title: Epidural corticosteroid injections as a possible cause of menorrhagia: a case report.
abstract: A 47-year-old female was referred for evaluation of chronic lower back pain. A magnetic resonance imaging of her lumbar spine revealed a broad-based disc herniation at L4-L5 with bilateral neural foraminal narrowing. A decision was made to treat her with bilateral L4-5 transforaminal epidural steroid injections. Following moderate pain relief, the procedure was repeated. Several days after each injection, the patient experienced unusually heavy and painful menstrual bleeding. We postulate that the introduction of exogenous corticosteroids directly into the neuraxial space can initiate a negative feedback loop on the hypothalamic-pituitary-ovarian axis. As a result, this may lead to decreased levels of circulating hormones, resulting in episodes of menorrhagia in the premenopausal population.
authors.affiliation: Albert Einstein College of Medicine, Department of Rehabilitation Medicine, Montefiore Medical Center, Bronx, NY 10467, USA. agitkind@montefiore.org
authors.forename: Andrew I
authors.initials: AI
authors.lastname: Gitkind
authors.forename: Binod
authors.initials: B
authors.lastname: Shah
authors.forename: Mark
authors.initials: M
authors.lastname: Thomas
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007268:Injections, Epidural / Q000009:adverse effects*; D007405:Intervertebral Disc Displacement / Q000188:drug therapy; D017116:Low Back Pain / Q000188:drug therapy / Q000209:etiology / Q000473:pathology; D008159:Lumbar Vertebrae / Q000473:pathology; D008595:Menorrhagia / Q000139:chemically induced / Q000209:etiology*; D008875:Middle Aged
chemical_list: D000305:Adrenal Cortex Hormones