Abstract
Objectives:To evaluate the effect of oral progesterone for the treatment of abnormal uterine bleeding in patients taking warfarin after prosthetic valve replacement.Methods:A total of 85 women of reproductive age, who were on warfarin due to prosthetic valve replacement were enrolled in the study. After detailed evaluation, their menstrual bleeding was quantified using Pictorial Bleeding Evaluation Chart. The patients were then prescribed an oral progesterone (Norethisterone) 5mg three times daily. The first follow up was done after one-month then at 3-months and at six months. The improvement in PBAC score was recorded at each visit. Data was entered and analyzed using SPSS (version 23.0). The mean ± Standard Deviation were calculated for quantitative variables while qualitative variables were presented in frequency table. The normality of data was checked using Kolmogorov-Smirnov test. Due lack of normal distribution of data in various groups, the Wilcoxon Sign Rank test was used to test the significance before and after treatment. The p-value of <0.05 was taken as statistically significant.Results:The mean age of the patients was 30.13±7.69 years. The mean PBAC score was 162.8 ± 24.86 before initiation of treatment while at the end of the treatment it was 105.48 ± 8.38. Forty-six (54.1%) patients had continuous per vaginal bleeding, 33 (38.8%) had menorrhagia, 4 (4.7%) had inter-menstrual bleeding and 2 (2.4%) had menorrhagia along with polymenorrhea. The mean dose of warfarin taken by the patients was 5.85 ± 2.69 mg. The median parity of the patients was 2. The Wilcoxon Sign Rank test showed p-value of <0.00001 for comparison of the pre-treatment PCBA values with those of one, three and six-months after the treatment. The Friedman’s test also had a p-value of <0.00001. This confirmed that the post treatment bleeding was significantly less than pretreatment bleeding.Conclusion:The warfarin induced abnormal uterine bleeding can be controlled effectively and safely with low dose of oral progesterone.
Highlights
The literature is scanty about menstrual problems among women on anticoagulants due to cardiac problems
The aim of this study was to evaluate the effect of oral progesterone for the treatment of abnormal uterine bleeding in patients taking warfarin after prosthetic valve replacement
A total of 85 women of reproductive age, who had undergone prosthetic valve replacement were enrolled in the study
Summary
The literature is scanty about menstrual problems among women on anticoagulants due to cardiac problems. The increased risk of abnormal uterine bleeding with Warfarin is widely established. Oral progesterone is as efficacious as that of other hormonal treatment like combined oral contraceptive pills which are relatively less safe in such patients. Sub dermal implants are less effective for menstrual problems while intrauterine devices are invasive mode of treatment with added cost.[1] Though, intra uterine devices provide a novel approach to tackle with this problem, these cannot be applied to unmarried girls and non-affording women. The safety profile, cost effectiveness and easy availability of oral progesterone can help to reduce various menstrual problems. The aim of this study was to evaluate the effect of oral progesterone for the treatment of abnormal uterine bleeding in patients taking warfarin after prosthetic valve replacement
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