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Discussant G. David Adamson, MD

JAMA. 1999;282:2347-2354.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

INTRODUCTION

DR DALEY: Ms B is a 36-year-old married medical writer with pelvic pain, endometriosis, and infertility. She lives near Boston with her husband and 1-year-old adopted daughter. She has managed care insurance.

Ms B experienced menarche at age 12 years. She reports moderate-to-severe dysmenorrhea for many years, intermittent abdominal cramping, diarrhea, "gas," and occasional urinary urgency and frequency. In 1994, she attempted pregnancy. Several months later, she was hospitalized with severe pelvic pain and a large ovarian mass. Laparoscopic surgery revealed a large (8-10 cm) ruptured hemorrhagic ovarian mass consistent with an endometrioma. The cyst was removed laparoscopically, and Ms B began treatment with leuprolide acetate (Lupron Depot). She experienced adverse effects including hot flashes and fatigue. During leuprolide therapy, the endometrioma recurred, and she underwent a second laparoscopic endometriomectomy. Ms B sought a second opinion and had a hysterosalpingogram that demonstrated normal uterus, patent . . . [Full Text of this Article]

MS B: HER UNDERSTANDINGS AND PERCEPTIONS

AT THE CROSSROADS: QUESTIONS TO DR ADAMSON

Pathogenesis and Pathophysiology

Clinical Presentation

Medical Treatment

Surgical Treatment

In Vitro Fertilization

Adoption

Making Choices

Recommendations for Ms B

The Future

QUESTIONS AND DISCUSSION

Author Affiliation: Dr Adamson is the Director, Fertility Physicians of Northern California, Palo Alto and San Jose; Clinical Professor, Department of Gynecology and Obstetrics, Stanford University School of Medicine, Stanford, Calif; and Associate Clinical Professor, University of California San Francisco School of Medicine.

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