Objective
The use of epidural steroid injections has increased dramatically, but knowledge of
potential adverse effects is lacking. An association between steroid injection and
subsequent abnormal vaginal bleeding has been suspected clinically, but evidence has
been limited to anecdotal reports.
Study Design
Paired observational retrospective cohort study using electronic medical records from
a large integrated health care system. Participants were all nonhysterectomized women
who underwent epidural steroid injections in 2011. For each steroid injection, encounters
for abnormal vaginal bleeding during the 60 days preceding and 60 days after the injection
were compared as paired observations. For women found to have bleeding, medical records
review was performed to examine menopausal status and bleeding evaluation outcomes.
Results
Among 8166 epidural steroid injection procedures performed on 6926 nonhysterectomized
women, 201 (2.5%) procedures were followed by at least 1 outpatient visit for abnormal
vaginal bleeding. Women were 2.8 times more likely to present with abnormal vaginal
bleeding during the postinjection period compared with the preinjection period (P < .0001). Of the 197 women with postinjection bleeding, 137 (70%) were premenopausal
and 60 (30%) were postmenopausal. Postinjection bleeding prompted endometrial biopsy
evaluation in 103 (52%) cases, with benign findings for 100% of premenopausal women
(59/59) and 95% of postmenopausal women (42/44).
Conclusion
Epidural steroid injections are associated with subsequent abnormal vaginal bleeding
for both premenopausal and postmenopausal women. Women undergoing epidural steroid
injection should be advised of abnormal bleeding as a potential adverse effect and
providers should be aware of this association when evaluating abnormal bleeding.
Key words
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Article info
Publication history
Published online: July 01, 2013
Accepted:
June 25,
2013
Received in revised form:
May 10,
2013
Received:
March 1,
2013
Footnotes
This study was supported by a grant from the Kaiser Permanente Northern California Community Benefits Program.
The authors report no conflict of interest.
Reprints not available from the authors.
Cite this article as: Suh-Burgmann E, Hung Y-Y, Mura J. Abnormal vaginal bleeding after epidural steroid injection: a paired observation cohort study. Am J Obstet Gynecol 2013;209:206.e1-6.
Identification
Copyright
© 2013 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
