Guest guest Posted May 23, 2012 Report Share Posted May 23, 2012 21 year old client, no history of hormonal contraceptive use, not sexually active. Experienced amenorrhea for 12 months, which she attributes to stress. Charting with me since February; shows an infertile pattern of discharge with an occasional day or two of mucus. Bleeding at regular intervals, but no Peak identified between bleeds. She is taking Accutane. Does anyone know if this could be compromising her mucus observations, or interfering with her ability to ovulate?a Van Uden, LPNAccredited Instructor, Billings Ovulation Methodwww.facebook.com/BillingsMethod Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 24, 2012 Report Share Posted May 24, 2012 a I do not know about mucus and accutane but if your client were to get pregnant on accutane the baby would have serious problems. It is HIGHLY teratogenic. If I had a patient on that drug which came to me for NFP I would either have her sign papers (informed consent) that proved I warned her of the serious possible harms to the baby if she were to get pregnant or have her stop the drug. Other doctors only prescribe accutane to young women if they agree to take the pill. I personally would urge her to get off the accutane. There are other ways to treat acne. Sometimes they only need about 5 months of treatment and they can stop. Pls be careful with this patient. BlessingsSent via BlackBerry by AT&TFrom: a V <nfplethbridge@...>Sender: Date: Wed, 23 May 2012 22:13:00 -0600< >Reply Subject: Accutane 21 year old client, no history of hormonal contraceptive use, not sexually active. Experienced amenorrhea for 12 months, which she attributes to stress. Charting with me since February; shows an infertile pattern of discharge with an occasional day or two of mucus. Bleeding at regular intervals, but no Peak identified between bleeds. She is taking Accutane. Does anyone know if this could be compromising her mucus observations, or interfering with her ability to ovulate?a Van Uden, LPNAccredited Instructor, Billings Ovulation Methodwww.facebook.com/BillingsMethod Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 24, 2012 Report Share Posted May 24, 2012 Dear a, just had a power surge, not sure if you got last message i sent - but basically, i urged you to be VERY careful with this patient. Accutane is a pregnancy category X . That is the worst you can get. If this woman gets pregnant while on accutane, her baby would probably have limb deformities. For this reason, virtually all physicians in my area (with the exception of me) put their young sexually active women on OCPS while accutane therapy is ongoing. How long has this woman been on accutane? Some women can get an effect from the drug after only 5 months. In addition, there are less harmful ways to treat acne. Accutane causes bone changes, hypertriglyceridemia and is a potent teratogen. I would try to get her off of it. Perhaps it is not so much the accutane causing cervical mucus changes, but that her underlying endocrine condition (that is causing the severe cystic acne) is what is predisposing her to the acne? You should have her provider check her for PCOS, high testosterone states, and the other conditions that can lead to this. If she won't get off the drug and she still wants to continue with NFP, i would have her sign a very detailed Informed Consent which states you told her the efficacy rates with Billings, and that she realizes if she gets pregnant, that Accutane is a potent teratogen. Does her doctor know that you are helping her with NFP? Usually doctors practically force their patients to take the pill while on this drug - won't even prescribe it unless they go on it? Be careful -- Blessings, Dr. Peck, MD, CCD, ABFM, Marquette NFP Instructor Pecks Family Practice, PLC 1688 W Granada Blvd, Ste 2A Ormond Beach, FL 32174 (386) 677-2018 fax: (386) 676-0737 cell: (386) 212-9777 "I have chosen you from the world, says the Lord, and have appointed you to go out and bear fruit, fruit that will last, alleluia" (Cf. Jn 15:16,19) From: a V <nfplethbridge@...> Sent: Thursday, May 24, 2012 12:13 AM Subject: Accutane 21 year old client, no history of hormonal contraceptive use, not sexually active. Experienced amenorrhea for 12 months, which she attributes to stress. Charting with me since February; shows an infertile pattern of discharge with an occasional day or two of mucus. Bleeding at regular intervals, but no Peak identified between bleeds. She is taking Accutane. Does anyone know if this could be compromising her mucus observations, or interfering with her ability to ovulate?a Van Uden, LPNAccredited Instructor, Billings Ovulation Methodwww.facebook.com/BillingsMethod Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 24, 2012 Report Share Posted May 24, 2012 She is not sexually active, very faithful Catholic young lady. Not even in a relationship right now. She was concerned about her reproductive health and is learning NFP to get on top of any problems now, rather than later in life.a Van Uden, LPNAccredited Instructor, Billings Ovulation Methodwww.facebook.com/BillingsMethod From: rbamer2@...Date: Thu, 24 May 2012 10:34:32 +0000Subject: Re: Accutane a I do not know about mucus and accutane but if your client were to get pregnant on accutane the baby would have serious problems. It is HIGHLY teratogenic. If I had a patient on that drug which came to me for NFP I would either have her sign papers (informed consent) that proved I warned her of the serious possible harms to the baby if she were to get pregnant or have her stop the drug. Other doctors only prescribe accutane to young women if they agree to take the pill. I personally would urge her to get off the accutane. There are other ways to treat acne. Sometimes they only need about 5 months of treatment and they can stop. Pls be careful with this patient. BlessingsSent via BlackBerry by AT & TFrom: a V <nfplethbridge@...> Sender: Date: Wed, 23 May 2012 22:13:00 -0600< >Reply Subject: Accutane 21 year old client, no history of hormonal contraceptive use, not sexually active. Experienced amenorrhea for 12 months, which she attributes to stress. Charting with me since February; shows an infertile pattern of discharge with an occasional day or two of mucus. Bleeding at regular intervals, but no Peak identified between bleeds. She is taking Accutane. Does anyone know if this could be compromising her mucus observations, or interfering with her ability to ovulate?a Van Uden, LPNAccredited Instructor, Billings Ovulation Methodwww.facebook.com/BillingsMethod Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 24, 2012 Report Share Posted May 24, 2012 just what is the "stress" she's experiencing? Sincerely yours, Dominic M. Pedulla MD, FACC, CNFPMC, ABVM, ACPh Interventional Cardiologist, Endovascular Diplomate, Varicose Vein Specialist, Noncontraceptive Family Planning Consultant, Family Planning Researcher Medical Director, The Oklahoma Vein and Endovascular Center (www.noveinok.com, veininfo@...) Executive Director, The Edith Stein Foundation (www.theedithsteinfoundation.com) 405-947-2228 (office) 405-834-7506 (cell) 405-947-2307 (FAX) pedullad@... "...the priestly ministry is not just a pastoral service; it ensures the continuity of the functions entrusted by Christ to the Apostles and the continuity of the powers related to those functions. Adaptation to civilizations and times therefore cannot abolish, on essential points, the sacramental reference to constitutive events of Christianity and to Christ himself." (Inter Insignores) Accutane 21 year old client, no history of hormonal contraceptive use, not sexually active. Experienced amenorrhea for 12 months, which she attributes to stress. Charting with me since February; shows an infertile pattern of discharge with an occasional day or two of mucus. Bleeding at regular intervals, but no Peak identified between bleeds. She is taking Accutane. Does anyone know if this could be compromising her mucus observations, or interfering with her ability to ovulate? a Van Uden, LPN Accredited Instructor, Billings Ovulation Method www.facebook.com/BillingsMethod Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 24, 2012 Report Share Posted May 24, 2012 I fully suppport Darcy's point. Acne is the result of hyperandrogenism. Androgens are converted by the corpus luteum into estrogen and progesterone if ovulation occurs. The chart and history already indicate that this patient is anovulatory. Diagnose and treat the underlying endocrinopathy and forget about accutane and ocp's. W. , M.D.,FACOG obdoc2000@... Billings Center For Fertility and Reproductive Medicine Accutane 21 year old client, no history of hormonal contraceptive use, not sexually active. Experienced amenorrhea for 12 months, which she attributes to stress. Charting with me since February; shows an infertile pattern of discharge with an occasional day or two of mucus. Bleeding at regular intervals, but no Peak identified between bleeds. She is taking Accutane. Does anyone know if this could be compromising her mucus observations, or interfering with her ability to ovulate? a Van Uden, LPN Accredited Instructor, Billings Ovulation Method www.facebook.com/BillingsMethod Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 24, 2012 Report Share Posted May 24, 2012 There are 5 common causes of ovarian dysfunction: hyperinsulinemia, hyperprolactinemia, cortisol abnormalities, thyroid abnormalities and inflammation. TSH should be <2.5 in women, Prolactin <20, and preferably less than 10. Salivary testing can rule out congenital adrenal hyperplasia, which would cause hyperandrogenism and hypercortisolemia. It will also accurately measure cortisol 4x daily as well as fasting and post-prandial insulins and test for gliadin (gluten sensitivity). The entire panel costs $120 and is available via www.Diagnostechs.com. Rare causes are CAH and tumors. And ultrasound can rule out the latter. The American Endocrine Society contends that salivary testing is preferable to serum hormone testing because of serum sex hormone binding globulin. I tick the common causes off on the fingers of my right hand when talking to patients about their abnormal cycles and infertility. Since the five fingers are on the same hand, the causes are interrelated. For example, dropping insulin levels during sleep will trigger high midnight cortisol levels and low AM levels. High insulin levels will drop daytime cortisol levels. So "stress" affects cortisol and insulin. Prolactin affects thyroid and insulin, etc. Hope this memnomic is helpful. obdoc2000@... Accutane 21 year old client, no history of hormonal contraceptive use, not sexually active. Experienced amenorrhea for 12 months, which she attributes to stress. Charting with me since February; shows an infertile pattern of discharge with an occasional day or two of mucus. Bleeding at regular intervals, but no Peak identified between bleeds. She is taking Accutane. Does anyone know if this could be compromising her mucus observations, or interfering with her ability to ovulate? a Van Uden, LPN Accredited Instructor, Billings Ovulation Method www.facebook.com/BillingsMethod Quote Link to comment Share on other sites More sharing options...
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