RE: Help for difficult GYN case

[Guest guest]

May need higher dose hormones in short term. Can be natural hormones, doesn't have to be artificial OCPs

For both short and longer term,

look up tranexamic acid

Sent from my iPhone

On Jun 25, 2012, at 8:03 AM, " cnmnancy@... " <cnmnancy@...> wrote:

Briefly for doc considering NFP only- how to treat actual case:

13y/o with arcuate uterus. Menstruation to the point of hemorrhaging and needing blood transfusion.

How do you treat without birth control pills?

And where can he get advice on other similar cases?

ASAP PLEASE!!!

Sandrock CNM

Sent from my Verizon Wireless 4G LTE DROID

[Guest guest]

Not sure the anatomy of the uterus would cause the bleeding. Don’t know.This year, similar pt in 20s treated sugically by Dr Beiter, New Brunswick, NJ – NaPro-trained OBGyn. , MDVirginia From: [mailto: ]On Behalf Of cnmnancy@...Sent: Monday, June 25, 2012 10:03 AM Subject: Help for difficult GYN case Briefly for doc considering NFP only- how to treat actual case:13y/o with arcuate uterus. Menstruation to the point of hemorrhaging and needing blood transfusion.How do you treat without birth control pills?And where can he get advice on other similar cases?ASAP PLEASE!!! Sandrock CNMSent from my Verizon Wireless 4G LTE DROID

[Guest guest]

She is not ovulating. Find out why. We are sold a bill of goods about girls having irregular cycles for the first 2 years post-menarche, according to Pilar Vigil, M.D.,Ph.D. Tranexamic acid will address the symptoms, but not the cause. Nor will simply giving progesterone. Order a TSH (should be <2.5) and a prolactin (<20, although I am suspicious if >10). The remaining causes are hyperinsulinemia, cortisol abnormalities and inflammation, in most cases. In this girl, Congenital Adrenal Hyperplasia should be ruled out. I have 5 in my practice. The youngest is a 7 yo girl who lost an ovary at age 5 due to torsion. Saliva testing is cheap and more accurate, according to the American Endocrine Society, and Diagnos-Techs will give the entire Adrenal Stress Index panel, which also rules out CAH, for $120.

obdoc2000@...

Re: Help for difficult GYN case

May need higher dose hormones in short term. Can be natural hormones, doesn't have to be artificial OCPs

For both short and longer term, look up tranexamic acid

Sent from my iPhone

On Jun 25, 2012, at 8:03 AM, "cnmnancy@..." <cnmnancy@...> wrote:

Briefly for doc considering NFP only- how to treat actual case:

13y/o with arcuate uterus. Menstruation to the point of hemorrhaging and needing blood transfusion.

How do you treat without birth control pills?

And where can he get advice on other similar cases?

ASAP PLEASE!!!

Sandrock CNM

Sent from my Verizon Wireless 4G LTE DROID

[Guest guest]

Arcuate uterus not a factor. The ovaries control the endometrium.

obdoc2000@...

Help for difficult GYN case

Briefly for doc considering NFP only- how to treat actual case:

13y/o with arcuate uterus. Menstruation to the point of hemorrhaging and needing blood transfusion.

How do you treat without birth control pills?

And where can he get advice on other similar cases?

ASAP PLEASE!!!

Sandrock CNM

Sent from my Verizon Wireless 4G LTE DROID

[Guest guest]

HI Did you already call directly to the Pope VI institute?http://www.popepaulvi.com/ncfwh-evaltreat.htmgo to abnormal uterine bleeding and then contact them ASAP!

Sounds like it would be a good thing to consult them on!On Mon, Jun 25, 2012 at 10:02 AM, cnmnancy@... <cnmnancy@...> wrote:

 

Briefly for doc considering NFP only- how to treat actual case:13y/o with arcuate uterus. Menstruation to the point of hemorrhaging and needing blood transfusion.

How do you treat without birth control pills?And where can he get advice on other similar cases?ASAP PLEASE!!! Sandrock CNMSent from my Verizon Wireless 4G LTE DROID

-- Therese , RN, FCP*

*FertilityCare Practitioner

www.potomacfertility.org

" your cycles, your fertility, in your hands "

[Guest guest]

To stop the immediate bleeding; draw labs for evaluation (ie FSH, LH, Prolactin, TSH, Estradiol, Progesterone, etc) start Aygestin (norithindrone 5 mg q 4 hr for 24 hr then QID for one week, TID for one week, then BID for one week, withdraw get menses and then cycle with Prometrium 200 mg hs day 16-25. You may need to give some IV premarin in the face of an acute bleed in the hospital to “prime” the endometrium with 20 mg IV q 6 hr for 3 or 4 doses if she has an IV in. That is what I would do in an emergency and it should stop bleeding within 24-72 hrs.Les Ruppersberger, D.O FACOOG From: [mailto: ] On Behalf Of Therese Sent: Monday, June 25, 2012 12:58 PM Subject: Re: Help for difficult GYN case HI Did you already call directly to the Pope VI institute?http://www.popepaulvi.com/ncfwh-evaltreat.htmgo to abnormal uterine bleeding and then contact them ASAP!Sounds like it would be a good thing to consult them on!On Mon, Jun 25, 2012 at 10:02 AM, cnmnancy@... <cnmnancy@...> wrote: Briefly for doc considering NFP only- how to treat actual case:13y/o with arcuate uterus. Menstruation to the point of hemorrhaging and needing blood transfusion.How do you treat without birth control pills?And where can he get advice on other similar cases?ASAP PLEASE!!! Sandrock CNMSent from my Verizon Wireless 4G LTE DROID-- Therese , RN, FCP**FertilityCare Practitionerwww.potomacfertility.org " your cycles, your fertility, in your hands "