Doctors have been unable to reach a consensus on the type of medical management indicated for various types of abnormal uterine bleeding or when surgery should be considered for the problem. Progestins are considered one of the primary treatments for abnormal uterine bleeding. However, a woman's satisfaction with progestin treatment depends on her age, fertility status, attitudes about uterine conservation, and intensity of desire to resolve the bleeding, finds a study supported by the Agency for Healthcare Research and Quality (HS09478).
Doctors should consider not only the type and severity of uterine bleeding and associated symptoms, but also whether this therapy is in line with a woman's treatment expectations, future reproductive plans, and beliefs about her cycle, suggests lead author, Holly E. Richter, Ph.D., M.D., of the University of Alabama at Birmingham. Dr. Richter and her colleagues studied 413 premenopausal women 30 years of age or older who had abnormal uterine bleeding, with or without fibroids, who were treated for 3 to 5 months with oral medroxyprogesterone acetate (MPA) at 10 to 20 mg per day for 10 to 14 days per month. They assessed the women's satisfaction with and willingness to continue MPA and examined sociodemographic, clinical, and other factors that might predict satisfaction.
Over half (57 percent) of the women who completed the survey said they were satisfied with MPA for control of bleeding. These women were more likely than dissatisfied women to report improvement in bleeding (100 vs. 29 percent), less likely to report bothersome side effects (4 vs. 31 percent), and more likely to express a strong preference for medical treatment over a hysterectomy (70 vs. 26 percent). Women aged 35 or older were nearly three times as likely to be satisfied with MPA as women aged 30 to 35. Those who wanted to conserve their uterus were 36 percent more likely to be satisfied with the treatment, while those who viewed cessation of bleeding as important and who had undergone tubal sterilization were less likely to be satisfied.
More details are in "Medroxyprogesterone acetate treatment of abnormal uterine bleeding: Factors predicting satisfaction," by Dr. Richter, Lee A. Learman, M.D., Ph.D., Feng Lin, M.S., and others, in the July 2003 American Journal of Obstetrics & Gynecology 189, pp. 37-42.
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