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Re: mini-period...Dr. Marchbein..THANKS!
From: anonymous (anonymous@obgyn.net)
Sat, 8 Apr 2000 20:48:40 -0500 (CDT)
Just wanted to say thanks for taking the time to answer my questions
after such a busy day. I hope you got some rest!
Thanks again!!
At Thu, 6 Apr 2000, Harvey S. Marchbein, M.D. wrote:
>
>Sorry. I may not get to the forum every day. Wednesdays are my 14 hour
>day in the office so I usually collapse after a late dinner (or early
>breakfast depending upon how you look at it). Let's see what I can do
>now.
>
>At Thu, 6 Apr 2000, anonymous wrote:
>>
>>Dr. Marchbein,
>>
>>I wasn't sure if my post got lost so i am sending again. I understand
>>you are very busy and if you do not have time to respond I understand
>>completly.
>>
>>I found a post that you responded to many years ago concerning this same
>>issue. You recommended seeing the doctor every 6 months to check the
>>IUD. Do yous till recommend this?
>
>Yes, I stil recommend it. there are some, however, who do not and I
>cannot say they are wrong. this is my comfort level with IUDs.
>
>>Since my doctor doesn't, do I just make an apt and tell her I want to
>>make sure it is in the right place and share my concerns about an IUD
>>with breastfeeding?
>
>What you may want to do is what you suggested OR I have one patient who
>likes to get a yearly sonogram to see if the uterus is in place (I think
>it's too much BWDIK). Some of my patients refuse 6 month exams and come
>in yearly. Haven't had a problem yet but my comfort level stays the
>same. As I mentioned about breast feeding, although small, the risk of
>perforation is increased.
>
>A brief summary of the 1998 article...
>
>A survey comprised 50 consecutive perforations occurring with
>intrauterine devices (IUD) reported to the National Patient Insurance
>Scheme Register during 1990 to 1993. All 50 women were parous and > 20
>years of age at the time of IUD insertion. Forty-two (84%) of the IUD
>were inserted by a midwife and eight by a gynecologist. A total of 45
>women (90%) had their IUD inserted < 1 year after a full-term pregnancy
>and 31 women (62%) had their IUD inserted < or = 12 weeks after
>delivery. Of the 50 women, 27 (54%) reported that they were
>breastfeeding at the time of IUD insertion. No particular IUD was
>overrepresented in relation to its share on the market. In 31 cases
>(62%), severe pain at insertion and during the first 24 h was recorded.
>In 14 women (28%), the perforation was diagnosed early (i.e., within 1
>month of insertion) and in 36 women (72%), the perforation was diagnosed
>> 1 month after insertion. Lower abdominal pain was the most frequent
>symptom at early diagnosis but in two cases, the main symptom was heavy
>bleeding. Among the 36 women in whom the perforation was discovered
>more than 1 month after insertion, the diagnosis was made when an
>unexpected pregnancy occurred in 20 women (56%). In 15 cases, the IUD
>strings were not visible during pelvic examination at a routine
>check-up, which led to efforts to locate the IUD. Thirty-two women
>(64%) underwent laparotomy for removal. We conclude that lactating
>women seem to be a risk group for perforation and that a national
>register of IUD perforations could provide a better means of quality
>control.
>
>HSM
>
>>Thanks again!
>>At Wed, 5 Apr 2000, anonymous wrote:
>>>
>>>Dr. Marchbein,
>>>
>>>I'm sorry but I have more questions.
>>>
>>>My beta HCG came back negative! :)(It would have been my FIFTH baby!) I
>>>asked about skipping a period and how it relates to the IUD. I am told
>>>I ahve nothing to worry about and that it isn't a big deal for me to
>>>skip this. I was only talking to the nurse not my doctor.
>>>
>>>I want to keep the IUD in place but am worried about a perforated
>>>uterus. I know what it means to have this happen, but what problems can
>>>it cause? The string feels like it is the same length. If it perforated
>>>that means it moved right? and therefore the string would be shorter?
>>>Should I only worry if the length of the string changes?
>>>
>>>As you can tell, I am very confused as to what to do. You asked about
>>>my doctors comfort level, well, since I only talked with the nurse, I am
>>>not sure how she feels. My guess is that she is ok with this since she
>>>is the one who inserted it and knew I was breastfeeding.
>>>
>>>can you help me more please??? Thanks!
>>>
>>>Cindy
>>>
>>>P.S. You mentioned that inserting an IUD while breastfeding is not
>>>recommended in different parts of the world. What makes a group of
>>>doctors feel differently about studies than others? I am in Ohio and
>>>being seen by a DO.
>>>
>>>At Tue, 4 Apr 2000, Harvey S. Marchbein, M.D. wrote:
>>>>
>>>>At Tue, 4 Apr 2000, anonymous wrote:
>>>>>
>>>>>Hi Dr. Marchbein,
>>>>
>>>>Hi anonymous,
>>>>
>>>>>You mentioned about a perforated uterus. What would this feel like?
>>>>
>>>>Usually no symptoms at all. It can be diagnosed by sonography or
>>>>(gulp!) at surgery.
>>>>
>>>>>Wouldn't I have more bleeding vs. less?
>>>>
>>>>Nope.
>>>>
>>>>>I had a beta HCG done today and
>>>>>will know the results tomorrow. If negative, should I make an appt with
>>>>>my gyn to get further answers or is it ok to not have a period?
>>>>
>>>>With a negative HCG, I'd still touch base with the doctor and see what
>>>>his/her comfort level is.
>>>>
>>>>>Thank for your time!
>>>>
>>>>You're welcome.
>>>>
>>>>HSM
>>>>
>>>>>At Mon, 3 Apr 2000, Harvey S. Marchbein, M.D. wrote:
>>>>>>
>>>>>>At Mon, 3 Apr 2000, anonymous wrote:
>>>>>>>
>>>>>>>Hi,
>>>>>>>
>>>>>>>I started having some spotting on day 25 of my cycle. I am on day 31
>>>>>>>and it has never gotten heavier. There is just enough there when I wipe
>>>>>>>and no more. The discharge has been dark red almost orange in color.
>>>>>>>
>>>>>>>I have had an IUD for 5 months and I am breastfeeding.
>>>>>>
>>>>>>Things are different in different parts of the country but around where
>>>>>>I practice, we consider breast feeding a relative contraindication to
>>>>>>the IUD - there was a report of a greater risk of perforation of the
>>>>>>uterus AFTER insertion (as opposed to being associated with insertion of
>>>>>>the IUD) while breastfeeding.
>>>>>>
>>>>>>>My periods were
>>>>>>>very frequent and extremely heavy prior to this month. Also, I have cut
>>>>>>>back on breastfeeding.
>>>>>>>
>>>>>>>I took a pregnancy test on Sunday and it was negative. Is there any
>>>>>>>chance that I am still pregnant?
>>>>>>
>>>>>>It may be too early to diagnose. If there's any concern, get a blood
>>>>>>pregnancy test and if deemed appropriate, a sonogram to confirm that the
>>>>>>IUD is still in the uterus..
>>>>>>
>>>>>>>Should I be concerned or do anything
>>>>>>>further? I feel crampy at times but nothing more is happening.
>>>>>>>
>>>>>>>Please help.
>>>>>>
>>>>>>--
>>>>>>Harvey S. Marchbein, M.D. FACOG, FACS
>>>>>>Great Neck, New York
>>>>>>
>>>>>>**Note: Opinions expressed here are for educational purposes only
>>>>>>and, as such, do not constitute a physician-patient relationship.
>>>>>>This information is not intended to supplant the need for you to
>>>>>>consult with your physician prior to choosing therapeutic options
>>>>>>and/or interventions.
>>>>>>
>>>>>>**Private emails cannot be entertained due to time constraints,
>>>>>>consequently no private emails will receive a response.
>>>>>>
>>>>>>**Thank you for your understanding ;-)
>>>>>>
>>>>--
>>>>Harvey S. Marchbein, M.D. FACOG, FACS
>>>>Great Neck, New York
>>>>
>>>>**Note: Opinions expressed here are for educational purposes only
>>>>and, as such, do not constitute a physician-patient relationship.
>>>>This information is not intended to supplant the need for you to
>>>>consult with your physician prior to choosing therapeutic options
>>>>and/or interventions.
>>>>
>>>>**Private emails cannot be entertained due to time constraints,
>>>>consequently no private emails will receive a response.
>>>>
>>>>**Thank you for your understanding ;-)
>>>>
>--
>Harvey S. Marchbein, M.D. FACOG, FACS
>Great Neck, New York
>
>**Note: Opinions expressed here are for educational purposes only
>and, as such, do not constitute a physician-patient relationship.
>This information is not intended to supplant the need for you to
>consult with your physician prior to choosing therapeutic options
>and/or interventions.
>
>**Private emails cannot be entertained due to time constraints,
>consequently no private emails will receive a response.
>
>**Thank you for your understanding ;-)
>
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