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. Study Design: 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.

Gitkind AI, Shah B, Thomas M: Epidural corticosteroid injections as a possible cause of menorrhagia: a case report. Pain Med 2010;11:713-715.
Çok OY, Eker HE, Çok T, et al: Abnormal uterine bleeding: is it an under-reported side effect after epidural steroid injection for the management of low back pain? Pain Med 2011;12:986.
Hirsch JG, Hsu ES: Abnormal uterine bleeding following lumbar epidural corticosteroid injections and facet medial branch blocks in both pre- and postmenopausal women: a case series. Pain Med 2012;13:1137-1140.
Suh-Burgmann E, Hung YY, Mura J: Abnormal vaginal bleeding after epidural steroid injection: a paired observation cohort study. Am J Obstet Gynecol 2013;209:206.e1-e6.
Shanthanna H, Busse JW: Abnormal vaginal bleeding after epidural steroid injection: is there a cause for concern? Evid Based Med 2014;19:e16.
Van der Windt DA, Koes BW, Deville W, Boeke AJ, de Jong BA, Bouter LM: Effectiveness of corticosteroid injections versus physiotherapy for treatment of painful stiff shoulder in primary care: randomised trial. BMJ 1998;317:1292-1296.
Cunningham GR, Caperton EM Jr, Goldzieher JW: Antiovulatory activity of synthetic corticoids. J Clin Endocrinol Metab 1975;40:265-267.
Cunningham GR, Goldzieher JW, de la Pena A, Oliver M: The mechanism of ovulation inhibition by triamcinolone acetonide. J Clin Endocrinol Metab 1978;46:8-14.
Carson TE, Daane TA, Lee PA, Tredway DR, Wallin JD: Effect of intramuscular triamcinolone acetonide on the human ovulatory cycle. Cutis 1977;19:633-637.
Thiruchelvam U, Dransfield I, Saunders PT, Critchley HO: The importance of the macrophage within the human endometrium. J Leukoc Biol 2013;93:217-225.
Thiruchelvam U, Maybin JA, Armstrong GM, Greaves E, Saunders PT, Critchley HO: Cortisol regulates the paracrine action of macrophages by inducing vasoactive gene expression in endometrial cells. J Leukoc Biol 2016;99:1165-1171.
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