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Re: An Intersting Case From: D. Ashley Hill, M.D. (dahmd@mpinet.net) Sat Mar 20 20:18:08 1999 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: fran wilson: "Re: Quality of life" Previous message: Dr James Lie: "Fw: Jelly Beans for Glucola" In reply to: Dr Eberhard W Lisse: "Re: privacy of records" Next in thread: John Robertson M.D.: "Re: privacy of records" At Sat, 20 Mar 1999, Dr. M. P. Shrivastava wrote: >A young lady aged 24 years had TOP ( Termination of pregnancy) at 12 >weeks, 2 years back. 6 months after TOP , she came back to me with the >complaints of Sec. amenorrhoea and excessive vaginal discharge. She had >period once after TOP, after that she is not having her regular period. Dr. Shrivastava: If your patient has a withdrawl bleed after taking medryoxyprogesterone acetate (for example, 5-10mg per day orally for 10 days), *and* her thyroid (TSH) and prolactin studies are normal, then her amenorrhea is likely due to anovulation, and will respond to oral contraceptives. If she wishes to become pregnant, she may require clomiphene citrate. If she does not have a withdrawl bleed, then she may have diminished estrogen. To test for this, prescribe 20 days or so of estrogen (for example conjugated equine estrogen, 1.25 mg per day orally for 20 days) followed by 10 days of medroxyprogesterone acetate. If she bleeds, the likely source of her amenorrhea is diminished estrogen, either from a "central" source (abnormal follicle stimulating hormone, FSH, production) or from shutdown of the ovaries (premature ovarian failure). An FSH level will help make the diagnosis; if it is elevated, ovarian failure is likely, but if it is normal to low, then a pituitary problem is possible. Please note that normally patients who do not bleed after taking the estrogen/progesterone combination may also have an outflow tract problem, like Asherman's. However, you have ruled this out with a hysteroscopy. Good luck, and best wishes. In this case, obtaining follicle and leutinizing hormone levels (FSH and LH) would be indicated. -- Ashley D. Ashley Hill, M.D. Associate Director Department of Obstetrics and Gynecology Florida Hospital Family Practice Residency Orlando, Florida Next message: fran wilson: "Re: Quality of life" Previous message: Dr James Lie: "Fw: Jelly Beans for Glucola" In reply to: Dr Eberhard W Lisse: "Re: privacy of records" Next in thread: John Robertson M.D.: "Re: privacy of records"

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