DMPA Users' Endometritis Tied To Inflammation, Not Infection


MINNEAPOLIS — Chlamydia trachomatis was not the cause of chronic endometritis in a new study of women using depot-medroxyprogesterone acetate, a finding that holds implications for treatment of endometritis, reported Dr. Andrea R. Thurman.

C. trachomatis is recognized as a cause of breakthrough bleeding—an occurrence often associated with chronic endometritis—among women using oral contraceptive pills.

About 70% of women using depot-medroxyprogesterone acetate (DMPA) also experience breakthrough bleeding during the first year, and a considerable number discontinue the contraceptive.

To determine if C. trachomatis is implicated in the breakthrough bleeding among DMPA users, a cross-sectional study compared endometrial biopsies from 20 women with bleeding and 20 women who were amenorrheic, Dr. Thurman wrote in a poster session at the annual meeting of the Association of Reproductive Health Professionals.

The most common histologic finding on the biopsies was chronic endometritis, which was defined as two plasma cells per endometrial sample, according to Dr. Thurman of the department of obstetrics and gynecology, University of Texas Health Sciences Center, San Antonio.

Chronic endometritis was the histologic diagnosis in 25% of the 40 participating women, and was seen in 35% of women experiencing breakthrough bleeding, compared with 15% of those without bleeding.

Polymerase chain reaction technology then was used to identify C. trachomatis in paraffin-embedded endometrial biopsy tissue sections. Only one patient in each group was infected, and neither of these two patients had chronic endometritis as their histologic diagnosis, Dr. Thurman said.

Despite the fact that the study population was predominantly African American, young, and medically indigent—all risk factors for C. trachomatis infection—there was no correlation between C. trachomatis infection and chronic endometritis in this group.

This finding suggests that chronic endometritis in DMPA users reflects an inflammatory state relating to endometrial atrophy, and supports the use of nonsteroidal anti-inflammatory drugs, rather than antimicrobials or hormonal medication, for treatment, she wrote.

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