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Quick Scroll Re: obg sallu 09.29.03 (5 years ago) #1
drmeenakshidua wrote:

Q15. treatment of choice in a perimenopausal women with bleeding PV due to multiple fibroids
a. TAH & BSO
b. TAH
c. Vaginal hysterectomy
d. Enucleating of fibroids




I would think its
TAH and BSO
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Quick Scroll hormonal problems! 09.29.03 (5 years ago) #2
Quote:
treatment of choice in a perimenopausal woman with multiple fibroids



why not jus remove the uterus? icon_surprised.gif
she is not having any problems with the ovaries? icon_eek.gif
why to deprive her of the normal hormonal status she can have for sum more period? icon_smile.gif

i wud rather take out only the utreus! 8)
let the ovaries rest in peace! icon_smile.gif

opinions please! icon_smile.gif
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Quick Scroll 09.29.03 (5 years ago) #3
totally agree with you..........fibroid uterus -take out the uterus .......leave the ovaries alone............you dont want to disturb her hormones while they can last good
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Quick Scroll 09.30.03 (5 years ago) #4
hi
about the fibroids question..
SHAW on Pg 284 mentions
" The ovaries may be conserved in a woman less than 45 yrs, provided they are healthy"
Now the answer depends on how we interpret it..
Since the question talks about a perimenopausal woman..we have to only assume her age.....
I opted to do BSO as well because of the higher risk of ovarian Pathology in this age group....and to avoid a second surgery for the same.....
Well i could be wrong with my reasoning....
others....?
any references...
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Quick Scroll 09.30.03 (5 years ago) #5
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I opted to do BSO as well because of the higher risk of ovarian Pathology in this age group

Buddy,what ovarian pathologies are common during the perimenopausal age group??

If you scratch your memory cells(neurons ,not T cells) you’ll remember that this patient scenario was pretty common in the Gynae OTs……….recall all the types of hysterectomies we use to fumble thru and keep forgetting????and indications of TAHBSO and only TAH??

On one such fine day in a Gynae OT during my rotations, while I was squeezing myself thru the crowd to have a look at the uterosacral ligaments of a 40yr female pt. with fibroids, the operating surgeon asked me a few questions. Happy with the answers, she told other kids how knowing theory was important to be a good surgeon when one absent minded kid asked…..is this TAHBSO???bloating with confidence I said……..of course!!!! Maa’m looked at me and said……now you’ll remove the ovaries and later you’ll give her HRT.!!!!

The next thing I remember is a big smack on my head and sheepishly standing and wondering while the OT was widely grinning at me waiting for the surgeon to wash again and change her gloves.

I learned two things that day…
One …….in an otherwise healthy patient with fibroids ,don’t remove the ovaries
Two……..I never want to be and never will be a gynecologist.
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