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GNRH agonists and adenomyosisFrom: Richard Chudacoff, MD (richardc@bcm.tmc.edu)Mon Mar 31 16:08:10 1997
31 yo G1P1 came to see me for a third opinion. First and second docs wanted to do a TAH for chronic pelvic pain. She has intermittant menorrhagia (10-12 days despite being on OCPS,) and severe dysmenorrhea, but her dull persistant pelvic pain is present constantly. But, she is getting married and wants more kids. Her numerous scope reports were contradictory (one mentions endometriosis, the other mentions adhesions, one mentions nothing.) My scope showed a normal pelvis, no evidence of endometriosis nor adhesions, with bilateral flow through the normal appearing fallopian tubes. Her uterus is slightly enlarged and globular. I have placed her on Clonidine and Elavil (although may change the latter after reading the posts about Zoloft) for CPP. Okay, here is the question. I believe she has adenomyosis, and I know she wants to wait a year into her marriage before she gets pregnant. There are a couple of reports about using GNRH agonists with adenomyosis for pain control. Anyone out there have experience with this management, assuming that paragraph 2 does not work? My thought is to use the GNRH agonist solo for three months and if there is relief, then start with add back therapy with the highest possible dose that does not cause a return of the pain. Whatjathink? Rick
-- Richard Chudacoff, MD Assistant Professor, OB/GYN Baylor College of Medicine
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