Endometrial Histology of Depomedroxyprogesterone Acetate Users: A Pilot Study

Thurman, Andrea Ries; Soper, David E.

doi:https://doi.org/10.1155/IDOG/2006/69402

Infectious Diseases in Obstetrics and Gynecology

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Clinical Study | Open Access

Volume 2006 | Article ID 069402 | https://doi.org/10.1155/IDOG/2006/69402

Endometrial Histology of Depomedroxyprogesterone Acetate Users: A Pilot Study

Andrea Ries Thurman¹and David E. Soper¹

Received27 Apr 2005

Revised30 Apr 2005

Accepted30 Jun 2005

Published22 Feb 2006

Abstract

Objective. To obtain pilot data on the endometrial histology of Depomedroxyprogesterone acetate (Depo-Provera, DMPA) users experiencing breakthrough bleeding (BTB) versus users with amenorrhea. To compare the endometrial histology of patients who used DMPA continuously for 3–12 months versus those who used it for 13 months or more. Methods. Cross-sectional study. Endometrial biopsy was obtained from all consenting patients who used DMPA for at least 3 months. Patients were divided into those with BTB in the last 3 months versus those with amenorrhea for at least 3 months. Histology results and duration of therapy were compared. Results. The proportion of women with chronic endometritis, uterine polyps, atrophic, proliferative, or progesterone-dominant endometrium did not differ between those DMPA users with BTB versus those with amenorrhea. Duration of therapy did not correlate with symptoms of BTB or endometrial histology. Chronic endometritis was the most common histologic finding (10/40, 25%) and occurred more often in women experiencing BTB (35% versus 15%) (RR 1.62 CI 0.91–2.87). Moreover, 45% of women with BTB had received DMPA for more than 12 months. Conclusions. BTB was more common than previously reported in women using DMPA for more than 12 months. Chronic endometritis, which may indicate an underlying infectious or intracavitary anatomic etiology, has not been previously reported as a frequent finding in DMPA users, and may be related to ethnic or other sociodemographic characteristics of our patient population. Further study to elucidate the etiology of chronic endometritis in these patients is warranted.

References

“Long-acting methods of contraception,” in Clinical Gynecologic Endocrinology and Infertility, L Speroff, R H Glass, and N G Kase, Eds., pp. 962–969, Lippincott Williams & Wilkins, Baltimore, Md, 6th edition, 1999.
View at: Google Scholar
A M Kaunitz, “Long-acting injectable contraception with depot medroxyprogesterone acetate,” American Journal of Obstetrics & Gynecology, vol. 170, no. 5 pt 2, pp. 1543–1549, 1994.
View at: Google Scholar
A M Kaunitz, “Injectable long-acting contraceptives,” Clinical Obstetrics and Gynecology, vol. 44, no. 1, pp. 73–91, 2001.
View at: Google Scholar
B A Cromer, R D Smith, J M Blair, J Dwyer, and R T Brown, “A prospective study of adolescents who choose among levonorgestrel implant (Norplant), medroxyprogesterone acetate (Depo-Provera), or the combined oral contraceptive pill as contraception,” Pediatrics, vol. 94, no. 5, pp. 687–694, 1994.
View at: Google Scholar
I S Fraser, “A survey of different approaches to management of menstrual disturbances in women using injectable contraceptives,” Contraception, vol. 28, no. 4, pp. 385–397, 1983.
View at: Google Scholar
L Speroff and P D Darney, A Clinical Guide for Contraception, Lippincott Williams & Wilkins, Philadelphia, Pa, 3rd edition, 2001.
S Schrager, “Abnormal uterine bleeding associated with hormonal contraception,” American Family Physician, vol. 65, no. 10, pp. 2073–2080, 2002.
View at: Google Scholar
Z Harel, F M Biro, and L M Kollar, “Depo-Provera in adolescents: effects of early second injection or prior oral contraception,” Journal of Adolescent Health, vol. 16, no. 5, pp. 379–384, 1995.
View at: Google Scholar
D F Archer, C A Philput, and M E Weber, “Management of irregular uterine bleeding and spotting associated with Norplant,” Human Reproduction, vol. 11, no. suppl 2, pp. 24–30, 1996.
View at: Google Scholar
S Díaz, H B Croxatto, M Pavez, H Belhadj, J Stern, and I Sivin, “Clinical assessment of treatments for prolonged bleeding in users of Norplant implants,” Contraception, vol. 42, no. 1, pp. 97–109, 1990.
View at: Google Scholar
A L Nelson, “Counseling issues and management of side effects for women using depot medroxyprogesterone acetate contraception,” The Journal of Reproductive Medicine, vol. 41, no. 5 suppl, pp. 391–400, 1996.
View at: Google Scholar
R A Lee, “Contraceptive and endometrial effects of medroxyprogesterone acetate,” American Journal of Obstetrics & Gynecology, vol. 104, no. 1, pp. 130–133, 1969.
View at: Google Scholar
S Jeppsson, E DB Johansson, O Ljungberg, and N O Sjoberg, “Endometrial histology and circulating levels of medroxyprogesterone acetate (MPA), estradiol, FSH and LH in women with MPA induced amenorrhoea compared with women with secondary amenorrhoea,” Acta Obstetricia et Gynecologica Scandinavica, vol. 56, no. 1, pp. 43–48, 1977.
View at: Google Scholar
M Karim, S Yassin, R Ammar, S El Mahgoub, B El Ganzoury, and F Fikri, “Effects of injectable contraceptive progestogens on the puerperal uterus,” International Journal of Gynecology & Obstetrics, vol. 9, no. 6, pp. 221–231, 1971.
View at: Google Scholar
D R Jr Mishell, M A El-Habashy, R G Good, and D L Moyer, “Contraception with an injectable progestin: a study of its use in postpartum women,” American Journal of Obstetrics & Gynecology, vol. 101, no. 8, pp. 1046–1053, 1968.
View at: Google Scholar
E M Belsey, S Peregoudov et al., “Determinants of menstrual bleeding patterns among women using natural and hormonal methods of contraception. I. Regional variations,” Contraception, vol. 38, no. 2, pp. 227–242, 1988.
View at: Google Scholar
D F Archer, “Endometrial histology during use of a low-dose estrogen-desogestrel oral contraceptive with a reduced hormone-free interval,” Contraception, vol. 60, no. 3, pp. 151–154, 1999.
View at: Google Scholar
W Hadisaputra, B Affandi, J Witjaksono, and P AW Rogers, “Endometrial biopsy collection from women receiving Norplant,” Human Reproduction, vol. 11, no. suppl 2, pp. 31–34, 1996.
View at: Google Scholar
L Bahamondes, E Maradiegue, J Diaz et al., “Endometrial histology in long-term users of the once-a-month injectable contraceptive Cyclofem,” Advances in Contraception, vol. 15, no. 1, pp. 1–7, 1999.
View at: Google Scholar
A Ferenczy, “Pathophysiology of endometrial bleeding,” Maturitas, vol. 45, no. 1, pp. 1–14, 2003.
View at: Google Scholar
C L Haggerty, R B Ness, A Amortegui et al., “Endometritis does not predict reproductive morbidity after pelvic inflammatory disease,” American Journal of Obstetrics & Gynecology, vol. 188, no. 1, pp. 141–148, 2003.
View at: Google Scholar
F Alvarez-Sanchez, V Brache, F Thevenin, L Cochon, and A Faundes, “Hormonal treatment for bleeding irregularities in Norplant implant users,” American Journal of Obstetrics & Gynecology, vol. 174, no. 3, pp. 919–922, 1996.
View at: Google Scholar
P Chotnopparatpattara, S Taneepanichskul, S Treratanachat, and N Charuruks, “Relationship between progesterone receptor level in endometrium and bleeding pattern in depot medroxyprogesterone acetate users,” Journal of the Medical Association of Thailand, vol. 86, no. 2, pp. 172–177, 2003.
View at: Google Scholar

Copyright

Copyright © 2006 Andrea Ries Thurman and David E. Soper. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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