title: Transvaginal Doppler sonography for evaluation of irregular uterine bleeding with DMPA.
abstract: BACKGROUND
  The main cause for discontinuation of depot medroxyprogesterone acetate (DMPA) use is irregular menstrual bleeding. The exact pathophysiological mechanisms of irregular bleeding have remained unclear. Transvaginal Doppler is a non-invasive method for studying changes in blood flow which may highlight the underlying pathology in those cases with irregular uterine bleeding. The aim of this study was to quantify the uterine and subendometrial microvasculature in DMPA users with irregular bleeding pattern in comparison to DMPA users with amenorrhea.
  
  
  METHODS
  This is a case control study. Forty users of DMPA were divided into two groups: one group included 20 users with irregular uterine bleeding and the second group included 20 amenorrheic users. Pulsatility index (PI) and resistance index (RI) of uterine and subendometrial blood vessels were determined. Power Doppler Energy was used to quantify the signal percentage of the subendometrial area.
  
  
  RESULTS
  There is significant reduction of PI and RI in the uterine artery and subendometrial microvasculature in cases of irregular uterine bleeding.
  
  
  CONCLUSIONS
  Irregular uterine bleeding with DMPA associated with increased perfusion of uterine and subendometrial blood vessels.
authors.affiliation: Obstetrics and Gynecology Department, Woman's Health Center, Assiut University Hospitals, Assiut, Egypt. mostafahmyd@yahoo.com
authors.forename: Mostafa
authors.initials: M
authors.lastname: Hussein
mesh_terms: D000328:Adult; D000568:Amenorrhea / Q000139:chemically induced / Q000000981:diagnostic imaging; D003271:Contraceptive Agents, Female / Q000008:administration & dosage / Q000009:adverse effects*; D004717:Endometrium / Q000098:blood supply / Q000000981:diagnostic imaging / Q000187:drug effects; D019160:Endosonography; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular; D017258:Medroxyprogesterone Acetate / Q000008:administration & dosage / Q000009:adverse effects*; D008796:Metrorrhagia / Q000139:chemically induced* / Q000000981:diagnostic imaging*; D012039:Regional Blood Flow / Q000187:drug effects / Q000502:physiology; D018615:Ultrasonography, Doppler, Color
chemical_list: D003271:Contraceptive Agents, Female; D017258:Medroxyprogesterone Acetate