Risk Factors for Postpartum Medroxyprogesterone Problematic Bleeding [8R

Abstract

INTRODUCTION: Medroxyprogesterone acetate is a safe and effective immediate postpartum contraceptive (MPA-PP). However, the resultant irregular bleeding attributed to MPA-PP is problematic. Little is known as to the contributing factors that increase risk of MPA-PP bleeding. Thus we compared patients that complained of MPA-PP bleeding to those who did not. METHODS: We reviewed the charts of all women receiving MPA-PP and had at least 3 months follow-up during 16 month period at a suburban health network. Age, ethnicity, BMI, Breast feeding status, parity, pregnancy complications and delivery type were collected. All visit between 3 months and 12 months were reviewed for persistent bleeding complaints and continuation rates of MPA. This study was approved by IRB. Those with and without bleeding complaints were compared using chi squared or t-test as appropriate. RESULTS: Of the 204 MPA-PP patients studied during the first PP year, 99 switched to alternative contraception or discontinued all contraception, 58 had no MPA bleeding complaints and 47 complained of persistent bleeding. Thirty of the 47 (64%) patients with bleeding stopped MPA. MPA bleeding group did not differ by age, BMI, ethnicity, and pregnancy complications. Although MPA bleeding group had lower cesarean delivery (p=0.06), breast feeding rates (p=0.11), and parity (p=0.07), they did not reach statistical significance. CONCLUSION: Of those wishing to continue MPA-PP, 47/58 (63%) complained of persistent bleeding during the first PP year. Although initiation of MPA in the postpartum period is associated with higher rates of bleeding than in the non-postpartum period, risk factors remain elusive.