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P elvic PainFrom: Elliot Greenberg (drebgz@wormhole.map.com)Fri Jul 26 11:37:49 1996
I've got a common but frustrating case to present for anyone with gynecologic wisdom. This is a case presented to me by my partner for a second opinion. 31 yo G1P1 female with a long standing history of pelvic pain and dysmenorrhea. Pelviscopy in '91 showed mild endometriosis . This was cauterized. Conceived not long after with normal vag. delivery. Pain and abnormal bleeding returned after breastfeeding done. Laparoscopy in '94 normal w/o endometriosis but pelvic congestion noted. Pt started on Depo-Provera and bled for 72 days. She was then placed on Depot-Lupron x 6 mos. with adequate but not compelete pain relief (described as 4/10). After 6 mos she was put on continuous Lo Estrin 1/20. She is now complaining of continued bad pain and cramping. The patient wants to continue to maintain fertility as she has no partner now and only one child. Considered continuous Lupron with add back but expensive and impractical long term. Any suggestions?
--
Elliot Greenberg MD
Baystate Medical Center
Springfield MA
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