Decidual casts, DMPA linked in young patients: four cases suggest decidual casts might be a rare but important side effect associated with the contraceptive.(Gynecology)

NEW ORLEANS -- Decidual cast expulsion may occur in young patients using depot medroxyprogesterone acetate Stephen M. Scott, M.D., said during the annual meeting of the North American Society for Pediatric and Adolescent Gynecology.

Although decidual casts are typically associated with ectopic pregnancy and can be confused with spontaneous abortion, Dr. Scott described four cases that suggest decidual casts might be a rare but important side effect associated with use of the hormonal contraceptive--particularly among those exposed after a prolonged period of anovulatory endometrial proliferation.

The first case involved a postanorexic 16-year-old girl who was on depot medroxyprogesterone acetate (DMPA) for contraception and presented 1 month after her first injection. She had a large amount of white tissue protruding from the cervical os.

The patient had experienced weight recovery and signs of estrogen stimulation at the time of the injection, but also had persistent amenorrhea at the time of injection.

The second case involved a 20-year-old with cerebral palsy and mental retardation, who was using DMPA for the treatment of dysfunctional uterine bleeding. She presented with tissue passing from the vagina 3 weeks after her first injection.

The third case involved an 11-year-old with factor VIII deficiency, who was treated with DMPA to control hemorrhaging that occurred at her first menarche 8 months earlier. She presented with severe cramps and the sensation of a mass in the vagina.

An examination revealed white tissue protruding from the cervical os.