|Discussion in 'All Categories' started by dr.y.deshmukh - Nov 26th, 2011 10:04 pm.|
I am general practitioner in small town in Maharashtra.
24yrs unmarried female came to my hospital with c/o severe abdominal pain & p/v bleeding after giving symptomatic treatment i reffered her to gynecologist..
according to her USG report
UTERUS ANTEVERTED BULKY MEASURES (88*48*64)shows anterior wall reply fibroid (45*30)
and was diagnosed as a case UTERINE FIBROID..
I advised her for second opinion
Another gynecologist dignosed her as a case of adenomyosis..
her second USG report is as follows..
MINIMALLY BULKY UTERUS.ANTERIOR MYOMETRIUM APPERAED THICKENED COMPARED TO POSTERIOR.HETEROHENEOUS ANTERIOR MYOMETRIUM.NO DISCRETE FOCAL LESION..
her third USG carried on advice of the same gynecologist is as follows..
UTERUS IS STRAIGHT,BULKY,SIZE 96*46*63THE MYOMETRIAL ECHOGENECITY IS INCREASED & COARSE WITH ILLDEFINED HYPOECHOIC LESION (21*16)IN ANTERIOR WALL OF FUNDUS ENDOMETRIAL ECHO 12MM,THICK
BOTH OVRIES ARE BULKY E/OMULTIPLE SMALL FOLLICLES (3-7MM)AT PERIPHERY
RT OVARY 42*20MM,LEFT41*19
She is on TAB OVARAL-G,since 01/11/2011 as prescribed by her first gynecologist..
as she is unmarried,no doubt our aim of treatment shoud be targeted towrds saving her uterus..
what are the other treatment options available in her case?
What advice shoud be given to her family regarding her marraige,
is there any answer to her question that healthy pregnancy is possible for her or not..?
waiting for ur adivice..
re: Adenomyosis treatment options for my patient by Dr M.K. Gupta - Nov 26th, 2011 11:20 pm
Dr M.K. Gupta
|Dear Dr. Y. Deshmukh
MEDICAL FIBROID Treatment methods are BEST OPTION FOR YOUR PATIENT ACCORDING TO HER AGE AND BECAUSE SHE IS UNMARRIED.
Medical treatments are those that use a medicine to reduce the heavy menstrual bleeding, that is experienced by women too with fibroids. Treatments are often recommended before surgical treatments.
There are a variety of medical treatments available, including some which use hormones plus some that do not.
Hormonal birth control - Hormonal methods of birth control range from the pill, skin patch, vaginal ring, shot, hormonal IUD, and implant. These treatments reduce bleeding, cramps, and pain on your PATIENT'S menstrual period. It might take three months for bleeding to enhance once you begin taking hormonal contraception.
Pills, patch, vaginal ring - Most forms of hormonal birth control, such as the pill, skin path, and vaginal ring, are created to be employed for 3 weeks consecutively, followed by 1 week off. Throughout the fourth week, your patient will have menstrual bleeding. It could take 3 months for bleeding to enhance once patient begin taking hormonal birth control.
Hormonal intrauterine device - It comes with an intrauterine device (IUD) that slowly releases a kind of a progesterone-like hormone known as a progestin, into the uterus. There is no estrogen within the IUD. The IUD prevents pregnancy and reduces menstrual bleeding for up to 5 years. You can place the IUD within the uterus. Laser hair removal is best for women who do not have plans to become pregnant over the following 6 to Twelve months.
Implant - It comes with an implant that slowly releases a progestin into Your patient bloodstream. It prevents pregnancy and reduces menstrual bleeding for approximately three years. You can place the implant (that is concerning the size a match stick) under the skin within the upper inner arm. It is called Implanon® in the US and elsewhere. Laser hair removal is the best for ladies who don't have intends to become pregnant within the next 6 to Twelve months.
Shot - Medroxyprogesterone acetate (Depo-Provera®) is a long-acting form of a progesterone-like hormone called a progestin. It's a shot given once every three months. Laser hair removal prevents pregnancy and can reduce heavy menstrual bleeding. The shot is the best for women who do not have intends to become pregnant within the next 6 to Twelve months.
The most common side effect of medroxyprogesterone acetate is bleeding and spotting, particularly during the first couple of months. A lot of women completely stop having menstrual periods after by using this strategy to one year. More detailed information about medroxyprogesterone acetate is available separately.
Antifibrinolytic medicines - Antifibrinolytic medicines can help to slow menstrual bleeding quickly. These medicines work by helping blood to clot. Antifibrinolytic medicines do not shrink fibroids. Tranexamic acid (Lysteda®) meets the approval of america Food and Drug Administration for the indication of heavy menstrual bleeding.
The benefits of antifibrinolytic medicines over other medical treatments are that:
The medicine slows bleeding quickly (within two to three hours)and Your patient need to take the medicine only a few days each month. The medicines do not affect your odds of getting pregnant.
Negative effects may include headache and muscle cramps or pain. Your patient should not take antifibrinolytic medicines with hormonal birth control unless your doctor or nurse approves; there may be a heightened chance of blood clots, stroke, and cardiac arrest when taken together.
NSAIDs aren't expensive, have few side effects, reduce pain, and you only have to drive them on your period. You can take NSAIDs in conjunction with any of the treatments discussed here. However, NSAIDs do not reduce bleeding too other treatments do.
Gonadotropin-releasing hormone (GnRH) agonists - GnRH agonists really are a medicine given by injection.