title: Mifepristone for the prevention of breakthrough bleeding in new starters of depo-medroxyprogesterone acetate.
abstract: Depo-medroxyprogesterone acetate (DMPA) is an effective injectable contraceptive with worldwide availability. However, it is associated with a high incidence of breakthrough bleeding (BTB) during the first 6 months of use which often leads to discontinuation. Mifepristone is a progesterone receptor antagonist that has been demonstrated to decrease BTB caused by the levonorgestrel subdermal implant (Norplant). The purpose of this study was to determine if mifepristone would decrease BTB in new starters of DMPA. Twenty regularly cycling women who were new starters of DMPA were randomized to receive 50 mg of mifepristone or placebo every 2 weeks for 24 weeks. Percent days of BTB and number of cycles with bleeding intervals > or =8 and > or =14 days were evaluated using daily bleeding diaries. Ovulation was determined by measuring thrice-weekly urinary metabolites of estrogen and progesterone. Endometrial concentrations of ER and PR were determined by immunohistochemistry. Mifepristone significantly decreased the percent days of BTB and the number of cycles with prolonged bleeding intervals when compared to placebo. No subject ovulated in either group. ER immunostaining increased and PR immunostaining decreased after mifepristone treatment. In conclusion, a 50 mg dose of mifepristone taken every 2 weeks decreases the incidence of BTB in new starters of DMPA. This effect may be due to modulation of endometrial estrogen and progesterone receptors.
authors.affiliation: Department of Obstetrics and Gynecology, University of Southern California Keck School of Medicine, 1240 N. Mission Road Room 8K6, Los Angeles, CA 90033, USA. jjain@usc.edu
authors.forename: John K
authors.initials: JK
authors.lastname: Jain
authors.forename: Antonia F
authors.initials: AF
authors.lastname: Nicosia
authors.forename: Deborah L
authors.initials: DL
authors.lastname: Nucatola
authors.forename: Jing J
authors.initials: JJ
authors.lastname: Lu
authors.forename: John
authors.initials: J
authors.lastname: Kuo
authors.forename: Juan C
authors.initials: JC
authors.lastname: Felix
mesh_terms: D000328:Adult; D003271:Contraceptive Agents, Female / Q000627:therapeutic use; D003280:Contraceptives, Oral, Synthetic / Q000627:therapeutic use; D004717:Endometrium / Q000187:drug effects; D047628:Estrogen Receptor alpha; D004967:Estrogens / Q000652:urine; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D017258:Medroxyprogesterone Acetate / Q000627:therapeutic use*; D015735:Mifepristone / Q000627:therapeutic use*; D010060:Ovulation / Q000187:drug effects; D011374:Progesterone / Q000652:urine; D011897:Random Allocation; D011960:Receptors, Estrogen / Q000378:metabolism; D011980:Receptors, Progesterone / Q000378:metabolism; D013997:Time Factors; D014592:Uterine Hemorrhage
chemical_list: D003271:Contraceptive Agents, Female; D003280:Contraceptives, Oral, Synthetic; D047628:Estrogen Receptor alpha; D004967:Estrogens; D011960:Receptors, Estrogen; D011980:Receptors, Progesterone; D015735:Mifepristone; D011374:Progesterone; D017258:Medroxyprogesterone Acetate