Perimenopausal Vaginal Bleeding: Diagnostic Evaluation and Therapeutic Options

A pharmacovigilance study based on the FAERS database focusing on anticoagulant and hormonal drugs that induce vaginal hemorrhage

Numerous medications have been associated with an increased risk of vaginal hemorrhage in women. In this study, we analyzed data from the FDA Adverse Event Reporting System (FAERS), focusing on reports of drug-induced vaginal bleeding in women. Risk signals were assessed using disproportionality analyses, specifically the reporting odds ratio (ROR) and the proportional reporting ratio (PRR), to identify significant associations between drugs and adverse events. We found that anticoagulants, hormonal drugs, psychotropic drugs, hypoglycemic agents, antineoplastic agents, anti-inflammatory drugs, immunological agents, and some drugs for osteoporosis were significantly associated with the risk of vaginal hemorrhage. Hormonal drugs, anticoagulants, and particularly antifungal agents were attributed to a notably high proportion of vaginal hemorrhage cases, necessitating further investigation into the underlying mechanisms. Therefore, precise clinical management of medications and optimization of treatment regimens are necessary to reduce the risk of vaginal hemorrhage and improve safety.

Abnormal uterine bleeding following lumbar epidural corticosteroid injections and facet medial branch blocks in both pre- and postmenopausal women: a case series

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.

PATIENTS

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.