Endometrial Histology of Depomedroxyprogesterone Acetate Users: A Pilot Study

摘要

Objective. To obtain pilot data on the endometrial histology ofDepomedroxyprogesterone acetate (Depo-Provera, DMPA) usersexperiencing breakthrough bleeding (BTB) versus users withamenorrhea. To compare the endometrial histology of patients whoused DMPA continuously for 3–12 months versus those who used it for13 months or more.Methods. Cross-sectional study. Endometrialbiopsy was obtained from all consenting patients who used DMPA for atleast 3 months. Patients were divided into those with BTB in the last 3 monthsversus those with amenorrhea for at least 3 months. Histologyresults and duration of therapy were compared.Results. Theproportion of women with chronic endometritis, uterine polyps,atrophic, proliferative, or progesterone-dominant endometrium didnot differ between those DMPA users with BTB versus those withamenorrhea. Duration of therapy did not correlate with symptoms ofBTB or endometrial histology. Chronic endometritis was the mostcommon histologic finding (10/40, 25%) and occurred more oftenin women experiencing BTB (35% versus 15%) (RR 1.62 CI0.91–2.87). Moreover, 45% of women with BTB had receivedDMPA for more than 12 months.Conclusions. BTB was more commonthan previously reported in women using DMPA for more than 12months. Chronic endometritis, which may indicate an underlyinginfectious or intracavitary anatomic etiology, has not beenpreviously reported as a frequent finding in DMPA users, and maybe related to ethnic or other sociodemographic characteristics ofour patient population. Further study to elucidate the etiology ofchronic endometritis in these patients is warranted.