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Re: Ascus management question From: Joanne Bulley, MD (islesannie@gmail.com) Thu Jul 31 11:58:44 2008 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Joanne Bulley, MD: "Factor V Leiden & Contraception" Previous message: Srinivas Rao: "Re: Ascus management question" In reply to: ENDODOK@aol.com: "Ascus management question" Next in thread: Andrew Folley: "Re: Ascus management question" I have been able to get endocervical cells on many of these by prescribing estrogen vaginal cream (my preference is Estrace so it is 17BetaEstradiol and not equine or other conjugated estrogens or estropipate: give the cervix what it used to have). 1gm nightly for 2 weeks. don't use for 2 days and come into the office. Amazing how often that lets you get a good sample of the endocervix. Otherwise, yes to the narrow cone / LEEP. Does she "need" her uterus : probably not - but even if you take the uterus - her vagina will still harbor the HRHPV - so you won't keep her from getting vaginal squamous cell carcinoma from HR HPV by taking the uterus. Also - any surgery carries anesthesia and surgical complications. If she wants a hyst - fine - but only after you know you don't have an endocervical carcinoma. If she does not want a hyst and you talk her into it and she has a pulmonary embolus - she will be one unhappy camper .... Joanne At Thu, 31 Jul 2008, ENDODOK@aol.com wrote: > >Have a 50 yr old postmenopausal clinic pt that I inherited when I took over >as managing gynecologist in March. Over the last 4 years she has had >recurrent Ascus smears, with positive high risk HPV screen. A couple of years ago she >did have a single Bx of CIN 1. Subsequent smears done every 4-6 months >remain Ascus/ HRHPV pos. Colposcopy repeatedly neg for exocervical lesions. ECC >not possible because of total cervical stenosis. No atypical glandular cells >ever encountered. Clinic NP's and OB/GYN Director concerned that cervical canal >not adequately assessed . They are inclined to proceed with LEEP/ cone bx. > Apppreciate your comments. > >J. Glenn Bradley MD > -- Joanne Bulley, MD solo gyn Keene, NH Next message: Joanne Bulley, MD: "Factor V Leiden & Contraception" Previous message: Srinivas Rao: "Re: Ascus management question" In reply to: ENDODOK@aol.com: "Ascus management question" Next in thread: Andrew Folley: "Re: Ascus management question"

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