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Obstetrics & Gynecology 2006;108:924-929
© 2006 by The American College of Obstetricians and Gynecologists
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ORIGINAL RESEARCH

Oral Medroxyprogesterone Acetate and Combination Oral Contraceptives for Acute Uterine Bleeding

A Randomized Controlled Trial

Malcolm G. Munro, MD1,3, Nakia Mainor, MD1, Romie Basu, MD1, Mikael Brisinger, MD2 and Lorena Barreda1

From the Departments of Obstetrics and Gynecology, 1Kaiser Permanente Southern California Los Angeles Medical Center; 2West Los Angeles Medical Center; and the 3University of California, Los Angeles, Los Angeles, California.

OBJECTIVE: To compare the efficacy of multidose medroxyprogesterone acetate and a multidose monophasic combined oral contraceptive (OC) for hemodynamically stable women with nongestational, acute uterine bleeding.

METHODS: Hemodynamically stable patients with acute uterine bleeding sufficient to justify immediate medical or surgical intervention were enrolled in an open-label, randomized trial comparing oral medroxyprogesterone acetate 20 mg and a monophasic combination OC containing 1 mg norethindrone and 35 µg of ethinyl estradiol, each administered three times per day. Doses were reduced after 1 week to 20 mg per day and one tablet per day for the next 3 weeks for the medroxyprogesterone acetate and OC groups, respectively. Following baseline assessment, patients completed daily treatment and symptom logs collected at 14 and 28 days after initiation of therapy.

RESULTS: Forty patients were randomly assigned, 20 in each group; 33 were evaluated at the 14-day visit. Emergency surgical procedures were avoided in 100% of those women taking medroxyprogesterone acetate and 95% of the OC group. Cessation of bleeding had occurred in 88% of the OC group and 76% of those receiving medroxyprogesterone acetate, with a median time to bleeding cessation of 3 days for both groups. Compliance with therapy was higher in the medroxyprogesterone acetate group than the OC group, but there was no overall difference in the incidence of treatment-related nausea and bloating.

CONCLUSION: This randomized trial is limited by sample size but suggests that both regimens may be effective and reasonably well tolerated.

CLINICAL TRIAL REGISTRATION: Current Clinical Trials (clinicaltrials.gov, www.clinicaltrials.gov) Identifier: NCT00350480

LEVEL OF EVIDENCE: II-1






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