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A survey of different approaches to management of menstrual disturbances in women using injectable contraceptives.
Contraception. 1983 Oct; 28(4):385-97.C

Abstract

This report summarises a survey of the management of menstrual disturbances occurring during injectable progestogen use (depot-medroxyprogesterone acetate, DMPA, and norethisterone enanthate, NET-EN) by 35 investigators from 20 countries with ongoing experience of these contraceptives. A wide range of approaches are described. The most frequently emphasised aspect of management is thorough pre-treatment counselling with further support and counselling at follow-up visits. Oestrogens in various forms are widely used for the treatment of prolonged, frequent or heavy episodes of bleeding, but nowadays are not usually used for the induction of withdrawal bleeding in women with amenorrhoea. Heavy or "severe" bleeding appears to be very uncommon and figures of 1-2% were frequently mentioned. Anecdotal information suggests that intramuscular doses or longer courses (14-21 days) of oral oestrogen, including the combined pill, are more likely to successfully stop an episode of bleeding than short courses. However, there are no hard data to show that a course of oestrogen treatment has any beneficial effect on long-term bleeding patterns. Nevertheless, temporary cessation of spotting or light bleeding may be sufficiently reassuring to the patient to ensure continued use of the method. There appears to be very little risk associated with the short-term oestrogen regimens currently used. Dilatation and curettage is almost never necessary to stop an episode of bleeding, but may occasionally be recommended for diagnostic reasons. It is clear that the bleeding disturbances associated with DMPA and NET-EN use are poorly understood and that urgent research is necessary to clarify pathophysiological mechanisms and improve management.

Authors

No affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

6230212

Citation

Fraser, I S.. "A Survey of Different Approaches to Management of Menstrual Disturbances in Women Using Injectable Contraceptives." Contraception, vol. 28, no. 4, 1983, pp. 385-97.
Fraser IS. A survey of different approaches to management of menstrual disturbances in women using injectable contraceptives. Contraception. 1983;28(4):385-97.
Fraser, I. S. (1983). A survey of different approaches to management of menstrual disturbances in women using injectable contraceptives. Contraception, 28(4), 385-97.
Fraser IS. A Survey of Different Approaches to Management of Menstrual Disturbances in Women Using Injectable Contraceptives. Contraception. 1983;28(4):385-97. PubMed PMID: 6230212.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A survey of different approaches to management of menstrual disturbances in women using injectable contraceptives. A1 - Fraser,I S, PY - 1983/10/1/pubmed PY - 1983/10/1/medline PY - 1983/10/1/entrez KW - Amenorrhea KW - Bleeding KW - Contraception KW - Contraceptive Agents KW - Contraceptive Agents, Female KW - Contraceptive Agents, Progestin--side effects KW - Contraceptive Agents--side effects KW - Contraceptive Methods--side effects KW - Counseling KW - Curettage KW - Diseases KW - Family Planning KW - Injectables--side effects KW - Medroxyprogesterone Acetate--side effects KW - Menstrual Cycle--changes KW - Menstruation KW - Menstruation Disorders KW - Norethindrone Enanthate--side effects KW - Norethindrone--side effects KW - Reproduction KW - Signs And Symptoms KW - Treatment SP - 385 EP - 97 JF - Contraception JO - Contraception VL - 28 IS - 4 N2 - This report summarises a survey of the management of menstrual disturbances occurring during injectable progestogen use (depot-medroxyprogesterone acetate, DMPA, and norethisterone enanthate, NET-EN) by 35 investigators from 20 countries with ongoing experience of these contraceptives. A wide range of approaches are described. The most frequently emphasised aspect of management is thorough pre-treatment counselling with further support and counselling at follow-up visits. Oestrogens in various forms are widely used for the treatment of prolonged, frequent or heavy episodes of bleeding, but nowadays are not usually used for the induction of withdrawal bleeding in women with amenorrhoea. Heavy or "severe" bleeding appears to be very uncommon and figures of 1-2% were frequently mentioned. Anecdotal information suggests that intramuscular doses or longer courses (14-21 days) of oral oestrogen, including the combined pill, are more likely to successfully stop an episode of bleeding than short courses. However, there are no hard data to show that a course of oestrogen treatment has any beneficial effect on long-term bleeding patterns. Nevertheless, temporary cessation of spotting or light bleeding may be sufficiently reassuring to the patient to ensure continued use of the method. There appears to be very little risk associated with the short-term oestrogen regimens currently used. Dilatation and curettage is almost never necessary to stop an episode of bleeding, but may occasionally be recommended for diagnostic reasons. It is clear that the bleeding disturbances associated with DMPA and NET-EN use are poorly understood and that urgent research is necessary to clarify pathophysiological mechanisms and improve management. SN - 0010-7824 UR - https://www.unboundmedicine.com/medline/citation/6230212/A_survey_of_different_approaches_to_management_of_menstrual_disturbances_in_women_using_injectable_contraceptives_ L2 - https://linkinghub.elsevier.com/retrieve/pii/0010-7824(83)90040-9 DB - PRIME DP - Unbound Medicine ER -