.net) Mon Apr 7 16:48:45 2008 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Glen Elrod: "Re: Hydrosalpinx and IVF" Previous message: art fougner, md: "Re: Hydrosalpinx and IVF" In reply to: art fougner, md: "Re: PMB after ablation" Next in thread: Joanne Bulley, MD: "Re: PMB after ablation" I agree with the management of a 94 y/o postmenopausal bleeder. If a postmenopausal patient is bleeding, that needs to be explored. But if the patient stops HRT and her bleeding completely stops, then she doesn't have postmenopausal bleeding any longer. My experience is that if she has endometrial CA, she'll have some degree of bleeding unless there is obstruction to outflow in which case she will develop a hematometra, which I have also seen post-ablation. I'm not saying that being diagnostically aggressive is wrong as I perform EMBs and HSCs very aggressively for any persistent postmenopausal bleeding. But I have never been burned if a patient's bleeding completely stopped when HRT was discontinued. If you're not comfortable with waiting for any further bleeding episode, then I would not perform EMB post ablation, even though I have no data to support this. I would not be confident of getting an adequate sample because of the theoretical risk of adhesions obscuring the bleeding site and a negative sample would not reassure me. I agree that the next diagnostic step in a post ablation patient should be hysteroscopy. If I couldn't get a complete view of the endometrium on hysteroscopy, then I would be left with the dilemma of just watching to see if there was further bleeding prior to recommending hysterectomy or just proceeding with hysterectomy. That's why I suggested that I might take a wait and see approach to begin with. If the patient had any persistent bleeding, I wouldn't hesitate to recommend hysterectomy after an inadequate HSC. Charles -----Original Message----- >> >>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 Next message: Glen Elrod: "Re: Hydrosalpinx and IVF" Previous message: art fougner, md: "Re: Hydrosalpinx and IVF" In reply to: art fougner, md: "Re: PMB after ablation" Next in thread: Joanne Bulley, MD: "Re: PMB after ablation"

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