title: Abnormal uterine bleeding following lumbar epidural corticosteroid injections and facet medial branch blocks in both pre- and postmenopausal women: a case series.
abstract: BACKGROUND
  Epidural steroid injections (ESIs) are now increasing in popularity with regard to the management of chronic lumbar radiculopathy. While ESIs have been shown to be effective in relieving low back and radicular pain, adverse reactions have also been reported, notably abnormal vaginal bleeding.
  
  
  OBJECTIVE
  We present a case series of four women, both pre- and postmenopausal, with chronic lumbar radiculopathy and corresponding pathology who developed abnormal vaginal bleeding after receiving either ESIs or facet medial branch blocks (MBBs) for pain management. Setting.  University of California, Los Angeles.
  
  
  METHODS
  Four women, both pre- and postmenopausal.
  
  
  CONCLUSIONS
  We discuss the potential effects of corticosteroids on the hypothalamic-pituitary-ovarian axis and highlight our patients' risk factors for abnormal vaginal bleeding, both exogenous and endogenous, as well as focus on the technical approaches to corticosteroid administration utilized in our patients' procedures. We acknowledge that because this is a small case series, further prospective investigation is warranted regarding the above topics. Until then, it may be beneficial to consider whether patients, both pre- and postmenopausal, have risk factors for abnormal uterine bleeding prior to undergoing interventional pain management strategies, specifically ESI and MBB, and to inform all women upon consent that abnormal vaginal bleeding is a potential risk following procedures with corticosteroids.
authors: Department of Anesthesiology, University of California, Los Angeles, CA, USA. jhirsch@mednet.ucla.edu
authors: Jason G
authors: JG
authors: Hirsch
authors: Eric Shen-Zen
authors: ES
authors: Hsu
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage* / Q000009:adverse effects*; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007268:Injections, Epidural / Q000009:adverse effects*; D008161:Lumbosacral Region; D008875:Middle Aged; D009407:Nerve Block / Q000009:adverse effects*; D017697:Premenopause; D011843:Radiculopathy / Q000188:drug therapy; D014592:Uterine Hemorrhage / Q000209:etiology*; D021801:Zygapophyseal Joint
chemical_list: D000305:Adrenal Cortex Hormones