title: Depot medroxyprogesterone acetate: a risk factor for cervical stenosis after loop electrosurgical excisional procedure management of cervical intraepithelial neoplasia?
abstract: OBJECTIVE
  In our anecdotal experience and sporadically in the literature, gynecologists have observed a connection between patient's use of depot medroxyprogesterone acetate (DMPA) and increased occurrence of cervical stenosis during follow-up after loop electrosurgical excisional procedure (LEEP). We decided to formally examine this association in our clinic population.
  
  
  METHODS
  We performed a chart review, enrolling 257 patients and tabulating data on demography, use of hormonal contraceptives, characteristics of the LEEP, and presence or absence of cervical stenosis at 1- and 6-month follow-up evaluations. Univariate tests of association between the independent variables and the dependent variable of cervical stenosis were examined via the chi and Student t tests for discrete and continuous variables, respectively. To characterize the relative importance of independent variables significantly associated with cervical stenosis, logistic regression was performed.
  
  
  RESULTS
  Of the 257 charts reviewed, 127 patients (49.4%) completed 1 and 6 months after LEEP follow-up appointments, providing adequate data for analysis. In this population, we observed 25 cases of cervical stenosis, or an overall rate of 19.7%. Of patients using DMPA at the time of LEEP or during the follow-up period, 9 (41.0%) of 22 developed stenosis, whereas of those who did not use DMPA, 16 (15.2%) of 105 developed stenosis, indicating a significant difference (odds ratio = 3.85, 95% CI = 1.41-10.50).
  
  
  CONCLUSIONS
  In our clinic population, use of DMPA was associated with higher rates of development of cervical stenosis, calling for larger studies of the association of DMPA in this LEEP complication.
authors.affiliation: Department of Obstetrics and Gynecology, UVA Health System, Charlottesville, VA 22908, USA. tem2p@virginia.edu
authors.forename: Tovia Elizabeth
authors.initials: TE
authors.lastname: Martirosian
authors.forename: Steven Christopher
authors.initials: SC
authors.lastname: Smith
authors.forename: Alexander Spyridon
authors.initials: AS
authors.lastname: Baras
authors.forename: Mixon M
authors.initials: MM
authors.lastname: Darracott
mesh_terms: D000328:Adult; D003251:Constriction, Pathologic / Q000139:chemically induced*; D003271:Contraceptive Agents, Female / Q000009:adverse effects*; D003692:Delayed-Action Preparations / Q000009:adverse effects*; D004598:Electrosurgery / Q000379:methods; D005260:Female; D006801:Humans; D017258:Medroxyprogesterone Acetate / Q000009:adverse effects*; D008875:Middle Aged; D011183:Postoperative Complications / Q000139:chemically induced*; D012307:Risk Factors; D002577:Uterine Cervical Diseases / Q000139:chemically induced*; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000601:surgery*
chemical_list: D003271:Contraceptive Agents, Female; D003692:Delayed-Action Preparations; D017258:Medroxyprogesterone Acetate