[Physician Comment] Short course of progesterone therapy treats abnormal uterine bleeding

Feb 16th – A 3-day course of progesterone therapy was effective in treating abnormal uterine bleeding (AUB).

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1. A 3-day course of progesterone therapy was effective in treating abnormal uterine bleeding (AUB).

2. This treatment regimen resulted in the cessation of bleeding within 5 days.

This pilot clinical trial found that IM injection of depot-Provera (DMPA) followed by three days of medroxyprogesterone acetate (MPA) PO TID was effective in treating acute of prolonged episodes of AUB. The mean time to cessation of AUB was 2.6 days and 5-day adherence and symptom resolution were 100%. These findings suggest an abbreviated 3-day course of therapy may be a suitable alternative to longer-term therapies.

Findings are limited by a single-arm study design. Without a comparison, it is impossible to comment on the non-inferiority or superiority of this regimen compared existing therapies. Additional limitations include volunteer bias, social desirability, and recall bias in self-report of medication adherence. Strengths include 100% adherence and 100% follow-up 3 months after treatment.

Click to read study in the current issue of AJOG

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1. A 3-day course of progesterone therapy was effective in treating abnormal uterine bleeding (AUB).

2. This treatment regimen resulted in the cessation of bleeding within 5 days.

Study author Anita Nelson, M.D. talks to 2 Minute Medicine: 

photo“Evidence is lacking about the efficacy, safety and satisfaction of the most commonly used outpatient therapies to arrest acute abnormal bleeding. To date the largest and best trial demonstrated that a 28-day course of MPA was very effective. Our study shows that a 3-day combination regimen was also effective at rapidly arresting heavy bleeding in women with an array of nonmalignant endometrial pathologies.”

 

 

This [prospective, pilot clinical trial] assessed the use of a 3 day combination therapy of one-time depot-Provera (DMPA) injection with DMPA/MPA treatment regimen to treat acute or prolonged abnormal uterine bleeding (AUB), defined as heavy bleeding (>1 pad/hour or subjective assessment) requiring immediate intervention. Forty-eightwomen were prospectively followed for five days to assess treatment efficacy, feasibility and tolerability during phone and in-person interviews. Medical records were available for retrospective chart review, including confirmation of histologic results of endometrial biopsies and assessment of AUB control 3 months after treatment (n=39).

Participants reported 100% adherence and near-complete resolution of symptoms by Day 5, with minor side effects and high satisfaction. Mean time to bleeding cessation was 2.6 days. A minority of subjects reported experiencing side effects, including bloating (15%), fatigue (13%) and cramping (6%). Overall, patient satisfaction with the treatment was high (>90%). At three months following treatment, chart review showed that a minority of patients (15%) returned with complaints of refractory AUB.

Further reading:

  1. UpToDate: Managing Severe or Prolonged Uterine Bleeding
  2. UpToDate: Medroxyprogesterone Acetate
  3. UpToDate: Depot Medroxyprogesterone Acetate
  4. ACOG: Abnormal Uterine Bleeding

In sum: This pilot clinical trial shows that IM injection of depot-Provera (DMPA) followed by three days of medroxyprogesterone acetate (MPA) PO TID was effective in treating acute of prolonged episodes of AUB. The mean time to cessation of AUB was 2.6 days and 5-day adherence and symptom resolution were 100%. These findings suggest an abbreviated 3-day course of therapy may be a suitable alternative to longer-term therapies.

Findings are limited by a single-arm study design. Without a comparison, it is impossible to comment on the non-inferiority or superiority of this regimen compared existing therapies. Additional limitations include volunteer bias, social desirability, and recall bias in self-report of medication adherence. Strengths include 100% adherence and 100% follow-up 3 months after treatment.

Click to read study in the current issue of AJOG

By Denise Pong and Leah Hawkins

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