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HRT ProblemFrom: Clifford J. Goodman, Jr., MD (momdoc@getnet.com)Sat Apr 27 12:33:17 1996
Please, group, I need help on a case: A 43-year-old G2P2002 underwent TAH/BSO for hard indications four years ago. Since then she has gone through every oral, vaginal cream and transdermal preparation available in Arizona. We were unable to get her euestrogenic, judged by symptoms, physical exam or serum estradiol levels, until we went to Depo-Estradiol q 3 weeks. By training and experience (twenty-two years in a busy community OBG practice) I would almost rather eat okra than have somebody on injections, but I am a realist. She suffers also from multiple food and environmental allergies, sees an allergist for ongoing desensitization injections. She is very slender, has perhaps 3 - 5% body fat. A few months ago, she started getting an immediate (within 15 - 20 min) reaction around the injection site (in the only fat pads we can find on her, on her buttocks) about 3 - 4-cm radius from the site, erythematous, firm, not tender. This persists for several days. Her allergist is convinced that it is not allergic. I tend to agree with him, but . . . After the same thing occurred with every injectable we can try, the allergists suggested that the problem is a chemical or mechanical reaction to the oil in the subQ fat/muscle. This usually sweet lady, her husband and her gynecologist cannot deal with her(self) when her serum E2 is down. We are now trying a very small dose every week, but I am not hopeful, nor is she. Any suggestions? Anything (an implantable or a vaginal ring, etc.?) available to help her? Thanks!
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