title: Prospective Case-Control Study of Abnormal Bleeding after Outpatient Corticosteroid Injection.
abstract: OBJECTIVE
  This study is aimed at evaluating the incidence of bleeding among women having outpatient corticosteroid injection compared to matched controls, using mailed surveys and electronic health records.
  
  
  METHODS
  Prospective survey study of women receiving outpatient corticosteroid injection for joint or back pain (cases) compared to women matched for visit, diagnosis of joint/back pain, and age, who did not receive an injection (controls). A survey was mailed 45 days following outpatient visit, inquiring about menstrual history, abnormal bleeding, and potential risk factors. The proportion of women reporting abnormal bleeding was compared between cases and controls, and stratified by menopausal status.
  
  
  RESULTS
  One thousand and sixty two surveys were mailed to 531 identified cases/control pairs, and 40% response was seen from each group. Of 379 analyzable responders, 135 (36%) were premenopausal and 244 (64%) postmenopausal. Postmenopausal women who had a corticosteroid injection were more likely to report recent abnormal bleeding compared to controls (17 vs. 7%, p = 0.02), whereas rates were similar among premenopausal women (50 vs. 43%, p = 0.39). When logistic regression was performed, injection was associated with bleeding among postmenopausal women, independent of body mass index and hormone use.
  
  
  CONCLUSIONS
  Corticosteroid injection is associated with increased abnormal vaginal bleeding among postmenopausal women.
authors.affiliation: The Kaiser Permanente Northern California Gynecologic Cancer Program, The Permanente Medical Group, Walnut Creek, Calif., USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Suh-Burgmann
authors.forename: Jennifer Y
authors.initials: JY
authors.lastname: Liu
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage* / Q000009:adverse effects*; D000328:Adult; D000553:Ambulatory Care; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D008875:Middle Aged; D010045:Outpatients; D017698:Postmenopause; D017697:Premenopause; D011446:Prospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014592:Uterine Hemorrhage / Q000139:chemically induced* / Q000453:epidemiology
chemical_list: D000305:Adrenal Cortex Hormones
keywords: Corticosteroid; Postmenopausal bleeding; Vaginal bleeding