Study backs OCs as aid in acute uterine bleeding.(Gynecology)

WASHINGTON -- Oral medroxyprogesterone acetate and oral contraceptives are equally effective in stopping nonges-tational acute uterine bleeding, according to a small randomized controlled trial presented at the annual meeting of the American College of Obstetricians and Gynecologists.

Cessation of bleeding occurred in 88% of the women randomized to oral contraceptives and in 76% of the women randomized to medroxyprogesterone. The mean time to cessation in the oral contraceptive group was 3.2 days vs. 3.8 days in the medroxyprogesterone group, reported Dr. Malcolm G. Munro, professor of obstetrics and gynecology at the University of California, Los Angeles, and chairman of the abnormal uterine bleeding working group for Kaiser Permanente, Southern California.

Women with nongestational acute uterine bleeding are seen frequently, and yet there has been a paucity of research on how best to treat them. Oral contraceptives are the most commonly used treatment in North America, but their efficacy for this indication has not been scientifically tested, Dr. Munro said. "There's never been a case report, a series, or a comparative trial. To my knowledge, the use of some type of combination oral contraceptives is based on a textbook that espouses this as being a treatment, and probably because it seems to work reasonably well, people perceive that a lot of research has been done in the area, but that is not the case."

Currently, treatment options have been surgical therapy (D & C) or medical therapy with gonadal steroids, estrogen alone, progestins alone, or a combination estrogen-progestin formulation, Dr. Munro said.

He noted that only two studies of acute uterine bleeding have been reported in the literature. The first, a study of unopposed estrogen given intravenously in 32 women, was published in the early 1980s, and the second, a study of medroxyprogesterone acetate in 24 women, was published in 1997. "This is the ...