Depot-medroxyprogesterone acetate in anticoagulated patients with previous hemorrhagic corpus luteum.

Abstract

OBJECTIVE:

To investigate the safety of depot-medroxyprogesterone acetate (DMPA) in women of reproductive age with prosthetic heart valves, as well as the impact of DMPA on the prevention of hemorrhagic corpus luteum in these patients with previous bleeding events.

METHODS:

In this prospective study we enrolled 13 patients who were receiving chronic anticoagulation for prosthetic heart valves, and who suffered from ovarian bleeding. After the initial bleeding episode(s), DMPA was initiated with the intent of preventing recurrent bleeding events by means of ovulation suppression. Follow-up included close monitoring of anticoagulation intensity, lipid profile, measurement of systolic and diastolic blood pressures and weight, and a general physical and gynecological examination.

RESULTS:

Of the participating 13 patients, one stopped DMPA after the third injection because she wanted to have a child. Among the remaining 12 women, over a mean follow-up of 39.9 months all patients were well and no hemorrhagic corpus luteum was observed. During the follow-up, anticoagulation intensity, assessed by the international normalized ratio (INR), was in the optimum therapeutic ranges at all times (range 2.5-3.5), except for values of 4.6, 5.8 and 5.9 in three patients at 9, 12 and 24 months, respectively. With regard to lipid profile, we observed a significant decrease in high-density lipoprotein cholesterol levels at 12 months, and significant increases in total cholesterol and triglyceride levels after 30 months compared to baseline serum levels. No significant changes were observed in serum low-density lipoprotein cholesterol levels. Mean body weight was higher at months 12 and 30, compared with baseline values (p > 0.05).

CONCLUSION:

DMPA, which is an effective contraceptive agent, can be used to prevent bleeding from the corpus luteum by means of ovulation suppression in anticoagulated patients with prosthetic heart valves. However, meticulous surveillance should be provided during the follow-up, including close monitoring of anticoagulation intensity and lipid profile.

• Authors: M Sönmezer, C Atabekoğlu, B Cengiz, F Dökmeci, S D Cengiz
• Journal: The European journal of contraception & reproductive health care : the official journal of the European Society of Contraception (Eur J Contracept Reprod Health Care) Vol. 10 Issue 1 Pg. 9-14 (Mar 2005) ISSN: 1362-5187 [Print] England
• PMID: 16036292 (Publication Type: Comparative Study, Journal Article)

Chemical References

• Anticoagulants
• Contraceptive Agents
• Delayed-Action Preparations
• Medroxyprogesterone Acetate

Topics

• Adult
• Anticoagulants (therapeutic use)
• Contraceptive Agents (adverse effects, therapeutic use)
• Corpus Luteum (drug effects, physiopathology)
• Delayed-Action Preparations
• Drug Interactions
• Female
• Follow-Up Studies
• Heart Valve Prosthesis
• Hemorrhage (diagnosis, etiology)
• Humans
• Injections, Intramuscular
• Medroxyprogesterone Acetate (adverse effects, therapeutic use)
• Probability
• Prospective Studies
• Risk Assessment
• Treatment Outcome