Using phytoestrogens as aprophylaxis against irregular uterine bleeding possibly occurring while using Depot-medroxyprogesterone acetate (DMPA) as a contraceptive method

Iman Ali Abd El Fattah

Abstract


Background: High-dose progestogen - only contraceptives, such as injectable DMPA, inhibit follicular development and prevent ovulation as their primary mechanism of action. Inhibition of ovarian function during DMPA use causes the endometrium to become thin and atrophic. These changes in the endometrium in the first months of use results in irregular or unpredictable bleeding or spotting, or rarely, heavy or continuous bleeding  .Phytoestrogens are plant-derived xeno-estrogens functioning as the primary female sex hormone not generated within the endocrine system but consumed by eating phytoestrogenic plants. Also called “dietary estrogens”, they are a diverse group of naturally occurring non-steroidal plant compounds that, because of their structural similarity with estradiol (17-β-estradiol), have the ability to cause estrogenic or/and antiestrogenic effects through binding to estrogen receptors. The management of women who present with unscheduled bleeding while using hormonal contraception is challenging. Although numerous research studies have attempted to investigate preventative and therapeutic treatments for women using hormonal contraception with unscheduled bleeding, none are of sufficient quality to guide management in clinical practice usefully. In this study we are testing the ability of phytoestrogens to prevent the break-through bleeding that can occur during the use of depot medroxy-progesterone acetate as a contraceptive.

Methods: Fifty cases of depot provera users are selected and divided into two groups: group I: 25 cases will start the injection alone. Group II: 25 cases will start the injection with using regular daily phytoestrogen. All cases are followed up for the first six months after the injection for the occurrence of break-through bleeding, and the endometrial thickness using the trans-vaginal ultrasonography.

Results: There was a statistically significant difference in the endometrial thickness between group receiving depot provera alone and the group receiving both depot provera and phytoestrogen.

Conclusions: We can use phytoestrogens to decrease DMPA-associated vaginal bleeding. 


Keywords


Contraception, Depot-medroxy progesterone acetate, Estrogen receptors, Phytoestrogens, Breakthrough bleeding, Endometrial thickness

Full Text:

PDF

References


Glasier Anna. Contraception. In: DeGroot Leslie J, Jameson J. Larry, eds. Endocrinology. 5th ed. Philadelphia: Elsevier Saunders; 2006: 2993-3003.

Loose Davis S, Stancel George M. Estrogens and progestins. In: Brunton Laurence L, Lazo John S, Parker Keith L, eds. Goodman & Gilman’s The Pharmacological Basis of Therapeutics. 11th ed. New York: McGraw-Hill; 2006: 1541-1571.

Hatcher Robert A. Depo-provera injections, implants, and progestin - only pills (Minipills). In: Hatcher Robert A, Trussell James, Stewart Felicia H, Nelson Anita L, Cates Jr Willard, Guest Felicia, et al., eds. Contraceptive Technology. 18th ed. New York: Ardent Media; 2004: 461-494.

Speroff Leon, Darney Philip D. Injectable contraception. In: Speroff Leon, Darney Philip D, eds. A Clinical Guide for Contraception. 4th ed. Philadelphia: Lippincott Williams & Wilkins; 2005: 201-220.

Rivera R, Yacobson I, Grimes D. The mechanism of action of hormonal contraceptives and intrauterine contraceptive devices. Am J Obstet Gynecol. 1999;181(5 Pt 1):1263-9.

Yildiz Fatih. Phytoestrogens in Functional Foods. In: Yildiz Fatih, eds. A Book. 2nd ed. UK: Taylor & Francis Ltd; 2005: 3-5, 210-211.

Turner JV, Agatonovic-Kustrin S, Glass BD. Molecular aspects of phytoestrogen selective binding at estrogen receptors. J Pharm Sci. 2007 Aug;96(8):1879-85.

Johnston I. Phytoestrogens. In: Johnston I, eds. Phytochem Functional Foods. 1st ed. UK: CRC Press Inc; 2003: 66-68.

Sahdev A. Imaging the endometrium in postmenopausal bleeding. BMJ. 2007;334(7594):635-6.

Dubinsky TJ. Value of sonography in the diagnosis of abnormal vaginal bleeding. J Clin Ultrasound. 2004;32(7):348-53.

Noyes RW, Hertig AT, Rock J. Dating the endometrial biopsy. Am J Obstet Gynecol. 1975;122:262-3.

Jabbour HN, Kelly RW, Fraser HM, Critchley HOD. Endocrine regulation of menstruation. Endocr Rev. 2006;27:17-46.

Smith OP, Critchley HO. Progestogen only contraception and endometrial break through bleeding. Angiogenesis. 2005;8:117-26.

Said S. Clinical evaluation of the therapeutic effectiveness of ethinyl oestradiol and oestrone sulphate on prolonged bleeding in women using depot medroxyprogesterone acetate for contraception. Hum Reprod. 1996;11:1-13.

Tantiwattanakul P, Taneepanichskul S. Effect of mefenamic acid on controlling irregular uterine bleeding in DMPA users. Contraception. 2004;70:277-9.

Abdel-Aleem H, d’Arcangues C, Vogelsong K, Gulmezoglu AM. Treatment of vaginal bleeding irregularities induced by progestin only contraceptives. Cochrane Database Syst Rev. 2007;4:CD003449.

Jain JK, Nicosia AF, Nucatola DL, Lu JJ, Kuo LJ, Felix JC. Mifepristone for the prevention of breakthrough bleeding in new starters of depo-medroxyprogesterone acetate. Steroids. 2003;68:1115-9. Nathirojanakun P, Taneepanichskul S, Sappakitkumjorn N. Efficacy of a selective cox-2 inhibitor for controlling irregular uterine bleeding in DMPA use. Contraception. 2006;73:584-7.

World Health Organization. Selected practice recommendations for contraceptive use. In: WHO, eds. WHO Guide. 2nd ed. Geneva: World Health Organization; 2005: 1-174.