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Endometriosis and fibroids From: Garry E. Siegel (garrys@atl.mindspring.com) Thu Oct 31 18:45:33 1996 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Kenneth J. Moise: "PMS treatment" Previous message: Garry E. Siegel: "Re: Patient vs. client" Dear readers: I would like to solicit some opinions on a case today. If any of you are reproductive endocrinologists, I would especially welcome your thoughts--posted to the list or directly emailed, faxed, phoned, etc. 29 YO nulligravida who in 8/95 had a laparotomy with multiple myomectomies and cautery of endometriosis of the ovaries and pelvis elsewhere. I have reviewed this op note, and it isn't particularly explicit. Postop, she took DepoLupron for 4 months. She was seen by my nurse practitioner for an annual exam in june 96, with a normal exam, desiring pregnancy. At that time, I relayed through the nurse practitioner for her to get the op note, and if not pregnant in 4 to 6 months, to see me. She presented with an unusually painful period last week, and had a uterus that was the upper limit of normal, slightly tender, and normal ovaries on exam. Her preg. test was negative, and a sonogram (I send these out, sorry, don't get mad at me) revealed bilateral 4 cm. cystic ovaries that the radiologist really thought were endometriomas, and a couple of fibroids, one pedunculated. The scan was transvag and pelvic. I offered Lupron again, but she wanted to go to the OR for scopes, with which I agreed, given the vagueness of her op note, and her sonographic findings. Her diagnostic hysteroscopy, done to r/o submucous fibroids was normal, and at laparscopy she had AFS Stage 3 (36 points, where 40 = stage 4) endo, bilateral 4 cm. endometriomas that shelled easily, bilateral superficial sidewall disease, easily excised, and a few other spots of endo that were ablated. There were not adhesions to speak of, and the tubes were normal, mobile, and open to Methylene Blue. I feel that she had an optimal resection. She also had a 3 cm. left posterior fibroid, intramural mostly, below the left cornual area, left alone. Should I: 1. Put her on Lupron for 6 months? 2. Tell her to try to conceive immediately? 3. Tell her to try to conceive immediately, and go to superovulation with Clomid + intrauterine insemination? P.S.--Her sister, also a patient (not a client, ya'll) first presented to me with a hemoperitoneum from a tubal preg, resected, and a 10 week fibroid uterus and endometriosis! LOL -- Garry E. Siegel, M.D. garrys@mindspring.com voice (770)664-7013 fax (770)475-1712 Next message: Kenneth J. Moise: "PMS treatment" Previous message: Garry E. Siegel: "Re: Patient vs. client"

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